A safer, more precise procedure

Traditionally, esophagectomies have been high-risk surgeries, requiring large incisions in the chest and abdomen. Recovery could take up to a month in the hospital, followed by months of recovery at home. Robotic-assisted techniques are changing that reality.

Instead of one large incision, surgeons make small incisions in the chest and abdomen. Using the da Vinci 5 robotic surgery system, doctors can operate with more accuracy and control. This allows them to get touch-like (haptic) feedback that helps them feel what’s happening during the surgery.

According to a recent report in the Annals of Thoracic Surgery, robotic esophagectomy “proves to be a safe and effective option for patients with midesophageal to distal esophageal cancers.”

"The advantages of the robotic platform are lesser length of stay in the hospital, earlier return to work or activity because of shortening incisions and better lymph node yield," says Burhan Hassan, MD, staff thoracic surgeon with OSF HealthCare.

Benefits of robotic esophagectomy

Patients undergoing the robotic approach can experience:

• Faster and easier recovery
• Less blood loss
• Reduced pain during recovery
• Minimal scarring
• Lower risk of infection
• Shorter hospital stays
• Greater accuracy in delicate procedures

“Our length of stay since we started performing robotic esophagectomy has come down to seven days on average, which is five days under the national standard,” Dr. Hassan says.

Who is affected by esophageal cancer?

Esophageal cancer generally falls into two types:

• Squamous cell carcinoma – often linked to smoking and alcohol use
• Adenocarcinoma – usually affecting the lower esophagus, with cases on the rise

“While squamous cancer cases have remained steady or even declined, adenocarcinoma cases are increasing, and poor diet is a contributing factor,” Dr. Hassan explains. "Reflux is one of the reasons why a patient would have lower esophagus cancer. Reflux is related to diet. Most gastric cancer is traditionally related to diet, that's why it's mostly seen in the Japanese population, because of the diet there. But in the U.S. subset, the biggest cause is reflux."

More frequent use of scans and EGDs (esophagogastroduodenoscopy) has also led to earlier detection of esophageal cancers, giving patients a better chance of successful treatment.

What patients can expect

A robotic esophagectomy typically lasts five to six hours. Patients usually spend one day in the intensive care unit (ICU) and another five to six days in a general hospital room.

Dr. Hassan and his team aim to completely remove the tumor while preserving surrounding healthy tissue. Recent clinical guidelines also recommend shifting away from radiation as a treatment option, instead favoring chemotherapy followed by surgery for better outcomes.

Transforming cancer care

Once considered one of the most invasive cancer surgeries, esophagectomy is being redefined with robotics. For patients at OSF HealthCare, this means faster recoveries, shorter hospital stays and improved quality of life.

To learn more about robot-assisted surgeries at OSF, visit the OSF HealthCare website.

Video Interview Clips

Da Vinci 5 B-Roll

According to the National Institute of Diabetes and Digestive and Kidney Diseases, 20% of people in the United States have gastroesophageal reflux, commonly referred to as GERD. One of the complications of GERD is esophageal stricture, when a person’s esophagus becomes too narrow. This can lead to major problems with swallowing.

There’s a minimally invasive procedure available that can provide serious relief for patients dealing with these issues. One that can be done in one sitting and have you back to normal life as soon as you leave the hospital.

Introducing upper endoscopy

"This procedure is an upper endoscopy. We frequently refer to it as EGD (esophagogastroduodenoscopy). There are various treatments we can do with this procedure, including balloon dilation," says Raza Hamdani, MD, attending gastroenterologist at OSF HealthCare St. Mary Medical Center in Galesburg, Illinois. "Balloon dilation is one of the techniques we have for patients who have obstruction of the esophagus."

Common complaints that lead to EGD:

The main complaint seen when patients get referred for an EGD is difficulty swallowing certain food like bread or meat. However, depending on the severity, it can even be soft foods or liquids causing issues while being consumed.

“It's usually described as a sensation of choking or things slowing down," Dr. Hamdani says. "Things not being able to go through”

Carrie McCance, the public relations communications coordinator (PRCC) at OSF St. Mary, usually is creating content about the work OSF providers do. This time, she has become part of the story.

“I was having frequent issues with food getting stuck in my esophagus, so much so that I couldn’t even swallow bread. After undergoing an X-ray, I was diagnosed with dysphagia, which is the medical term for difficulty swallowing,” McCance says.

McCance spoke with her care team at OSF and underwent an X-ray to try and get answers. The X-ray revealed she had scar tissue in her esophagus created by acid reflux, creating an esophageal ring that narrowed her esophagus.

“A normal esophagus measures about 20 millimeters in diameter, but mine had narrowed to 12 millimeters,” McCance says.

How the upper endoscopy works

McCance decided to get the upper endoscopy procedure, performed by Dr. Hamdani. Done under sedation, a thin, flexible tube called an endoscope gently passes through the patient’s throat.

A dilating balloon that has been inserted through the scope is carefully inflated, stretching the esophagus back to its normal size.

“This definitely improved my swallowing,” McCance explains.

Her treatment became a family affair, after Carrie’s mother, Mary Guenther, who had been experiencing similar issues, saw McCance go through the process.

“I was happy she told me about this. After I saw her go through the procedure without issues, it was easier for me to go through the process,” Guenther says.

Guenther’s esophagus was even narrower than McCance’s, at eight millimeters. Guenther says she went directly from the hospital and out to breakfast, and her swallowing has been better ever since.

McCance says having this procedure available in Galesburg saved her from hours of travel time, which she is very grateful for.

“I was in and out of the hospital within just a few hours. It couldn’t have been more convenient. Originally, I was expecting to travel to Peoria for the procedure, but thanks to Dr. Hamdani coming to the area, I was able to receive care close to home,” McCance says. “It also meant a lot to have the same option available for my mother. Being able to take her in for her procedure and have her back home in less time than would take just to drive to and from a larger city made a big difference for the both of us.”

