Complex T.H.E. surgery requires skill, practice

Shopper News: News From Fort Sanders Regional Medical Center

Cut down here and up there, remove this pipe down to there, pull up this drain and hook ’em together up here. It sounds simple enough, but a trans-hiatal esophagectomy (THE) is a lot more complicated than reworking the kitchen plumbing.

Gregory Midis, MD, FACS

Gregory Midis, MD, FACS

As with many complex surgical procedures, data show the best results for esophagectomy (or removal of all or part of the esophagus) come from surgeons whose expertise and skills have sharpened through practice at high-volume medical centers.

In fact, most surgeons and published literature says a surgeon needs to perform a minimum of 12 to 25 esophagectomies per year to maintain proficiency needed. At Fort Sanders Regional, which has been designated as a Center of Excellence, surgeons perform 20 to 30 per year.

Cardiothoracic surgeon Dr. Lacy Harville has been doing esophagectomies like Ron Houser’s for 23 years, often teaming over the last eight years with Fort Sanders surgical oncologists Drs. Paul Dudrick or Gregory Midis.

Lacy Harville, MD, FACS

Lacy Harville, MD, FACS

“I used to do them all myself or with my partners, but having Dr.  Midis and Dr. Dudrick makes it easier because it’s a two-surgeon thing,” said Harville. “These are six- to eight-hour operations, but our average time is somewhere between two and three hours, and our average length of hospital stay is down to about eight to 10 days.”

“The bottom line is: We’ve found there are better outcomes when thoracic surgeons and surgical oncologists adopt a team approach for esophageal cancer,” said Dr. Midis.

“It’s a logical way to treat patients. With our high volumes, Dr. Harville and I feel comfortable that we have the same outcomes and complication rates as the national standards.”

In Houser’s THE, one incision was made from the bottom of the sternum to the belly button and another was made in the left side of his neck near the carotid artery. The surgeons then could work simultaneously removing the cancerous esophagus and an upper portion of the stomach to reduce the possibility of recurrence.

Dudrick3_2015_1000px

Paul Dudrick, MD, FACS

Then, pulling up the stomach to serve as a replacement esophagus, the surgeons reconnect the stomach and remaining esophagus via the neck. Midis also placed a feeding tube in Houser’s small intestine to provide nourishment until he was well enough to eat and drink again.

The surgery does require some lifestyle changes. “These are complex and difficult operations to have, and the patients must live with alterations to their diets afterwards,” said Dr. Midis. In addition, Harville said, patients can no longer lie on their back after a meal because “we take away all the protective mechanisms for things to reflux back. Gravity is their friend once they’ve had a meal.”

Still, Harville said, most patients are able to get back to doing the things they want to do after surgery. “Now, their diet is a little different,” he cautioned. “But I would say 85 percent of people will get back to almost their normal diet. It’s just because now their stomach, instead of being a big weigh station for food to drop into, it’s now a tube, and they can’t hold as much food, so their meals have to be smaller. But they also need to be careful because normally your stomach functions to neutralize everything.”

Dr. Gregory Midis and Dr. Paul Dudrick are surgical oncologists with the Premier Surgical Associates office located at Fort Sanders Medical Center. Dr. Lacy Harville is a cardiovascular & thoracic surgeon with East Tennessee Cardiovascular Surgery Group.

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