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Minimally Invasive Surgery Provides New Options for Patients with Esophageal Cancer
A new minimally invasive surgery has been developed for the treatment of esophageal cancer and is being performed at Yale Cancer Center. Over the past three decades esophageal cancer has been shown to be increasing in incidence in the United States. This can be attributed to new and better methods of detection, but also to an increase in obesity and reflux disease; risks for esophageal cancer.
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"The principle of minimally invasive surgery is first and foremost not to compromise the quality of the operation," said Dr. Daniel Boffa, Assistant Professor of Thoracic Surgery at Yale School of Medicine and a member of the Yale Cancer Center Thoracic Oncology Program, an expert in minimally invasive surgery. "We can control all aspects of the surgery, but getting the cancer out of the patient in a curative manner is priority one. The good news is minimally invasive techniques do a very good job of this."
Minimally Invasive Esophagectomy, or MIE, is a video-assisted surgical procedure that utilizes instruments introduced into the body through very small incisions and a laparoscope, or tiny camera. Patients who are candidates for MIE undergo extensive preoperative evaluation involving laparoscopic staging, endoscopic ultrasound and CT scans to assess the extent of the disease. MIE removes the esophagus and creates the reconstruction using small access incisions, or small incisions, and using a camera to see areas that normally were only able to be seen by looking through a substantially larger incision.
Up until this point, esophageal cancer was treated with a traditional esophagectomy that required a long recovery. With this new minimally invasive surgery, patients spend about half as long in the hospital, their recovery time is about half as much, and the need for pain medicine is significantly decreased. Dr. Boffa commented, "When you perform an esophagectomy, it is not so much the size of the incision, as it is the amount of retraction on the tissues that causes patients to have discomfort after surgery. By using smaller incisions, and by eliminating the need to retract the body wall, there is a lot less stress to the tissues. As a result there is less inflammation, and a faster recovery." Other than the incisions, the actual procedure of removing the tumor and reconstructing the esophagus is essentially the same as the more traditional open techniques. Many feel that MIE allows patients who would not be candidates for conventional surgery to pursue the MIE option, but there is no data to support this yet.
Most patients with tumors considered to be resectable by conventional open surgery would be candidates for MIE. MIE is safe and effective for most esophageal cancer patients. To learn more, visit our esophageal cancer page at http://ycctrials.med.yale.edu/detail.asp?nm=CDR62960