What puts people at risk:

For those with trouble swallowing, it normally starts off with a slight feeling and then progresses to a “strong sensation,” Dr. Hamdani points out. This looks like food items are not passing through the throat or even getting stuck. This can even send some patients to the emergency department.

"If you cannot control the acid sensation or burning. Or even if you can, but you've had that kind of sensation for several years, that puts you at some risk for developing scar tissue and obstructions," Dr. Hamdani adds.

Dr. Hamdani encourages patients to "take action" if they are experiencing these complications, just like McCance did.

“Having this procedure truly changed my life. I can now eat without the constant fear of food getting stuck in my esophagus,” McCance adds.

Dr. Hamdani and McCance agree, saying first speak with your primary care provider. They can start by prescribing medications that can help relieve symptoms. If these symptoms don't go away completely, then you should get further consultation with a gastroenterologist to prevent issues from becoming more serious.

Acid reflux isn’t the only challenge these patients can face. Allergies can also affect the esophagus, creating the need for an EGD procedure.

For more information on gastroenterology specialists in the Greater Galesburg region, visit the OSF HealthCare website.

Video Interview Clips

In his year-long battle with cancer of the esophagus, Jim Corby encountered many nerve-wracking moments.

But when asked about it, one memory comes to mind for the retired construction worker from Alton, Illinois. One that happened far away from a doctor’s office.

On July 27, 2022, Corby was chosen to throw the ceremonial first pitch at the Alton River Dragons baseball game. Members of care team at OSF HealthCare Moeller Cancer Center in Alton, James Piephoff, MD, and Manpreet Sandhu, MD, were at his side. Also watching was a group of young women Corby coaches on the softball diamond.

“He knew if he didn’t throw a strike, he would never hear the end of it from the girls on his team,” Dr. Piephoff says.

No pressure, Jim.

Esophageal cancer: The basics

Dr. Piephoff, a radiation oncologist, says around 20,000 people in the United States are diagnosed with esophageal cancer each year. The cancer claims around 16,000 lives in the U.S. each year.

There are two types. The most common (around 70% of U.S. cases) is adenocarcinoma in the lower esophagus. The other type is squamous cell carcinoma, typically above where the airway separates into the lungs.

Both types are associated with excess smoking and drinking, something Corby found out the hard way.

“I smoked two-and-a-half to three packs of cigarettes a day,” Corby says. “The day I went in for surgery, I threw them out the window. I haven’t smoked since.”

Obesity is also a risk factor for adenocarcinoma.

“Obesity leads to increased risk of gastroesophageal reflux disease,” Dr. Piephoff explains. “It’s the acid churning up in the lower esophagus that leads to the risk of developing what’s called Barrett’s esophagus. That’s a precancerous condition.”

Screening isn’t common for cancer of the esophagus, so Dr. Piephoff says it’s important to watch for symptoms, which can mimic those of heartburn. See a doctor if symptoms won’t go away.

“Know your body. Don’t be afraid to talk to your doctors about it. Don’t try to minimize your symptoms,” Dr. Piephoff urges. “If there’s a change you notice, you need to convey that to your doctor.”

On treatment, Dr. Piephoff says he typically sees a person go through chemotherapy and radiation to shrink the cancer followed by surgery to remove the tumor. During surgery, instruments are sent down the throat and not through the chest, meaning an easier recovery for the person. Early detection could mean surgery only.

“There are some patients who are not able to have surgery because of medical conditions like a bad heart or bad lungs,” Dr. Piephoff says. “They get treated with radiation and chemotherapy without surgery.”

Immunotherapy is also a part of the treatment plan for some people. This involves changing how your immune system works so it can fight cancer, according to the American Cancer Society.

Jim’s journey

Corby says he started having pain in his midsection last year when he ate. Treatment for heartburn and acid reflux didn’t help. An ultrasound and CT scan didn’t get his doctors any closer to a solution. All the while, Corby says it hurt so much to eat, he started losing weight.

In September 2021, doctors examined Corby’s esophagus with a camera.

“The doctor came in and sat down, which I knew was not a good sign,” Corby recalls.

“That day was when my life changed,” he says.

The exam found a cancerous mass in Corby’s lower esophagus. The next few months were a whirlwind.

“It happened real fast,” Corby says.

“They got me here [to Moeller Cancer Center] to see Dr. Piephoff and Dr. Sandhu. They came up with a program to try to get me going,” Corby says. “I went through chemotherapy and radiation first. Then they sent me over to St. Louis, and in January I had surgery.”

The surgery to remove the cancer preceded a nine day stay in the hospital where Corby says he couldn’t eat or drink aside from the occasional ice cubes or water sopped from a sponge.

Sometime later – Corby can’t remember exactly when – he was back at OSF Moeller Cancer Center meeting with Dr. Sandhu.

“She said ‘Your scan came back. You’re cancer free.’” Corby says.

“I couldn’t believe it,” Corby adds. “How many times do you hear about people who have cancer who die? You hear more of that than you do cancer free.

“The odds were against me 100%, but I guess I beat the odds.”

The first pitch

Corby’s first pitch at the River Dragons game went – where else? – right down the middle of the plate, eliciting a cheer from his support system and all the fans learning his story for the first time. For Corby, it was a sigh of relief. No need to worry about razzing from his softball players.

“I got lucky,” Corby says, fighting back happy tears.

Learn more

Visit the OSF HealthCare website to learn about cancer treatment. This includes the new OSF Cancer Institute in Peoria, Illinois, which will serve the entire OSF service area will the latest treatment, education and more.

Interview clips - Dr. James Piephoff

Interview clips - Jim Corby