Esophageal Cancer
Minimally invasive esophagectomy within a multidisciplinary foregut team
Esophageal cancer treatment has changed substantially in the past few years: most patients now receive chemotherapy before and after surgery, sometimes combined with immunotherapy, and the operation itself is increasingly done through small incisions. Dr. Papenfuss performs minimally invasive esophagectomy as part of a multidisciplinary foregut team at St. Luke's in Milwaukee, serving patients from across Wisconsin.
What it is
The esophagus carries food from the throat to the stomach. Two cancer types dominate: adenocarcinoma, usually in the lower esophagus and linked to chronic acid reflux and Barrett's esophagus, and squamous cell carcinoma, more common in the upper and middle esophagus and linked to smoking and alcohol. Difficulty swallowing, especially solids, is the most common first symptom. Tumors at the GE junction are grouped with esophageal cancer for treatment planning.
How it is treated
Perioperative chemotherapy, given before and after surgery, is now the standard of care for most locally advanced adenocarcinomas of the esophagus and GE junction. A 2024 head-to-head trial (ESOPEC) showed better survival with perioperative FLOT chemotherapy than with chemoradiation before surgery, and for GE junction tumors the immunotherapy drug durvalumab is now FDA-approved in combination with perioperative chemotherapy.
Chemoradiation before surgery remains the standard for squamous cell carcinoma and an option for patients who cannot tolerate full-dose chemotherapy. Patients with cancer still present after chemoradiation and surgery receive immunotherapy afterward.
Esophagectomy, removal of most of the esophagus with the stomach pulled up into the chest to replace it. Dr. Papenfuss performs this through minimally invasive and robotic-assisted approaches, which reduce the size of chest and abdominal incisions and the pulmonary complications associated with open surgery.
Endoscopic resection for very early tumors confined to the lining, done by gastroenterology.
Definitive chemoradiation without surgery for some squamous tumors and for patients who are not surgical candidates.
Feeding support, often with a temporary feeding tube, is planned before treatment begins so weight and strength hold through chemotherapy and recovery.
Dr. Papenfuss's approach
Esophagectomy is a major operation, and outcomes track closely with surgeon and hospital experience. All patients are reviewed at a multidisciplinary conference with thoracic surgery, medical and radiation oncology, gastroenterology and nutrition before treatment begins, so the sequence of chemotherapy, immunotherapy, radiation and surgery is set for each patient rather than by default. Enhanced recovery protocols are used to shorten hospital stay and return patients to eating sooner.
When to get a second opinion
If surgery was offered before any chemotherapy, if chemoradiation was the only preoperative plan discussed for an adenocarcinoma, if an open operation was the only approach offered, or if you want to understand whether you need surgery at all after a complete response to treatment, a second opinion is worthwhile. Call 414-649-3240 or request a consultation.
This page is general information, not medical advice for any individual patient.