Duke Health Referring Physicians


Treating Late-Stage Esophageal Cancer

An active, 58-year-old rancher from Florida consulted his primary care physician after he started having difficulty swallowing and began unintentionally losing weight. The physician referred him to an oncologist, who diagnosed him with stage III esophageal cancer and treated him with chemotherapy and radiotherapy. He was advised to undergo esophagectomy after he had recovered.

The patient initially scheduled robotic-assisted esophagectomy at one medical center; however, knowing that, like any major surgery, esophagectomy can have serious complications, he consulted several other surgeons at large medical centers. He decided to have Duke thoracic surgeon Thomas Anthony D’Amico, MD, perform the surgery instead because he could offer minimally invasive esophagectomy without using robotic assistance.

There is no demonstrable advantage of robotic-assisted surgery, D’Amico says, and, because the patient felt more comfortable with standard minimally invasive esophagectomy, it was the right approach for him.

D’Amico adds that the patient was wise to consider only large medical centers for his surgery.

“Institutions that have high volumes are where patients do best,” he explains. “For some procedures it doesn’t matter as much; you can have great quality care at lower volumes. But research shows that, in the case of esophagectomy, the more experience the hospital and surgeon have, the better the patients do.”

The patient returned to Duke, and D’Amico performed the surgery with no complications. On postoperative day 1, the patient began walking 3 miles a day to help with his recovery. Less than 1 week later, he was discharged to a local hotel and then home.

D’Amico notes that the patient tolerated the surgery very well and felt ready to go home by day 5, but D’Amico wanted to keep him close to Duke for 1 full week in case he had complications and needed to be seen again.

At the patient’s 3-month follow-up appointment, D’Amico says the patient reported being just as active as he was prior to surgery, with no limitations, and was back to working on his ranch operating heavy equipment.

The patient will continue visiting Duke for scans every 3 months for a 2-year period. If the cancer has not recurred by that time, then he has a high likelihood of being cured, D’Amico says, although Duke will continue formally monitoring the patient for an additional 2 years.