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A New Surgery Saves a Life

Early Diagnosis and Prompt Operation Make the Difference for an Esophageal-Cancer Patient

You'd never call Roger A. Nickerson lucky. The Kingston resident developed esophageal cancer, an often deadly illness that, according to the American Cancer Society, will cause an estimated 14,530 deaths in the U.S. this year.

But he was fortunate that his disease was spotted early. That enabled doctors at Westchester Medical Center to perform a surgical procedure called esophagogastrectomy to remove the cancerous parts of his esophagus and stomach, successfully treating a malignancy that, left untreated, would probably have been fatal.

Warning signs led to an endoscopy

Nickerson, 62, is a retired carpenter who lives with his wife, Kristy, and has two grown sons and three grandchildren. This spring, he began feeling tired. He also had stomach pains. "I'd get very bloated after I ate," he recalls.

In April, his doctor performed an endoscopy, in which a camera and surgical instruments were sent down his throat to diagnose the problem. The test found lesions, and a tissue sample from them was taken for a biopsy. The results confirmed he had an adenocarcenoma, the most common type of esophageal cancer. It typically occurs at the junction of the esophagus and the stomach.

A link to GERD

The past two decades have seen a dramatic rise in this cancer, especially among middle-aged white men. The reason for this is not clear, but doctors believe it could be related to the rise in obesity and a condition that often accompanies it, acid reflux.

Acid reflux occurs when stomach acids move back up the esophagus. Known medically as gastro-esophageal reflux disease or GERD, it causes a burning sensation behind the breastbone near the heart—heartburn.

If these acids continually burn the esophagus over long periods of time, the tissues lining the esophagus change into a roughened state called Barrett's esophagus, which now affects 700,000 Americans. Typically it does not cause symptoms itself or progress any further. But each year, in about one-half of 1 percent of cases, cells become cancerous.

A team approach to treatment

Nickerson, who has been taking reflux medications for two decades, was one of those cases. He was referred to Ashutosh Kaul, M.D., gastrointestinal surgeon and Director of Minimally Invasive and Robotic Surgery at Westchester, who called in Tauseef Ahmed, M.D., Director of Oncology. "We have a team approach with this disease," Dr. Kaul explains.

He and Dr. Ahmed first needed to find out how advanced Nickerson's cancer was, how far it had penetrated into the organ tissues and whether it had spread into the lymph nodes and other parts of the body. It turned out that it was stage 1, the most contained and therefore the most treatable stage.

However, treatment meant surgery, and soon. And that meant calling in the services of a third team member. Rocco Lafaro, M.D., Chief of Thoracic Surgery, was enlisted to perform the operation on Nickerson's esophagus, while Dr. Kaul worked on the stomach.

"Because the surgery is so complex, you need to enter two different body cavities: the chest and the abdomen," says Dr. Lafaro. Only an advanced medical center such as Westchester has surgeons with the experience to succeed in such a combined procedure, he says. "You really need to do a dozen of these operations a year, as we do here, to know how to do it well."

Nickerson's surgery was done laparascopically, as are most esophagogastrectomies these days. First, Dr. Kaul made four small incisions in Nickerson's belly. He introduced his surgical instruments and a camera through the openings and removed the stomach's cancerous cells, which encompassed about 1 centimeter. After closing the incisions, Dr. Kaul stepped aside as Dr. Lafaro performed essentially the same function, only through Nickerson's chest. He removed about 2 centimeters of the esophagus that contained cancer cells. He then reattached the esophagus and the stomach.

Nickerson spent about two weeks recovering in the hospital, and he may still need chemotherapy. (As of early June, his doctors weren't sure yet whether that would be necessary.) In any case, the cancer appears to be gone.

"They told me it's all cleared up and they're pretty sure they got it all," Nickerson says. "That's the kind of story I like to hear."

"His prognosis is good," reports Dr. Lafaro. "The key is that we got it early."

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