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Fall 2007

Minimally Invasive Esophagectomy

UCSF is pioneering a minimally invasive approach to the treatment of esophageal cancer, one that greatly reduces morbidity while providing a complete excision of the malignancy.

Minimally invasive esophagectomy is jointly performed by Pierre Theodore, M.D., and Marco Patti, M.D., who co-direct the newly formed Center for Esophageal Disorders at the Parnassus campus.

The new center encompasses a number of innovative treatments for esophageal disease, ranging from motility disorders such as gastroesophageal reflux disease (GERD) and achalasia to esophageal cancer. The center staff is composed of physicians from a variety of specialties, who work as a team to provide the highest level of expertise and care for patients with esophageal problems. The incidence of esophageal cancer has been increasing over the last 20 years, with approximately 14,000 cases now diagnosed annually. Most of the increase is in adenocarcinoma of the distal esophagus, a condition that is linked to persistent GERD.

"Over the last 18 months, we have been applying the minimally invasive techniques usually used for benign esophageal disorders to esophageal cancer," said Patti. The minimally invasive approach is suitable for any patient who has not undergone previous abdominal or chest surgery. The procedure involves less postoperative morbidity and pain, a shorter hospitalization and a faster recovery. It avoids the disfiguring incisions associated with traditional open surgery, while allowing surgeons to perform a thorough excision of the cancer.

Two surgeons trade off during the surgery, which uses the Ivor Lewis approach to esophagectomy. First, Patti performs the abdominal portion of the operation with the patient in a supine position. Then the patient's position is changed so he is lying on his left side and a thoracic surgeon, Theodore, completes the chest portion.

In addition to surgeons Patti and Theodore, the multidisciplinary center's staff includes gastroenterologists James Ostroff, M.D., and Chris Mathy, M.D., pulmonologists Jeffrey Golden, M.D., and Steven Hays, M.D., radiologist Fergus Coakley, M.D., cardiologist Michael Crawford, M.D., otolaryngologist Mark Courey, M.D., oncologists Andrew Ko, M.D., and Michael Korn, M.D., and anesthesiologists Errol Lobo, M.D., and Jeffrey Katz, M.D.

Consultations and Referrals

For more information, please contact Marco Patti, M.D., at (415) 353-2161 or Pierre Theodore, M.D., at (415) 353-7502.

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