Esophagectomy and Quality of Life
In the majority of cases in which the esophagus requires surgical removal, the goal of the Virginia Mason Seattle esophageal cancer treatment team is to cure cancer. Another important goal is to maintain the patient’s quality of life and the ability to eat normally.
Removal of the esophagus is a major surgical endeavor. The surgical team works in the patient’s chest and abdominal cavity and often in the neck. Depending on the location of the cancer, the surgery requires removal of a variable length of esophagus. The esophagus is replaced, typically with a portion of the stomach, which has been restructured into a tube. The operation can take from four to seven hours to complete and often involves placement of a feeding tube into the bowel (feeding jejunostomy) which is used to augment nutrition during the early postoperative period.
Although this operation results in a significant rearrangement in anatomy, it is important to understand that under normal circumstances it does not change the patient’s ability to taste or enjoy food and should not change the basic mechanism of swallowing food.
Virginia Mason in Seattle is a high volume esophagectomy center committed to providing patients with the highest chance of cure while maintaining the highest degree of quality of life. All patients undergoing removal of the esophagus at Virginia Mason are entered into a cancer registry database that continually monitors short-term surgical results and long-term outcomes including the ability to eat normally.
A recent Cancer Registry report assessed survival rates after esophageal removal at Virginia Mason. Five-year survivorship in patients undergoing esophagectomy for cancer exceeds the national average in cases in which cancer is confined to the esophagus (local disease) and when it spreads to nearby lymph nodes (regional disease).
Virginia Mason has also published reports in the medical literature specifically examining patients’ ability to eat and quality of life following surgical removal of the esophagus. A 2001 report included a survey of patients following esophagectomy at Virginia Mason. Patients reported that they routinely lost weight within the first six months of surgery. However, the majority gained weight after six months while maintaining their nutrition with oral intake alone. Ultimately, 85 percent categorized their diet and their ability to eat as normal or only minimally limited compared to their preoperative situation. The same study showed that approximately half of the patients had difficulty swallowing, usually for only a short period of time, while occasional regurgitation was reported in one quarter of patients. The majority of patients rated their quality of life as comparable to their preoperative status and 82 percent of patients who were employed full time were able to return to pre-surgical work levels. See Nutritional Therapy.
Another study specifically related quality of life measures to patients undergoing esophageal removal who had Barrett’s esophagus (with pre-cancerous changes or the very earliest form of cancer—intramucosal cancer). This study demonstrates that the level of cancer involvement in these patients can often be underestimated prior to surgery. However, following surgical removal of the esophagus in this subgroup of patients (who would have a high expectation of surgical cure) quality of life measurements were found to be comparable to the general population. See Health Related Quality of Life After Esophagectomy for High Grade Dysplasia or Intramucosal Cancer .
The Virginia Mason esophageal cancer treatment team considers it extremely important that every effort should be made to not only provide a cure, but also to help patients to continue enjoying a high level of quality of life following treatment of their esophageal cancer.