Logan Reid
Esophagectomy is a challenging surgical procedure that involves removing a diseased oesophagus and reconstructing the gastrointestinal tract. The operation is typically performed on patients with advanced cases of Barrett's oesophagus or esophageal cancer. Due to the complexity of the procedure, it is recommended that patients only undergo the surgery at high-volume medical centres with experienced surgeons who regularly perform esophagectomies. Stanford Health Care in the San Francisco Bay Area, for example, is known for its high volume and quality of esophagectomies, with 40-60 procedures performed annually and excellent morbidity/mortality outcomes. Duke Health in North Carolina is another high-volume centre, treating hundreds of patients with esophageal cancer and performing over 60 esophagectomies each year.
| Characteristics | Values |
|---|---|
| Hospitals that perform a high volume of esophagectomies | Stanford Health Care, Duke University Hospital, Massachusetts General Hospital |
| Number of esophagectomies performed annually | Stanford Health Care: 40-60; Duke University Hospital: 60+ |
| Mortality rate | Stanford Health Care: 1%; High-volume medical centers: 3-8%; Low-volume hospitals: 16-23% |
| Morbidity rate | Stanford Health Care: Top 15% |
| Types of esophagectomies | Minimally invasive esophagectomy (MIE), Standard open esophagectomy, Transhiatal esophagectomy (THE), Transthoracic esophagectomy (TTE) or Ivor-Lewis Procedure |
| Procedure | Removal of diseased esophageal tissue, including cancerous tissue and adjacent lymph nodes, followed by reconstruction of the gastrointestinal tract using part of the stomach |
| Surgery time | 4-6 hours |
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What You'll Learn
Stanford Health Care, San Francisco
Stanford Health Care in San Francisco is the highest-volume and highest-quality esophagectomy center in the San Francisco Bay Area. Stanford thoracic surgeons are highly experienced, performing 40-60 esophagectomies per year over the past several years, with excellent outcomes. The hospital's combined morbidity/mortality results place it in the top 15% of reporting hospitals, which are typically major centers of excellence.
The hospital's Thoracic Surgery service is dedicated to excellence in the surgical management of esophageal cancer, with a comprehensive approach to treatment. Stanford surgeons work closely with oncologists, radiation oncologists, pathologists, and radiologists at the Stanford Cancer Center to provide the best care for patients with esophageal carcinoma.
Stanford offers various types of esophagectomies, including the Ivor Lewis esophagectomy, a minimally invasive procedure involving small incisions in the abdomen and right thorax. This approach is particularly beneficial for patients with early-stage tumors and those with moderate lung disease who may be at higher risk for complications. Stanford also performs three-incision esophagectomies, with incisions in the abdomen, right chest, and left neck, recommended for tumors located high in the esophagus.
The hospital's surgical team is led by Dr. Joseph Shrager, a specialist in esophageal cancer surgery. Dr. Shrager is trained to perform esophagectomies with the lowest risk and the greatest chance of cure. Stanford also offers remote access to its world-class doctors through the Stanford Medicine Online Second Opinion program, providing convenience and easy consultation for patients.
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Duke University Hospital, North Carolina
Duke University Hospital in North Carolina is ranked first among hospitals in the state and is recognised for nursing excellence. Its cancer program is also nationally ranked and is the highest-ranked program in North Carolina. The hospital's surgical team performs more than 60 esophagectomies annually, which is considered a high volume. Most hospitals consider performing 20 esophagectomies a year as high volume.
Duke University Hospital's surgical expertise with esophagectomies is considered unmatched in the Southeast. The hospital offers advanced options, including minimally invasive surgery and robot-assisted surgery. Its surgeons are among the top five hospitals in the country for robot-assisted esophagectomy. The hospital's thoracic surgeons and medical and radiation oncologists focus on treating gastrointestinal cancers and have expertise in targeted treatments for esophageal cancer.
Duke University Hospital treats hundreds of patients with esophageal cancer every year, with patients travelling to Duke from across the US for their expertise, comprehensive treatment options, and breakthrough research. The hospital is part of the National Comprehensive Cancer Network (NCCN), an alliance of the nation's leading cancer centres. The hospital's high patient volume means its specialists are among the most experienced esophageal cancer experts in the nation.
The hospital's cancer centre is also a National Cancer Institute-designated Comprehensive Cancer Centre. Its surgeons, radiation oncologists, and medical oncologists have a detailed and thorough understanding of each patient's particular tumour, its behaviour, and treatment options.
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Minimally invasive esophagectomy
Esophagectomy is a surgical procedure that involves removing part of or the entire oesophagus, the tube that connects the mouth and the top part of the stomach. The procedure is performed to treat various conditions affecting the oesophagus, including cancerous and non-cancerous diseases.
The decision to perform a minimally invasive esophagectomy depends on various factors, including the patient's condition and the expertise of the medical centre. It is particularly suitable for patients with early-stage tumours, elderly individuals, and those with moderate lung disease who are at a higher risk for complications.
