Achieving the best outcomes for patients with esophageal cancer takes a team approach. At Duke Cancer Institute (DCI), gastroenterologists, medical oncologists specializing in gastrointestinal (GI) cancers, radiation oncologists, and thoracic surgeons collaborate to develop treatment plans that involve some of the most innovative, evidence-based surgical and systemic treatments available. 

“Our multidisciplinary approach brings patients the combined expertise of multiple disciplines and packages it so they receive multi-modal, high-quality care. We are one of the most comprehensive centers in the southeast treating esophageal cancer and other esophageal diseases,” says Hai Viet-Nguyen Salfity, MD, MPH, gastrointestinal and thoracic surgeon.

Esophageal surgery is one of the most difficult operations to complete due to the risks associated with it. Kaitlin C. Bevers, MD, thoracic surgeon, explains, “The best esophageal surgical outcomes require expertise from surgeons with the collaboration of gastroenterologists, medical oncologists, and radiation oncologists to manage nuances in systemic therapy, postoperative care, and nutrition. Our team approach and experience as a high-volume center support patients from diagnosis to treatment and through continued recovery.”

At Duke, patients with an esophageal cancer diagnosis are evaluated by the entire team from the start. This includes a coordinated approach where patients see all specialists in one day. “The upfront decision about a patient’s surgical care plan is made as a team, and we’re actively implementing surgical protocols supported by the latest science,” says Bevers. Care plans are also developed in close collaboration with GI medical oncologists specialists, including Hope E. Uronis, MD, MHS. 

From the start of a patient’s diagnosis, the team evaluates whether surgical intervention is the best approach because recent data shows some patients have a complete response after neoadjuvant therapy alone. “Patients can benefit from avoiding an unnecessary esophagectomy and preserving esophageal function,” says Bevers. “Our group was a part of this study, and our internal data shows excellent patient outcomes.”

For cases requiring surgery, the Duke thoracic surgery team has extensive experience in minimally invasive and robotic techniques to perform esophagectomies and other procedures to treat benign esophageal diseases and conditions.

“Minimally invasive and robotic approaches have been the focus of our program since it began, and all of our surgeons are very experienced in performing complex thoracic operations using these techniques,” says Salfity. Minimally invasive esophagectomies benefit patients with reduced complications, less pain, and faster healing times.

Patients with esophagectomies and other esophageal surgeries require comprehensive postoperative care including support from a dedicated nutritionist within our clinic along with a continuum of providers and close monitoring to ensure a smooth recovery. Our team are also equipped to perform any additional procedures. Salfity explains, “Some patients need esophageal dilation, ablation, or stenting after esophageal cancer treatment, and one of our team’s strengths is providing the whole spectrum of surgical and non-surgical care.”

DCI uniquely offers novel approaches and creative solutions for patients with some of the most complex or rare esophageal cancers. “We are a high-volume institution. Our whole team of thoracic surgeons is experienced in treating many thoracic cancers that don’t follow a traditional textbook scenario,” says Bevers.

The team is committed to advancing translational research that supports new treatment options. “From a more preventive standpoint, we’re evaluating a potential screening tool for Barrett’s esophagus that might not require endoscopy, which would be less invasive and more accessible to patients,” says Salfity. “We’re also looking at tissues and studying the inflammatory pathways in the development of esophageal cancer to develop more effective treatments.”