What is the criteria for getting esophagectomy?

When I was diagnosed with cancerous tumor in lower esophagus, I was not considered a candidate for surgery and had 28 days of radiation and chemo which worked. I am not sure of exact reason for no surgery. I am 79 and am on 2 daily pills for high blood pressure but otherwise am healthly.

Yes, there are definitely criteria for becoming surgery eligible. And yes, an esophagectomy is a massive surgery... and more complex than say, open heart surgery.

But in medicine in general, each and everything that is done to us by our doctors must have a benefit for us. Contrary to popular belief, this surgery is not done so folks can make money. And I have seen some of us be turned down for this operation.

I suppose it is true that a surgeon could take on a case by himself, as long as both he (or she) and the patient agreed to go thru with it. But no... that's not the way it works... and this relationship wouldn't last long.

Becoming surgery eligible is highly dependent on a few things. The patient's cancer must be under control... and this means that there will be significant improvement to the patient's chances of long term survival by having this operation. The tumor board will weigh in on this, looking at all treatment data and scans, etc, to know EVERYTHING about the patient's readiness for surgery.

A stage 1 patient, with absolutely zero spread outside the esophagus, will almost always go straight to surgery... if their solid esophageal tumor could not be handled by a lesser procedure (RFA, EMR, ESD, cryoblation, etc). But very few of us are caught at stage 1 because we are not yet symptomatic. We are usually caught at stage 3 or 4. Stage 3's, like me, still have a good shot a getting to surgery. With the solid esophageal tumor pretty much all the way thru the layers of the the esophagus... but with only spread to maybe a local lymph node or two, treatments of chemo, radiation, and maybe immunotherapy, can keep things in check, stop any further spread, reduce the esophageal tumor down to a fried out cinder (hopefully), and now is the time to cut it out! But if spread continues, goes to more lymph nodes, distant lymph nodes or bones or organs... then surgery is off the table. Could it one day be an option again... yes... I've seen this happen. But new treatments must get things on order, spread eliminated, so that surgery will once again give the patient an incredible boost in survival odds.

Another surgery limitation is the patient himself. How old... what physical condition... what other comorbidities does this patient have? Yes, I have seen patients between 78 and 83 have the surgery... but this is rare. They must be judged by the surgeon to be in good enough condition to survive and recover from this difficult surgery. And it's going to take a year... so QofLife is a big factor. There must be a promise of extended QofLife.... or why bother.

Be well... and good luck. For those who cannot get to surgery... surgery is a big deal for them... a real shot at a cure (but still with no guarantees). But then again, once you have this crazy surgery... you'll wonder why the hell you did this! But after a year or more, when things get back close to normal (where I am now)... then it was worth it. But I had this surgery at 61... I'm now 65.

Gary

Hi @hope24, this is a great question to discuss with your cancer team. @mrgvw is absolutely right that the answer is largely "it depends" on both the tumor characteristics (size, location, spread, vascular involvement) as well as the patient characteristics (medical history, other medical conditions, health status, age, and above all, personal preference).

Esophagectomy is a common treatment for advanced esophageal cancer. Esophagectomy is done either to remove the cancer or to relieve symptoms.

It sounds like your husband is getting chemoradiation before (neoadjuvant) surgery to help reduce the tumor size and to allow clear surgical margins. When will he complete chemoradiation?

Hello- my husband had his 1st two radiation treatments and the last should be on January 24th. Had his first chemo yesterday. Trying to be proactive to prevent any nausea or vomiting which is his greatest fear at the moment. He will have a gtube placed Monday. Working on getting a port inserted. We wanted to avoid the tubes but the more we hear (and read) think it's even more important to avoid potential problems. Told yesterday the radiation will make swallowing even MORE difficult. Cancer sucks. Sending positive thoughts to everyone and great appreciation for all your tips.