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Hybrid treatment of upper GI cancer spares patients from major surgery

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A team of surgeons and gastroenterologists at Emory has been able to treat patients with tumors of the upper gastrointestinal tract without major surgery, using a minimally invasive approach combining endoscopy and laparoscopy.

In the journal Gastrointestinal Endoscopy, they describe the results for seven patients who, with standard procedures, would have needed removal of all or part of the esophagus, stomach, or intestine. The study will be published in the April 2012 issue.

“By working together, we were able to remove these tumors without any open incisions and without removing any major organs,” says lead author Field Willingham, MD, MPH, assistant professor of medicine at Emory University School of Medicine and director of endoscopy at Emory University Hospital. “The alternatives, such as total gastrectomy or a Whipple surgery, are major operations with long recovery periods and lifelong quality-of-life implications.”

The hybrid technique was successful in five out of seven cases. In the two other cases, both patients had more extensive GI stromal tumors, and more conventional laparoscopic procedures were used to remove the tumors. Follow-up treatment was variable because not all the tumors had the same level of malignancy; some patients received anti-cancer therapy afterwards.

In this group, there were no immediate or late complications. The postprocedure hospital stay was short, approximately 2 days, compared to two or three weeks for surgery such as total gastrectomy.

During the procedure, surgeons mobilize the tumor from the outside allowing the gastroenterologist to remove the tumor from the inside without taking out the organ from which the tumor arose.   The procedure involves general anesthesia, several tiny laparoscopic or keyhole incisions and an endoscopy (a long, flexible tube passed down the esophagus).

All hybrid procedures were performed by one attending surgeon (David Kooby, MD, Shishir Maithel, MD or Scott Davis, MD, all Emory surgical faculty) and one attending gastroenterologist (Willingham).

Reference: F.F. Willingham, S.S. Garud, S.S. Davis, M.M. Lewis, S.K. Maithel and D.A. Kooby. Human hybrid endoscopic and laparoscopic management of mass lesions of the foregut (with video) Gast. Endoscopy 75, 905-(2012)  

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