Exceptional Esophageal Surgery Outcomes at Roswell Park

 

Esophageal surgeries have changed dramatically in the past 20 years, says Moshim Kukar, MD, FACS, Chair of the Department of Surgical Oncology at Roswell Park Comprehensive Cancer Center.

Instead of relying on “big open-cut incisions” and leaving patients with long recovery times, now “things are done laparoscopically, with tiny incisions directed by trained surgeons specializing in robot-assisted procedures to allow for more precise procedures and a faster recovery time for patients.”

Roswell Park was one of the first locations in the country to perform a high volume of laparoscopic esophagectomies for cancer patients, Dr. Kukar says. “Over the last decade, we’ve moved on to doing these procedures robotically, where we’ve seen the best outcomes, with 3D visualization and the ergonomics. We have a unique way, that we have already published with our outcomes, that are already at par or the best anywhere in the world.”

A study published in the Journal of Gastrointestinal Surgery shows textbook outcomes for 90% of 150 consecutive robot-assisted, minimally invasive esophagectomies at Roswell Park, measured by factors including length of hospital stay and rate of complications, readmission to the hospital and mortality within 30 days post-surgery. By comparison, other high-volume international centers had a reported range of 40-45%.

Additionally, Dr. Kukar and his team perform procedures in which a patient’s esophagus can be reconnected to their stomach after a tumor is removed, a six-centimeter anastomosis, with less than a 1% leak rate, compared to 10-30% nationally and at other high-volume centers.

Patients at Roswell Park have options for gastroesophageal surgeries that aren’t available at other centers, and approximately 50 gastrectomies, full or partial stomach removals, are performed here annually, something most other centers can’t offer, Dr. Kukar says.  “The procedure is then tailored to the needs of the patient, not tailored to what the physician was trained to do. We offer a very comprehensive program and we work closely with our thoracic surgery colleagues based on the needs of the patient.”

Consulting with Roswell Park surgical oncologists as early after diagnosis as possible provides the best opportunity to explore all options for treatment. “Staging is so critical. We utilize multiple modalities, including endoscopy, PET scans, CT scans and digital laparoscopy, where we make small holes in the belly and look at the tumor from the outside and while inside, to know at the outset what procedure the patient is going to need after they go through systemic therapy.”