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Combining Technology and Surgical Expertise to Transform Esophageal Cancer Treatment

At UPMC Passavant–McCandless, highly skilled thoracic surgeons are using leading-edge technology to perform delicate, minimally invasive—and life-saving—surgery.

Niamh Parrish, a former program coordinator at the University of Pittsburgh School of Medicine, dealt with acid reflux for years. Despite taking medicine to control her heartburn and avoiding certain foods, the problem persisted. When she started having challenges swallowing in late 2019, her primary care doctor, Yaqin Xia, MD, recommended an endoscopy.

The endoscopy showed Niamh had Barrett’s esophagus—a precancerous condition caused by repeated exposure to stomach acid. But her gastroenterologist, Kevin McGrath, MD, also spotted a suspicious area near her stomach and called her back for a second endoscopy and biopsy.

“It was esophageal cancer,” says Niamh, 56, a Squirrel Hill resident. “He told me I needed surgery—and sooner, rather than later.”

She and her husband, Michael, began searching for the best available treatment. After researching and talking to people they knew in the medical community, she made an appointment with Ryan Levy, MD, chief of thoracic surgery at UPMC Passavant.

A challenging, complex procedure

The standard treatment for esophageal cancer is an esophagectomy—the removal of the esophagus and uppermost part of the stomach. The stomach is then reshaped into a new esophagus in a “pull through” procedure that brings it up the base of the neck to connect to the remaining esophagus.

“It is a technically challenging surgery,” says Dr. Levy. “It’s the most complex thoracic oncologic reconstruction that’s done.”

Surgeons at UPMC pioneered the next level of treatment with minimally invasive esophagectomy, which results in fewer complications, less pain, and a shorter hospital stay compared to the traditional open procedure. Nearly 100 esophagectomies are performed each year on average across UPMC’s hospitals. At UPMC Passavant, thoracic surgeons now perform approximately 40 minimally invasive esophagectomies a year.

“The average mortality rate at other large U.S. hospitals that perform esophagectomies is 3.7 percent, while we are at 0.9 percent, compared to the national average,” adds Dr. Levy.

According to Dr. Levy, studies show that the best patient outcomes for esophagectomies are when these procedures are done by expert surgeons who regularly perform them. Having an experienced team of nurses, therapists, nutritionists, and other staff in place to provide specialized postoperative care for patients is also key.

“It’s a very unique situation,” says Dr. Levy, “We do more esophagectomies a year at UPMC Passavant than many major academic hospitals. It’s a testament to the team we’ve built—and the results.”

Life-saving surgery

That experience and good outcomes are what led Niamh to UPMC Passavant and Dr. Levy. “We knew if Dr. Levy was there, the care would be top-notch,” she says. “He’s a very good surgeon, and he has a fantastic team. We had utter confidence in him.”

Niamh was already aware of the surgery she needed. But she appreciated the time Dr. Levy took to explain the procedure, the complexity, and the risks involved. “He was very clear about the course of action needed. It would be life-changing, but life-saving, surgery,” she says.

“There was no other alternative but surgery. I had to accept it, trust him, and have faith that everything would go OK—and Dr. Levy delivered.”

In mid-January 2020—just one month after Niamh’s cancer diagnosis—Dr. Levy performed a minimally invasive esophagectomy assisted by Nicholas Baker, MD, another thoracic surgeon at UPMC Passavant. An ear, nose, and throat specialist was also present to monitor the nerves in Niamh’s neck area during surgery.

Using a dozen dime-sized incisions to access the cavity in her abdomen, chest, and neck, Dr. Levy removed 75 percent of Niamh’s esophagus, 25 percent of her stomach, and 37 lymph nodes. He then rebuilt her esophagus with the remaining stomach, leaving a small reservoir to process food, and reconnected the “new” esophagus in her neck area. The entire surgery took about 10 hours.

Postoperative care

Niamh spent the next several days in the intensive care unit (ICU) at UPMC Passavant where she was cared for by an experienced team of doctors, nurses, respiratory therapists, physical therapists, and nutritionists.

“We have a dedicated pulmonary critical care team providing exceptional ICU care,” says Dr. Levy. “With an esophagectomy, every detail matters. This team understands the needs of our patients. It’s why we have such good results.”

Niamh agrees. “It was very difficult, but Dr. Levy and his team were wonderful. The ICU staff was fantastic,” she says. “They had me up and walking the day after surgery. They took care of my every need.”

Additional treatment

Initially, the preoperative PET scans and CT scans indicated Niamh’s cancer had been caught early. Of the 37 lymph nodes removed by Dr. Levy, one was later found to be cancerous. Instead of a stage I diagnosis, her cancer was stage III, which meant she needed chemotherapy.

“Her case illustrates why it’s important to do an aggressive lymph node dissection. Without it, she may have ended up with the wrong treatment plan,” says Dr. Levy.

Six weeks after her surgery, Niamh began six months of chemotherapy treatments at UPMC Hillman Cancer Center. She will have follow-up CT scans every four months for the first three years, then every six months during years four and five. Her most recent scan showed no sign of cancer.

“So far, everything looks good,” says Dr. Levy. “Her long-term prognosis is very good.”

Niamh says her ongoing recovery has been encouraging. She had to re-learn how to swallow and adapt to a smaller stomach—eating smaller meals and avoiding high-fat foods. Her voice is growing stronger, she has started to sing again, and her Irish lilt has returned. Seven months after her surgery, her daughter smiled and said, “Today is the first day you sound like yourself.”

“I can’t say enough good things about Dr. Levy. I feel very lucky to have had him as my surgeon,” says Niamh. “He and his team saved my life, and I’m very grateful.”

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