Esophageal Cancer: Surgery Or Not?

My spouse is dx with Stage 11 esophageal cancer lower 1/3. PET scan shows it is localized. We saw sx and he suggests Neoadjuvant Chemo then Ivor Lewis sx. My husband is a healthy 70 year old but is weighing option of just proceeding with Chemo/Radiation and no Sx. Very stressful decision.

My husband who will be 76 in a few weeks was dx with adenocarcinoma of GE juncture. He completed 4 rounds of FLOT chemo followed by Ivor Lewis surgery. He has since had 3 more FLOT rounds of chemo. He is eating much better now. He has lost a lot of weight but is starting to regain some strength and appetite. It’s a long process but things are going well now.

What is your husband... stage 1a... 1b? Or did you mean stage 2 (certainly not stage 11)? But yes... is it OK to just do treatments and forgo esophagectomy? Only if a complete pathological response is seen. But even then... he must remain closely monitored for many years, because it usually comes back. If he was a true stage 1 they'd still recommend straight to surgery. But initial staging is tricky... and not always accurate (whereas post-op pathology gives a more accurate staging... even though still not perfect). Wishing you both the best.

Gary

Wow! Why didn’t I find you all earlier? I will add my story, trying to keep it brief!

I am 71. Was diagnosed 6.5 years ago. Had chemo and radiation, refused surgery. A year layer, clear. Two years later, clear. Year three, there is the cancer! I had chemo. A year later, clear. Year later, clear. By Halloween last year, there it is again!

I finally decided I just might have to do the surgery. Surgery A … a “regular esophagectomy.” Okay, I can handle it. A few weeks later, “the tests show we can’t use your stomach for a new esophagus. We have to use your colon.” After a week, I was okay with this. Another meeting with the surgeon who opens our time by saying “your CT scan from yesterday shows the cancer has spread to a lymph node. We can’t do the second surgery.” Now an Ivor-Lewis is on the table, with a thoracic surgeon participating and breaking my ribs. MUCH longer recovery and much higher complications rate and higher rates of death.

I think this is more than I am willing to handle. Am back in chemo now and have to decide between the surgery, staying on chemo for likely the rest of my life, or my new, third, option …. Stopping treatment altogether.

I am not really concerned about the cancer actually. My esophagus has been constricted since I was 17 and will probably die from that, cancer or no cancer. I am now completely on a soft foods diet.

Would love to hear your thoughts and reactions, especially if you are also thinking about stopping treatment and just living out your life.

So glad to have found you!

I have refused the surgery for 6.5 years, which is 18 months longer than they gave me to live! It is such a hard decision! I have had a great six years (most if the time!!)

I am surprised the surgeon went immediately to Ivor Lewis, but of course, I know no details. Is the surgeon real experienced with esophagectomies? There are less invasive options, but perhaps don't apply…. The first surgeon I contacted wanted to go that route, but then I found a surgeon who specializes.

My surgery at Mayo was a non-invasive Ivor Lewis. Is that not an option? Still a tough recovery, but safer and less complicated.

I've chatted with a few cardiothiracic surgeons, and hundreds of my fellow EC patients. There are a few ways esophagectomies are performed. Some methods are dictated by the solid esophageal tumor type and location, some are used based on a patient's previous surgeries and scar tissue to navigate around, and some are used because that's what your surgeon knows best and is comfortable performing for a successful outcome. It would be incorrect to think every surgeon can perform all methods of esophagectomy as they simply aren't trained and experienced enough to do so. Whether it's the use of robotics... or their preference to open the patient up more to see the lymph nodes and esophagus to be removed... just a preference of each surgeon. Certainly what matters most is your surgeon is quite proficient at performing your esophagectomy perfectly! It is a crazy complex surgery to get the new stomaphagus "hanging right"... no twists and turns, the right amount of tension on the anastomosis and the pylorus, and to have no anastomotic leaks. Only the most skilled surgeons need apply... this is a much tougher surgery than open heart surgery!

How do you do a non-invasive Ivor-Lewis with three major incisions? Seems pretty invasive to me!

I meant to say minimally invasive. That's the optomist in me coming out. The incisions were a non-issue, but the overall recovery was difficult.

@etomami, treatment decisions are really hard to make. As well as understanding the benefits and potential side effects of each option, you'll want to consider your husband's current medical condition and personal preferences.

Did you and your husband decide on a treatment plan? How are YOU doing?