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.
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.