Complication rates are much lower at U-M than the Society of Thoracic Surgeons' average.

A Lot to Swallow

Less-invasive option aids esophageal cancer patients

issue 15 | Spring 2012

Physicians are seeing more patients like Jack Selby, a 68-year-old retiree living in Lansing who had suffered from heartburn all of his life. Selby thought over-the-counter antacids had solved his problem, but they were only masking Barrett's esophagus, which frequently leads to adenocarcinoma, a form of esophageal cancer.

The incidence of esophageal adenocarcinoma has increased by 350 percent over the last decade, making it the most rapidly increasing malignancy among white males.

"In patients who have ongoing gastro-esophageal reflux, the backwash of acid from the stomach into the esophagus for years and years can expose the lining of the esophagus to this bombardment of acid," says Mark Orringer, M.D., professor of Surgery in the Section of Thoracic Surgery at the U-M Medical School. "The esophagus was never meant to hold up to acid, and this can have significant implications."

Selby required an esophagectomy for Barrett's mucosa and early stage esophageal cancer.

He was treated at U-M by a team led by Orringer. U-M is considered a national leader in performing a type of esophagectomy — transhiatal esophagectomy, or THE — which is less invasive than conventional esophagectomy requiring a thoracotomy.

U-M has performed more than 3,000 of these procedures. Compared with data compiled in the Society of Thoracic Surgeons National Database, U-M has a substantially better 30-day patient survival rate with fewer complications and a shorter length of hospital stay.

"Many years ago, the esophagectomy operation, the traditional operation done through the chest, carried upward of a 20 percent mortality rate," says Orringer. "With the advent and the refinement of the transhiatal esophagectomy, the death rate from the procedure is around 1 percent at U-M."

Transhiatal esophagectomy was developed and refined at U-M and involves removing the diseased esophagus and rebuilding it. The procedure is performed through an incision in the neck and the abdomen and eliminates the need to open the chest.

"I had a transhiatal esophagectomy done about 15 months ago and I'm doing great now," says Selby, who weighed 260 before the esophagectomy. "I've lost about 70 pounds, have lots of energy and I feel very good."

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Mark B. Orringer, M.D. Bio