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 minimally invasive, 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 robotic assisted 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 significantly improved ergonomics compared to conventional laparoscopic surgery. 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 margin negative complete resection, length of hospital stay, 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, with a linear stapled six-centimeter anastomosis, with less than a 1% leak rate, compared to 10-30% nationally and at other high-volume centers, recently published in last two years.

Unique to Roswell Park is the collaborative comprehensive program between Surgical Oncologist and Thoracic Surgery team, where the treatment is tailored to patients needs and not which provider they see. Patients with cancers of the esophagus, gastroesophageal junction and stomach are offered several different approaches, including more novel proximal gastrectomy with double tract reconstruction. All patients are discussed at multidisciplinary tumor board and unique treatment plans offered based on multiple factors.

Patients at Roswell Park have options for gastroesophageal surgeries that aren’t available at other centers, and approximately 50 gastrostomies, full or partial stomach removals, are performed here annually, something most other centers can’t offer, Dr. Kukar says.  

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 diagnostic laparoscopy, where we make small holes in the belly and look at the tumor from the outside and endoscopically which helps us decide the sequencing of different therapies including chemotherapy, Immunotherapy and targeted therapy combined with surgery to provide the best curative outcomes.”