Advancing Tech, or risky changes?

[Makulit]

I am 4.5 years post op, Ivor Lewis. Laprascopis through the abdomen, then cracked open the ribcage, collapsed the right lung, removed the offending and stitched me up again. I recently met a senior surgeon in Taiwan and he was surprised to hear that they conducted this procedure so recently. He told me that they do the laprascopic, but instead of opening the ribs, they remove the tumour and surrounding tissue through an endoscope. He said it is far less traumatic and is common procedure in Taiwan.

I've been wondering about this and ask myself; is it economic pressures in the UK that result in old procedures being used when newer ones have been proven as, or more effective. Or is it the case that this new procedure I was told about is in fact less effective and more likely to potentially leave behind active cancer cells that my surgeon was easily able to remove.

Any ideas?

[Scrumtasticjojo]

Hi Makulit - I had my full oesophagectomy in Feb 2017 so coming up for 2 years. My surgery was done entirely via keyhole with an incision along my neck which has healed very well. I also had 23 lymph nodes in my chest area removed also. However it may have been due to not having a tumour which had I had might have changed the type of surgical procedure I had. My recovery - even though still the same major surgery-was very quick given that I had no huge open wounds, cracked ribs. They did have to collapse a lung for access and insert chest drains etc but my wounds are far less noticeable. Reading quite a few posts on here and peoples experiences of having an Ivor Lewis it sounds like a very traumatic experience. As we know science moves very quickly and I'm in no doubt that in the next 8-10 years there will be a better method for undertaking this procedure. Jo

[Rsw1fe]

Well my husband had his op 7 years ago entirely by keyhole surgery. Copybook recovery and is fine. Now nearly 84 and going strong. He was lucky with marvellous surgeons and team.

[Ivorlewisshark]

Yo Makulit. I’m 9 years ago. I had a tumour, a drawn out regime of chemotherapy, 18 weeks pre/post op. I also had the laprascopic through the abdomen. My op was 12 hour long. They removed 86 lymph nodes, Pancreas and 5 inches of my oesophagus. They also took a very large amount of my stomach away so they could drag and rejoin the pipes back up. Unlike you, my procedure was done through the right side of my back, a very big scar... and my abdomen has the trade mark shark look scar. Not pretty but very effective. All this was 11 months start to finish when I returned to work. On the whole I hardly had any pain after the initial op. I can now eat big, drink lots, play golf and holiday plenty. I’m normal, but reading other posts lots of people really suffer even with more recent new procedures of this op.

So, recapping, money is probably the biggest factor in this age. Obviously it’s less invasive but effective?? I had my op done at St Marys, Paddington and later was told , by one of the best surgeons in the world!! That’s the beauty of the NHS.

Dj.

[Hidden]

Hi

Having had IL nearly 3 years ago by Key hole for the abdominal part and the Chest part by a 3 inch posterior chest incision, no broken Ribs only chipped Ribs to allow access, chest drains and numerous IV drips and monitoring. Pain relief by epidural. No feeding tube all standard for my Sheffield Consultant. All as minimally invasive as possible. With 5 days ITU followed by a long 10 days on a ward, I have made a good recovery with the side effects most of us are managing. From stage 2/3 oesophageal cancer to being cancer free its a long journey aided by the skill of all the NHS staff involved and advances in technology by machines provided in some cases public funding.

I feel with the advance in technology for screening and tests such as Pet and CAT scans, Key Hole Surgery etc there seems to be little need for the Surgeon to cut open a stomach. These investigations can see more than the Human eye. Invasive surgery leads to more potential complications and risks that can be more costly to the NHS.

I have worked as a theater nurse in the past and have certainly known of some Consultants being more considered and reserved than others.

[Makulit in reply to Hidden]

Thank you Cath. Seems you are very well informed.

[Ivorlewisshark in reply to Hidden]

Yo cath. What is IL? A few years ago I noticed this terminology in my clinic notes after one of my post op clinic visits. I had a 3 stage oesophageal procedure. After being told of the cancer and location of it..... I spouted, they’ll have to smash me bleeding ribs to do it. That apparently was the only way ages ago. As you may know, they went in through my right side of back purposely deflating my right lung so as to manoeuvre. This resulted in 3 scars. The proverbial full frontal shark image, a large one on my back and lastly one just under my Adam’s apple where they rejoined my pipes back. How they stitched them together seemed unbelievable to me, or maybe they glued them. They removed 4 inches of my oesophagus, 86 lymph nodes, most of my stomach so as to be able to drag and rejoin my tubes. Not very pretty but effective and I’m still here 9 years on. I suppose your procedure is due to evolution, quite different. Similarly, I had the epidural, 3 days ITU, 3 days HDU, 10 days on ward. All done at St Marys, Paddington by a world leading surgeon, that’s the beauty of our NHS.

[Hidden in reply to Ivorlewisshark]

OOPs IL = Ivor Lewis

[Ivorlewisshark in reply to Hidden]

Yo cath. I wish I knew more,but at the time I took nothing in. The tests and chemo then it hit the fan. My wife being very clever, soaking all in . To this day I don’t know much. After the op, I wanted to know everything but I lost her very suddenly before she could reveal all. Although at times she would wind me up, delaying any info that she thought was revelant. That was 1 year 10 months ago. Needless to say ,I lost it.

[DavidP]

Hi Makulit.

I had keyhole surgery 5.5yrs back. When I heard it was to be keyhole I researched the pros and cons. At the time there was some concern that keyhole surgery might not remove all the disease, but providing the surgeon is well trained (I had a brilliant surgeon, one of the best in the UK), open and keyhole surgery have been shown to be equally effective. The benefit of keyhole is that it is associated with quicker recovery, less complications and scarring, and shorter time in HDU and hospital. This of course has financial benefits to healthcare providers but that's a win-win situation. I understand that many centres in the UK use keyhole but many still use the IL.

Best,

David

[Makulit]

Thank you David. I was confused when the young surgeon I met here told me the IL is considered old practice here in Taiwan. I felt that my treatment in the UK was second to none. I still wonder how the success rates compare, Taiwan v UK!!!! Despite his confidence I still like to think I was better off at home.