Advanced Esophageal Cancer Staging and Surgical Treatment Options

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• Importance of Accurate Staging
• Diagnostic Methods for Staging
• Multimodal Treatment Approach
• Surgical Techniques for Resection
• Innovative Reconstruction Method
• Improved Surgical Outcomes
• Full Transcript

Importance of Accurate Staging

Correct esophageal cancer staging is fundamental for surgical treatment planning and achieving radical tumor resection. Dr. Martin Schilling, MD, emphasizes that knowing the local tumor size and lymph node involvement directly impacts therapeutic decisions. This precise staging helps determine whether a patient is a candidate for surgery and what type of procedure will be most effective.

Diagnostic Methods for Staging

Staging of esophageal carcinoma utilizes several advanced imaging techniques. Dr. Martin Schilling, MD, explains that CT scans, endoscopy, ultrasound, and PET CT scans are essential tools. These diagnostic tests identify the extent of esophageal carcinoma spread and detect lymph node metastases. This comprehensive approach provides a complete picture of the disease before treatment begins.

Multimodal Treatment Approach

Treatment for locally advanced esophageal cancer typically involves a combination of therapies. Dr. Martin Schilling, MD, notes that patients usually receive pretreatment with chemotherapy and radiation therapy. This multimodal approach is followed by surgical operation to remove the esophageal carcinoma. The extent of esophageal cancer surgery is tailored to each patient's specific condition and disease stage.

Surgical Techniques for Resection

Esophageal cancer surgery can be performed through different anatomical approaches. Dr. Anton Titov, MD, discusses how surgeons may operate through the abdomen and diaphragm or through the thorax. Dr. Martin Schilling, MD, stresses that regardless of approach, the surgical operation must be radical. The primary goal is always complete resection of the esophageal cancer tumor for optimal outcomes.

Innovative Reconstruction Method

A major advancement in esophageal cancer surgery involves reconstruction techniques. Dr. Martin Schilling, MD, developed a specialized method that addresses the common complication of anastomosis leakage. This technique maintains optimal blood supply to the stomach while preserving the radical nature of the cancer surgery. The innovation significantly improves the success of esophageal reconstruction after tumor resection.

Improved Surgical Outcomes

The results of this innovative esophageal reconstruction technique are substantial. Dr. Martin Schilling, MD, reports that while typical esophagus-stomach anastomosis leakage rates reach 30%, his method achieves rates below 10%. This represents a threefold improvement in surgical outcomes. Dr. Anton Titov, MD, highlights the significant impact this has on patient recovery and overall treatment success.

Full Transcript

Leading gastrointestinal cancer surgeon discusses methods to determine the stage of esophageal cancer. It is important for surgical treatment planning. Correct tumor staging is key to radical esophageal carcinoma treatment.

Ultrasound and CT scan are used to identify esophageal carcinoma spread. These diagnostic tests find lymph node involvement.

Usual esophagus-stomach anastomosis leakage rates are up to 30%. With our method of esophageal reconstruction, we have leakage rates of below 10%.

Dr. Anton Titov, MD: Let's start with esophageal cancer. You have more than 30 years of experience. You treat esophageal cancer by surgical operation.

Dr. Martin Schilling, MD: Esophageal cancer is a disease that is often discovered at a locally advanced stage. The treatment of esophageal carcinoma could be difficult from a surgical perspective.

Dr. Anton Titov, MD: Could you please review your treatment strategy for esophageal cancer? Please discuss in particular the surgical aspects of esophageal cancer treatment.

Dr. Martin Schilling, MD: Treatment of esophageal cancer starts with proper staging of the esophageal tumor. You have to know the size of the local esophageal tumor. You have to know the extension of the tumor into lymph nodes and potential metastases.

Staging of esophageal cancer is usually done with the help of several diagnostic tests. It is CT scan, endoscopy, ultrasound, and PET CT scan. This is what we do.

Treatment depends on the stage of the esophageal cancer tumor. Therapy also depends on lymph node involvement in advanced esophageal cancer.

We would usually pretreat esophageal cancer patients with chemotherapy and radiation therapy. This is usually followed by surgical operation to remove esophageal carcinoma.

The extent of esophageal cancer surgery depends on the patient's condition. But it is always true that the surgical operation for esophageal carcinoma has to be radical. The surgeon always has to aim at a complete resection of the esophageal cancer tumor.

Dr. Anton Titov, MD: You do surgical operation through the abdomen and then the diaphragm. Or you can do esophageal cancer surgery through the thorax (chest) of the patient. These are two different methods to resect esophageal cancer.

You developed a particular surgical technique. You use it in the reconstruction of the esophagus. You published extensively on the reconstruction of the esophagus after resection of esophageal carcinoma. Can you discuss that method of esophagus reconstruction?

Dr. Martin Schilling, MD: One of the major complications of esophageal cancer resection is the breakdown of the suture between the esophagus and stomach, or separation of sutures between the esophagus and the intestines. Intestines are pulled to the esophagus.

This is mainly due to poor blood supply to the stomach. We developed a technique of esophageal reconstruction after cancer surgery. It maintains most of the blood supply to the stomach without compromising the radical nature of surgery.

Dr. Anton Titov, MD: You applied that esophageal reconstruction technique to your esophageal cancer patients. You also published the results of your esophageal reconstruction method. What results have you obtained after esophageal cancer surgery?

Dr. Martin Schilling, MD: There are many published series of esophageal cancer treatment. Usually they reported esophageal-stomach anastomosis leakage rates of up to 30%. Our method of esophageal reconstruction is much better. We have leakage rates of below 10%.

Dr. Anton Titov, MD: That is very significant. Your method of esophageal reconstruction after cancer surgery gives three times better results than on average.

Dr. Martin Schilling, MD: That is correct. That's correct.