University of Wisconsin Cardiovascular Surgery: Minimally Invasive Esophagectomy

Results

What to Expect After Surgery

After surgery, you will not be allowed to eat for approximately 5 days. A special swallowing expert will monitor your progress to assist you with relearning to eat. A barium swallow will be done to check the “hook-up” after surgery and to ensure that you are swallowing correctly. (See Figure #7) During that time, you may receive nutrients intravenously, or through a flexible plastic tube in your small bowel.

Most patients usually return home 6 to 10 days after surgery. You'll be able to eat normal food before you return home, but just in smaller portions and more frequently. For the first week, your diet will consist of soft foods, such as soup, ice cream or pudding. You'll receive a diet guide to help you determine how to get the proper nutrients after surgery. You should return to your normal diet by 2 to 3 months after surgery

You will have short-term pain and tenderness around the surgical sites. Most patients take pain medication for 3 to 6 weeks after surgery. We will check whether the cancer returns at follow-up visits approximately 3 months after surgery.

UW Program Results

The University of Wisconsin is considered a high-volume center for esophageal cancer surgery, according to the Leapfrog Group for Patient Safety. In 2004, we performed approximately 40 esophagectomies. We are the first and only hospital in Wisconsin to perform a totally minimally invasive (laparoscopic/thoracoscopic) esophagectomies.

For all types of esophagectomy (traditional or minimally invasive), we have a 0% mortality rate over the past 2 years. This is compared with the national average of approximately 10% (Baily SH et al. Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg. 2003 Jan; 75(1):217-22.)

Five-year survival is nearly doubled in patients who receive and respond to preoperative chemotherapy and radiation therapy. (Urba S. et al.) Compared to other academic centers, nearly two-thirds of our patients received chemotherapy and radiation therapy before surgery (Figure #9). This is due to our multidisciplinary approach

Figure #9

The length of time our patients stay in the hospital is also below the national average. (Figure #10) (Atkins BZ et al. Ann Thorac Surg. 2004 Oct; 78(4): 1170-6)

Figure #10

In addition, we also have a lower rate of postoperative pneumonia than the national average (Figure #11) (Baily SH et al. Ann Thorac Surg. 2003 Jan; 75(1):217-22) in part due to Swallowing Experts and superb nursing efforts to prevent aspiration (Figure #8 ). Studies show that if a patient develops pneumonia after an esophagectomy this correlates with a ~ 20% mortality rate. (Atkins et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg. 2004 Oct;78(4):1170-1176.)

Figure #11

Finally, at UWHC we have a special interest in providing safe, surgical care for the elderly population with esophageal cancer. We recently presented our prospective data demonstrating no difference in survival for patients over 70 years old undergoing esophagectomy, as compared to patients less than 70 years old. (Ibele A, Pfau P, Gopal D, Thomas J, Edwards N, Weigel T. Esophagectomy Can Be Performed Safely in Patients Over 70 Years Old. The Society of Surgery of the Alimentary Tract (SSAT). Chicago, IL. May 16, 2005.)