Patients are evaluated in our clinic after having the required initial tests such as a CT scan or an x-ray of the chest and abdomen, barium swallow, and an endoscopy and biopsy with a proven diagnosis of cancer. After this evaluation the patient is instructed in the method and option of surgery.  The case is then discussed at our multidisciplinary tumor board where considerations as to the risks, benefits and alternatives to treatment are reviewed. The patients are then started on their course of treatment either being directly prepared for surgery or beginning preoperative chemoradiation by arranging the proper appointments and accommodations.

If chemoradiation is selected, patients are seen at some point during their therapy, to schedule a surgery date.  Surgery is usually scheduled 2-4 weeks after the completion of radiation, since any significant delay beyond that significantly increases the risks associated with surgery in regards to surgical wound healing.

Patients are routinely admitted the morning of their surgery and taken directly to the operating room, after placement of an epidural catheter for postoperative pain control.  We no longer require an ICU admission, and patients are taken off the breathing machine (extubated) in the operating room and go directly to the general care floor. Patients are expected to be up and walking around the unit the next day and are taking clear liquids on day 3, eating a regular diet on day 5, and usually discharged on day 6. The average length of stay is currently 6.5 days and 95% are discharged eating a regular diet.

As with any major surgery, the biggest complication associated with the surgery is bleeding in the first 24-hour period.  The second most common complication is an anastomotic leak, which occurs in 5% of patients. This leak occurs in the neck where the stomach is connected to the remaining esophagus and is easily treated at the bedside with dressing changes and heals with only conservative treatment.

Many patients initially lose weight after this surgery but stabilize over the following 3 months. The most difficult adjustments that patient must overcome are the needs to eat smaller portions and to slow down their intake at meals. However, they are able to eat all food varieties except those which are extremely high in refined sugar or very high in fat.  All patients meet with our dietician before discharge and as needed in the postoperative follow up clinics.  There all patients with esophageal cancer are seen every 3 months until 2 years post-surgery and then every 6 months until 4 years after surgery and then annually.

Postoperative chemoradiation

While postoperative RT, with or without chemotherapy, has been useful in controlling incompletely resected local disease, there have been no studies demonstrating a survival advantage from postoperative chemoradiation for esophageal cancer.

Palliative care

For those patients who are not candidates for surgery and for whom chemotherapy/radiotherapy has not resolved their symptoms, other options include stenting, laser treatments, and photodynamic therapy. While all of these have their own proponents and complications, most trials have shown that stenting offers similar relief, is less costly, and has lower rates of complications.

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