Massachusetts General Hospital and Stanford Health Care are two examples of medical centres that offer minimally invasive esophagectomies. These hospitals have experienced surgeons and specialized programs for the treatment of oesophageal conditions. Additionally, UCSF is mentioned as a major regional referral centre for the multidisciplinary treatment of Barrett's and oesophageal cancer, performing esophagectomies with very low peri-operative mortality rates.
The length of hospital stay after an esophagectomy can vary from 7 to 14 days, depending on the type of surgery and the patient's condition. Patients typically spend a night in the intensive care unit and then move to an inpatient hospital room for further recovery and adjustment in eating patterns. During this time, patients may experience certain post-operative procedures and precautions, such as feeding tubes, chest tubes for fluid drainage, special stockings to prevent blood clots, and pain medication.
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High mortality rates at low-volume hospitals
Esophagectomy is a complex and lengthy surgical procedure that involves removing part of or the entire diseased oesophagus. The tube that connects the mouth to the top of the stomach is reconstructed using a portion of the stomach, which is pulled up into the chest and connected to the remaining healthy oesophagus or pharynx (throat). This procedure is often performed on patients with advanced cases of Barrett's oesophagus, a pre-cancerous condition, or those with oesophageal cancer.
Esophagectomy is associated with high morbidity and mortality rates, and recent studies have focused on the relationship between operative volume and mortality rates. Large, well-designed studies have shown that patient outcomes are highly dependent on the number of such procedures performed at the institution. While the surgeon's experience is a significant factor, the data suggests that high-volume hospitals have significantly lower mortality rates. The mortality rate at high-volume hospitals ranges from 3-8%, while low-volume hospitals have a mortality rate of 16-23%. This significant difference has been attributed to the safety benefits of centralizing esophagectomies to high-volume hospitals, which can provide better care for these patients.
One study found that high-volume hospitals reduced the risk of post-esophagectomy mortality by 53% compared to low-volume hospitals. This study defined high-volume hospitals as performing at least 45 esophagectomies per year, while low-volume hospitals performed fewer than 10 procedures annually. Another study, which analysed data from 714 patients who underwent esophagectomy between 2002 and 2021, found mortality rates of 6.9% at 90 days, 3.4% at 30 days, and 6.7% in-hospital.
To reduce the risk of complications and improve patient outcomes, it is recommended that patients undergo esophagectomy at hospitals with high volumes of procedures, such as Massachusetts General Hospital, which has a lower rate of complications from esophagectomy for cancer compared to the national average. These hospitals have the expertise and experience to handle the complex nature of esophagectomy procedures.
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The two most common esophagectomy procedures
Esophagectomy is a major surgery that treats oesophageal cancer by removing damaged tissue from the oesophagus. It is also used to treat conditions that increase the risk of cancer, such as Barrett's oesophagus. The procedure can involve removing all or part of the oesophagus, along with the uppermost part of the stomach and surrounding lymph nodes. After the surgery, the oesophagus is rebuilt using other organ tissues, typically the stomach, which is reshaped and reconnected to the remaining portion of the oesophagus.
There are two common types of esophagectomy procedures: the Ivor Lewis Esophagectomy (ILE) and the McKeown (Three-Hole) Esophagectomy.
The ILE approach consists of an upper midline laparotomy, followed by a right thoracotomy and the creation of an intrathoracic anastomosis. The abdominal stage is performed first with the patient in a supine position, and a double-lumen endotracheal tube is required for lung isolation. This procedure aims to preserve the gastroepiploic artery, which is the main blood supply to the gastric conduit.
The McKeown approach, on the other hand, uses three incisions: a right thoracotomy, an upper midline laparotomy, and a left cervical incision. As the chest is entered, lung isolation is required. This approach allows for addressing pathology at any level and performing dissection under direct vision. However, it increases the chance of wound complications and requires time-consuming repositioning of the patient.
Both procedures are performed by experienced surgeons and involve a long recovery process. Stanford Health Care, for example, has performed 40-60 oesophagectomies per year and is recognised for its high quality and low mortality rates. Massachusetts General Hospital also offers both minimally invasive and standard open esophagectomy procedures.
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Frequently asked questions
Some hospitals that perform a high volume of esophagectomies include Stanford Health Care in the San Francisco Bay Area, Massachusetts General Hospital, and UCSF.
An esophagectomy is a surgery to remove all or part of the esophagus, which is the tube that carries food and liquid from the throat to the stomach.
An esophagectomy is used to treat advanced cases of Barrett's esophagus, a pre-cancerous condition, and esophageal cancer that has not spread to other organs.
Studies have shown that the mortality rate of esophagectomies performed at high-volume medical centers is approximately 3-8%, while the surgical mortality rate at low-volume hospitals is significantly higher, at 16-23%.
