Laproscopic esopagectomy study for High-grade dysplasia and EC

[tmca]

I was surfing around looking for other hosp. that might be doing Lap esophagectomies besides the medical school in Penn. I found this on the National Cancer Institute site....

This seems to be a really large study as it involves hospitals in 33 states in the USA alone as well as hospitals in Australia, Peru, Puerto Rico and S. Africa....Some of the hosp. in the states involved in the study are Mayo Clinic, Standford Univ., and Cleveland Clinic taussiq cancer center...

RATIONALE: Laparoscopic-assisted surgery and video-assisted thoracoscopy are less invasive types of surgery for esophageal cancer that may have fewer side effects and improve recovery.

PURPOSE: Phase II trial to study the effectiveness of laparoscopic-assisted surgery and video-assisted thoracoscopy in treating patients who are undergoing esophagectomy for high-grade dysplasia of the esophagus or stage I, stage II, or stage III esophageal cancer.

OBJECTIVES:

Determine the feasibility of performing minimally invasive esopagectomy, in terms of 30 day mortality, in patients with high-grade dysplasia of the esophagus or stage I-III esophageal cancer..

Determine the complications associated with this procedure in these patients.

Determine the rate at which conversion to open operation is required in patients undergoing this procedure..

Determine the length of the operation, duration of intensive care stay, and length of hospital stay in patients undergoing this procedure..

The entire artical with eligibility requirements can be seen here:

http://www.clinicaltrials.gov/ct/show/NCT00063986?order-1

[daw]

Thanks Tessa.

I found it interesting that eligibility for this study excluded patients with prior anti-reflux or gastric operations.

[tmca]

Daw,

I also found that interesting...I wonder what their rationale is behind that? I also found it interesting that this study is being chaired by and the principle investigators are Dr. Luketich (U of P) and Dr. Sugarbaker ( Brigham and Women's Hosp)......I heard many positive things about Dr. Luketich and this surgery a year ago......

[Hawk]

My guess would be by looking at their purpose and objective, they did not want to complicate the data with another variable. (previous surgeries)

[tmca]

Hawk and Daw:

Yes Hawk, I'm sure your right about that reasoning...I'm sure they don't want the data complicated..

I have one more concern. The fact they also require stomach availability for conduit, they will allow cancer to extend no more than 20% into the stomach...Most of us know that when you have an esophagectomy they use your stomach..But, what about us that have had surgery and may not have 80% of a stomach....Not just from this studies guidelines but surgical guidelines in general. I wonder if some of us would even have enough stomach for surgery or if we would be the one's that would need to have part of the colon used? They used a significant amt. of my stomach for the gastroplasty/fundoplication....I don't know of or haven't seen anyone on the boards that had fundoplication and then later had to have esophagectomy....It would be interesting to know what happens in that situation....The more I learn the dumber I feel...

Tessa

[daw]

Tessa,
1) I've read about gastric bypass surgeries that leave a person with no stomach and a small quasi "stomach"pouch is made from the intestines. Whatever amount of stomach you have left from your surgery could be enough if needed. I don't remember reading how much of the stomach is needed in an esophagectomy....but 80%....can that be possible? The need for the cancer not to be spread into more than 20% of the stomach might not have to do with how much of the stomach they need but with other problems that might arise.
2) I'm sure there may be some on the EC forum that can answer these questions.

[daw]

Found this site with a description:

http://www.debakeydepartmentofsurgery.org/home/content.cfm?proc_name=esophagectomy&content_id=274

"Your surgeon will make four to five small incisions, and insert tube-like instruments through them. The abdomen will be filled with gas to help the surgeon view the abdominal cavity. A camera will be inserted through one of the tubes to display images on a monitor located in the operating room. Other instruments will be placed through the additional tubes. In this manner, your surgeon will be able to work inside your abdomen without using a larger incision. After exposing the stomach, the upper portion (fundus) will be stapled off and cut from the rest of the stomach.

The second part of the procedure is the thorascopic stage. Instruments will be inserted into the chest to cut the esophagus. After the fundus and lower esophagus are free, both will be removed. To reestablish continuity of the digestive tract, the stomach will be pulled upward to join with the remaining portion of the esophagus."

So it appears only the Fundus or its equivalent amount is removed. Remember the stomach includes the cardia(just below the junction), fundus, body, antrum and pylorus. If you have had a fundo then I would think the wrap would be undone and the fundus removed. If you had the collis then maybe part of the body may have to be removed.

[tmca]

Thanks Daw,

It makes a little more sense now....It amazes me that they can do a surgery like an esophagectomy laproscopically...I don't know about you but I find all these studies and trials very encouraging....Even if they don't neccessarily apply to our individual concerns or needs, or if information from the long term trilas may not be known in our lifetime..We have children and grandchildren, they may one day benefit from all the work that seems to be underway with reflux disease and it's complications.....Tessa