A Comprehensive Approach to Esophageal Cancer Care

By Nabil P. Rizk, MD  |  Wednesday, February 12, 2014

The incidence of esophageal adenocarcinoma is rising rapidly in the Western Hemisphere. In North America alone, there were 18,000 cases and 15,000 deaths from this disease in 2013. The most significant contributing factor is thought to be an increase in obesity-related gastroesophageal reflux disease (GERD) and the subsequent development of Barrett’s esophagus, which can result in dysplastic changes in the esophagus that can progress to cancer.

The management of patients with esophageal cancer is complex and requires input from multiple disciplines. At Memorial Sloan Kettering, we treat patients using a multidisciplinary approach that combines the breadth of experience that comes from treating a high volume of patients with the depth of experience that results from the dedication of our clinicians to the treatment of this disease. 

The Esophageal Disease Management Team includes surgeons, medical oncologists, radiation oncologists, gastroenterologists, and dedicated nursing and support staff all of whom are committed to the optimal treatment of esophageal cancer. We use all appropriate clinical information to formulate an individualized treatment plan for each patient.

Treatment Approaches

In patients with very early-stage disease or those with premalignant conditions, we can often offer an array of endoscopic and ablative therapies, including endoscopic resection and radiofrequency ablation (BARR-X). In appropriate patients, these treatments can provide a cure and avoid the need for invasive surgery.

In patients with local disease that is not amenable to endoscopic treatments, we recommend surgical resection. In these patients, surgery alone is frequently the only treatment needed, with a high potential for cure.

Most commonly, our patients present with locally advanced and regional disease. For the past 15 years, we have been at the forefront of treating these patients  by offering a multimodality approach, resulting in outcomes that far surpass expected results. In these patients, chemotherapy and radiation are administered before surgical treatment, significantly improving the chances for a cure. 

In addition to traditional open surgery, we are innovating minimally invasive surgical techniques, including the use of surgical robotics and advanced thoracoscopic and laparoscopic approaches. These methods enable patients to recover more quickly, experience less pain, and have shorter hospital stays and achieve the same levels of patient safety, oncologic excellence, and survival outcomes.

Memorial Sloan Kettering is one of the highest-volume esophageal surgery centers in North America. Our world-renowned expertise, passion, and commitment to excellence in the care of these patients have led to surgical morbidity and mortality rates that not only are the best in the tristate area but also are among the best in the nation.

In our ongoing clinical and basic-science research efforts, we are actively investigating advances in medical and surgical care for patients with esophageal cancer. These include exploring and establishing clinical trials to screen for esophageal cancer and Barrett’s esophagus, characterizing the genetic/molecular components of esophageal cancers and targeted therapy options, and advancing minimally invasive approaches to surgery.

Our Thoracic Surgery Service also maintains one of the largest single-institution databases on esophageal cancer in the world, with information on more than 1,800 patients. This ever-growing database has been instrumental in guiding recent revisions to the current esophageal cancer staging system and has helped define international standards of care in the treatment of these patients (see selected readings in bibliography). Many of these exciting advances will be detailed in future editions of the Thoracic Surgical Oncology Clinical Update.

Visit our esophageal cancer guide for more information about our experts and our approach to the treatment of this cancer. 

Figure 1. Annual case volume and hospital mortality for patients undergoing esophagectomy for cancer at Memorial Sloan Kettering Enlarge Image Figure 1. Annual case volume and hospital mortality for patients undergoing esophagectomy for cancer at Memorial Sloan Kettering

Lou F, Sima CS, Adusumilli PS, et al. Esophageal cancer recurrence patterns and implications for surveillance. J Thorac Oncol. 2013;8:1558-62.

Molena D, Sun HH, Badr AS, et al. Clinical tools do not predict pathological complete response in patients with esophageal squamous cell cancer treated with definitive chemoradiotherapy. Dis Esophagus. 2013 [Epub ahead of print].

Sarkaria IS, Rizk NP, Finley DJ, et al. Combined thoracoscopic and laparoscopic robotic-assisted minimally invasive esophagectomy using a four-arm platform: experience, technique and cautions during early procedure development. Eur J Cardiothorac Surg. 2013;43:e107-15.

Rizk NP, Ishwaran H, Rice TW, et al. Optimum lymphadenectomy for esophageal cancer. Ann Surg. 2010;251:46-50.

Rizk NP, Tang L, Adusumilli PS, et al. Predictive value of initial PET-SUVmax in patients with locally advanced esophageal and gastroesophageal junction adenocarcinoma. J Thorac Oncol. 2009;4:875-9.

Sarkaria IS, Rizk NP, Bains MS, et al. Post-treatment endoscopic biopsy is a poor-predictor of pathologic response in patients undergoing chemoradiation therapy for esophageal cancer. Ann Surg. 2009;249:764-7.

Rizk NP, Venkatraman E, Bains MS, et al. American Joint Committee on Cancer staging system does not accurately predict survival in patients receiving multimodality therapy for esophageal adenocarcinoma. J Clin Oncol. 2007;25:507-12.

Rizk NP, Seshan VE, Bains MS, et al. Prognostic factors after combined modality treatment of squamous cell carcinoma of the esophagus. J Thorac Oncol. 2007;2:1117-23.

Rizk N, Venkatraman E, Park B, et al. The prognostic importance of the number of involved lymph nodes in esophageal cancer: implications for revisions of the American Joint Committee on Cancer staging system. J Thorac Cardiovasc Surg. 2006;132:1374-81.

Moskovitz AH, Rizk NP, Venkatraman E, et al. Mortality increases for octogenarians undergoing esophagogastrectomy for esophageal cancer. Ann Thorac Surg. 2006;82:2031-6.