Hybrid Treatment Allows Patients with Upper GI Cancer to Avoid Major Surgery

April 2012

"Human hybrid endoscopic and laparoscopic management of mass lesions of the foregut," a study published in the April 2012 issue of Gastrointestinal Endoscopy, describes the use of a minimally invasive approach combining endoscopy and laparoscopy to treat seven patients with tumors of the upper gastrointestinal tract. First author Dr. Field Willingham, a gastroenterologist and director of endoscopy at Emory University Hospital; senior author Dr. David Kooby, associate professor of surgery of the division of surgical oncology; and their co-authors report the results of this technique for patients who would have otherwise required major surgery encompassing removal of all or part of the esophagus, stomach, or intestine. These procedures, such as total gastrectomy or Whipple surgery, are intensive and impacting operations that include long recovery periods and can have lifelong quality-of-life effects.

The hybrid procedures were performed by a team of one attending surgeon—either Dr. Kooby or fellow Emory surgical oncologists and co-authors Dr. Shishir Maithel and Dr. Scott Davis—and one attending gastroenterologist—Dr. Willingham in these cases. After the surgeons mobilized the tumor from the outside, Dr. Willingham was able to remove the tumor from the inside without removing the organ from which the tumor originated. The procedure involves general anesthesia, several tiny laparoscopic or keyhole incisions, and an endoscopy (a long, flexible tube passed down the esophagus).

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

For the seven patients, there were no immediate or late complications. The postprocedure hospital stays were short, approximately two days, compared to the two or three weeks that are typical of such surgeries as total gastrectomy.