James Bailey began suffering last spring from a serious problem with acid reflux, known as GERD (gastroesophageal reflux disease). That’s when backwash from the stomach enters and causes injury to the esophageal tissue, posing a risk for adenocarcinoma — or cancer — in the lower esophagus.
Oftentimes, Bailey would eat and as soon as the food hit the point where his esophagus meets the stomach, he would be in pain.
“Some things I ate were OK,” he said. “Some, it would hurt terribly. It would hurt so bad.”
He was given medication in July for acid reflux, but after a month, he was still having terrible pain. His next diagnosis was esophageal cancer — a malignant tumor located in the esophagus at its junction with the stomach.
He visited Dr. Joseph D. Whitlark, a thoracic specialist who owns Thoracic & Vascular Associates of Kinston. Whitlark had been training on various parts of the procedure for nearly a year, receiving training in using a scope at Duke Hospital and the University of Pittsburgh for the last seven years.
Thoracic procedures involve the chest cavity, but problems with the esophagus can also involve the abdominal cavity, the doctor said. Usually, a thoracic surgeon will work above the diaphragm, while a general surgeon will perform surgery in the area below.
Whitlark, through a series of training opportunities over the last few years, has learned to use a scope in both areas of the body. He’s performed numerous partial minimally-invasive esophagectomies. He recently completed a final course at Duke and has performed the complete MIE surgery twice — with Bailey being his first patient Nov. 26.
“It’s important to understand that sometimes minimally-invasive surgery is really good for people,” he said. “You’re able to operate on sicker and older people that you normally would not.”
Bailey would not likely have met the criteria for traditional surgery due to his age and scar tissue from a previous surgery for aneurysms. He had been a smoker and had been exposed to asbestos in pipe insulation in the early years of working at DuPont — where he retired in 2004 after 37 years as pipefitter, welder and mechanic.
“This is a bad cancer,” Whitlark said. “The treatment is very extensive and people often can’t tolerate it.”
With traditional treatment, the five-year survival rate is about 15 percent, the doctor said. Traditional surgery involves making a large cut in both the abdomen and chest and pulling the stomach up to the chest to remove the cancer and reattach the esophagus to the stomach. If the cancer is higher up, the surgeon may have to make a cut in the neck, as well. Recovery time is lengthy.
The survival rate after surgery can be as much as 50 percent when combined with chemotherapy and radiation, Whitlark said. Bailey had responded well to chemotherapy and radiation treatments.
Laposcopic surgery, which was first used about 20 years ago for gall bladder surgery, involves inserting a scope and thin surgical instruments through tiny incisions at various points on the body. With esophageal cancer, the cancer is removed through those small incisions.
“We at Lenoir (Memorial Hospital),” he said, “are now doing this with just a scope in the belly and we put a scope in the chest.”
The surgery is longer — usually around nine hours. But the mortality rate is lower, pain and blood loss is less and the hospital stay is shorter — as early as the next day, Whitlark said.
For Bailey, his stay at the hospital was longer at 18 days. But it wasn’t because of the procedure; he experienced problems with his heart rhythm and his blood had to be built up, Whitlark said.
“He’s done very, very well,” he said about Bailey. “In many places, he would not have been offered surgery.”
A week ago, Bailey had a drainage tube removed. Before that, a nurse would visit daily at his home to assist with the tube. He continues to carry oxygen with him and is easily tired, but the procedure was a success.
“Well, I thought I ought to be feeling a little better, strength-wise,” Bailey said. “The problem with swallowing is completely gone, and the doctors tell me I have been completely cured of the cancer.”
Whitlark said he believes he is the only doctor east of I-95 who performs MIE surgery.
“The operation itself is very complicated,” he said. “It takes a long time to do it. And it takes a team to do it. … This is a cutting edge surgery you’re not going to find in many places, and we do it at Lenoir.”
Despite his slow recovery, Bailey is pleased he is cancer-free.
“With prayers offered up for me, and the good Lord and Dr. Whitlark’s expert ability,” he said, “I think I’ve done really well.”
Breakout box:
Estimates in 2012 for esophageal cancer in the U.S. were:
n About 17,460 new esophageal cancer cases diagnosed (13,950 in men and 3,510 in women)
n About 15,070 deaths from esophageal cancer (12,040 in men and 3,030 in women)
n The lifetime risk of esophageal cancer in the U.S. is about 1 in 125 in men and about 1 in 435 in women. The disease was once more common in blacks, but has decreased. It has increased slightly in whites, making the rates fairly equal now
Source: American Cancer Society
Margaret Fisher can be reached at 252-559-1082 or Margaret.Fisher@Kinston.com.