Therapy after Surgery for Esophageal and Gastric Cancers

Questions About Upper GI or Esophageal Cancer?

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Expectations Before and After Surgery

Most operations performed for gastro-esophageal malignancies are complex surgeries (see list above). Our number one priority is to perform these operations safely with outcomes comparable to any major cancer center in the US. The details of your surgery will be discussed with you by your surgeon prior to any operation. Our thoracic surgeons/surgical oncologists have extensive experience with these complicated procedures. We recognize the importance of accurate nodal staging and dissect appropriate lymph node stations for all gastro-esophageal cancers. Most patients with advanced gastro-esophageal malignancies will have a feeding tube inserted around the time of surgery, especially in the setting of significant weight loss or poor nutritional status before surgery. Indications for a feeding tube insertion are discussed with each patient individually.

Each patient is different, and so could be their postoperative course. We have standardized postoperative pathways for major gastro-esophageal surgeries. Most patients should expect to spend 5-10 days in the hospital. Many patients get an epidural catheter inserted prior to surgery. Most patients come out of the operating room with various tubes and drains inserted during surgery. Patients maybe observed in the ICU for a day or two even if everything goes well. From the ICU, patients are transferred to either a stepdown unit or a surgical floor. We will help and encourage you to get out of bed as soon as possible to reduce the chance of blood clots, infections and to help you to feel better. We will advance your diet depending on how well you tolerate liquids.

Most patients are seen by a Registered Dietitian after surgery. Most patients undergo a swallowing study prior to their diet being advanced. This is done to make sure the new connections or anastomoses are intact. Patients have to meet standardized criteria prior to discharge. It will take several weeks to months to completely recover from surgery. You will likely be able to return to work, at least part time, before you completely recover.

Esophageal Cancer Therapies After Surgery

Adjuvant therapy following surgical resection of the primary tumor and regional lymph nodes is used selectively. Typical scenarios are a close margin of resection to the primary tumor or more extensive nodal involvement than appreciated before surgery. These scenarios are discussed with patients individually. Adjuvant therapy following neoadjuvant treatment and surgical resection is even less likely, as currently there is no evidence to suggest any difference in outcome with the administration of additional cycles of adjuvant chemotherapy.

Gastric Cancer Therapies After Surgery

Following nationally accepted guidelines, most patients with a diagnosis of gastric cancer are candidates for additional local or systemic therapy after surgery. This could be cycles of systemic chemotherapy with or without radiation. The indications for these therapies are discussed with all patients individually. While there is a lot of variation in the preoperative and postoperative treatment of gastric cancers, most experts would agree, that a combination of systemic therapy and surgery has better long term outcomes than surgery alone.

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