Esophagectomy

In 2004 the American Cancer Society reported approximately 14,250 new cases of esophageal cancer and 13,570 deaths in the United States resulting from this cancer. The treatment of esophageal cancer has been challenging because many patients present symptoms late in the evolution of the disease, resulting in the cancer being advanced at the time of diagnosis. Late presentation has been one of the issues in the past that has resulted in only 15 percent of patients who develop esophageal cancer being cured.

The incidence of esophageal cancer is dramatically increasing, especially in white males. The most common type of cancer at the present time is adenocarcinoma, which likely develops following a change in the lining cells of the esophagus due to chronic irritation from gastroesophageal reflux disease. This condition is called Barrett's esophagus. Patients who have Barrett's esophagus are monitored with scheduled endoscopy to look for changes that can indicate an increased risk of developing esophageal cancer or to detect when cancer has occurred in an early stage that can be cured with surgery. Surgical resection of the esophagus for cancer is a complex operation that entails removing the esophagus and replacing it with either the stomach or the colon. Recent research within the Medicare population in the United States indicates that the mortality rates associated with esophageal resection, in hospitals that perform the operation infrequently, can be as high as 18 to 20 percent. In medical centers that perform the operation frequently, the average mortality rate is 8.4 percent.

Virginia Mason has been a recognized center of excellence for esophageal surgery for many years. A recent study in the American Journal of Surgery compares the outcome of esophageal resection at Virginia Mason to published results during the same period (1996 to 2002). In 174 consecutive resections in a population whose mean age was more than 65 years of age, Virginia Mason patients demonstrated improved results in areas including blood loss, length of stay and complication rates, as compared to the literature. In addition, the mortality rate in this series was zero.

In the American Journal of Surgery in 2001, Virginia Mason reported on a series of patients three years after their esophageal resections to assess their ability to maintain weight and to eat normally. Patients were typically seen to consume a normal daily caloric intake, which allowed them to maintain their weight at or above ideal body weight. Eighty-five percent of patients reported that their diet and food variety was either the same or only minimally restricted compared to their preoperative situation. Learn more about quality of life after having an esophagectomy.

Another publication from Virginia Mason documented that precise intraoperative management of patients undergoing esophageal resection, including minimizing blood loss and intraoperative fluid requirements, improves complication rates and overall outcomes. Additional research in the Archives of Surgery in 2006 examined the quality of life in patients who had undergone esophageal resection for high-grade dysplasia in Barrett's esophagus or very early cancer. This study was done after five years of follow-up and demonstrated that overall quality of life equaled or exceeded comparisons to sex- and age-matched norms within the general population. It also demonstrated that 80 percent of patients felt that their eating patterns were normal or insignificantly affected.

The results obtained at Virginia Mason with respect to esophageal resection for cancer are comparable to those achieved anywhere in the world. Patients requiring esophageal resection should seek a center performing high volumes of these procedures with published outcomes in the medical literature. See the Relevant Publications section for references.

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