Chapters Transcript Video Esophageal Surgery Outcomes at Roswell Park So the incidence of the gastroesophageal junction cancers are on the rise, and annually about combining both esophageal and gastric cancers, we see about 50,000 to 70,000 of these patients that are diagnosed annually in America. Uh, at Roswell, we see, uh, roughly around 150 to 200 new patients, uh, in our clinics, and, uh, 60 to 70% of them are candidates for a curative resection. That get a combination of both chemotherapy and and and surgery. Hi, my name is Marsham Kukar. I'm the uh professor and chair of surgical oncology and also the program director for the Complex General Surgical Oncology Fellowship here at Roswell Park Comprehensive Cancer Center. So for upper GI cancers that that that includes the cancers of the esophagus, the stomach, and where the esophagus meets the stomach, which is called the gastroesophageal junction. Uh, Rosal offers a plethora of options starting from pre-cancers to all the way to advanced cancers. So for some of the pre-cancers where we can see some changes early in the esophagus, uh, that you can treat them by endoscopy, which is this, uh, tube that is inserted through the mouth with a camera on it where we can actually either, um, thermally ablate those pre-cancerous lesions or we can remove them. Uh, to a little bit more advanced procedures that are known as endoscopic mucosal resection where you take away the first layer of the esophagus or you can even take the deeper layers of the esophagus for some of the, the more, uh, the, the cancers that are growing into the lining of the esophagus. Now these are advanced cancers that present usually with trouble swallowing. Well, patients will complain that they have a sensation of food getting stuck here in the chest. Those are patients that have locally advanced tumors that are treated with a combination of chemo. Immunotherapy plus minus targeted therapies and then a good operation to remove that cancer. Esophageal surgery is something that I've, uh, spent almost two decades, uh, uh, on this procedure, and I've, we've gone through in my training in early 2000s when we were doing this with big open cut incisions, big on the cut on the belly, big cut on the chest, to then moving to do these operations with sticks laparoscopically, and we were actually one of the few centers in the country that was doing a high volume dose and over the last decade we. Moved on to doing these procedures robotically where we've seen the best outcomes with these procedures, uh, just given the, the, the platform with the 3D visualization and the ergonomics and everything that we can accomplish with this. So, so we have a unique way that we have already published with our outcomes that are, uh, sort of at par or or best of anywhere in the world, uh, and we have a unique way of doing this connection that we do from the esophagus to the stomach after we remove the cancer, uh, in sort of a, a side to side staple denasto. So it's a 6 centimeter staple anastomosis and the leak rates and the stricture rates that we've been able to achieve is both less than 1%, uh, nationally, the, the leak rates are more in the range of anywhere from 10 to 30% and even in high volume centers, and the stricture rates are again anywhere from like 10 to like 30-40%, uh, because the, uh, majority of the other centers do what is called an end to end anastomosis, and that creates a much smaller diameter of this anastomosis which leads to higher stricture rates and leak rates. So one thing unique at Roswell is that within the umbrella of surgical oncology, we offer all options for gastroesophageal surgery. So patients can either get If they get an esophagectomy, the connection can be made in the chest, can be made in the neck, and then sometimes we don't even need to go into the chest cavity, and we can do what is called a gastrectomy, that we can remove the, the top half of the stomach, sometimes the bottom half of the stomach based on the location of the tumor. So the procedure is then tailored to the needs of the patient, not tailored to what the physician was trained to do in their training. So we offer that very comprehensive program. And we work closely with our thoracic surgery colleagues based on the needs of the patients to be able to offer them. So we do about, uh, roughly about 40 to 50 formal gastrectomies where we remove the top half of the stomach, which is a procedure very few centers in the country offer, uh, and we have a unique way of making these connections. It's called a double track reconstruction, and, uh, that's something that we offer here at Roswell and then, uh, of course, the other formal technique. Of, uh, total gastrectomy or a distal subtotal gastrectomy with a very adequate lymph adenectomy that you have to remove at least 16 lymph nodes around, uh, the area of the stomach to get a good oncologic operation. I think it is critical that the surgical team is involved at the outset when the patient is diagnosed with these cancers because staging is so critical, and I think we utilize multiple modalities including endoscopies, PET scans, CAT scans. And sometimes even what is called a diagnostic laparoscopy where we make small holes in the belly and look at the tumor from the outside and and from the inside, and this is critical to know at the outset what procedure the patient is gonna need down the road after they go through some period of systemic therapy, uh, and also, a majority of these patients do need nutritional access, and I think that can be done at the same time when you're doing the diagnostics of these procedures, so, uh, I think the surgical team being involved at. Outset, getting the right tissue, uh, getting the the biomarkers tested, uh, and the sequencing of therapy in the right operation. So all this happens in our multidisciplinary tumor board that every patient that we see gets discussed, uh, to come up with a, an individualized care plan for that patient. So as you know, for these procedures, uh, they're complex and nuanced. Uh, the more you do, the better you get, not just from a technical perspective, but also the team that's taking care of these patients, the anesthesiologist, the nursing team, the APP team. Uh, and our advanced, uh, GI practice providers and radiologists, uh, so we do see a lot of patients that are traveling to seek care several hours away within New York or even outside the state that we work with their local oncologists and their team to take care of them as every oncologist wants the best care for their patients, we're there to. Help you in the process and we can start this even as a virtual visit, review all the imaging scans to help guide uh patients for their best care and if uh the patients need to travel to Roswell, then we have all the resources to be able to get them here and provide them that that care. So please help us help your patients so we can work together to get them the best care. Created by
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