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Cutting Edge, Robotic Surgery for Esophageal Cancer


Fifty-nine-year-old David Hunt of Woburn is an EMT, but even as a healthcare professional he says he didn’t realize Tufts Medical Center could treat his cancer. “People don’t think of Tufts MC as a cancer hospital,” said Hunt. “I never even knew Tufts MC treated cancer patients.”

David HuntHunt says the skilled surgeons, oncologists, nurses, and support staff at Tufts MC– as well as cutting edge care he’s received there – saved his life. He was diagnosed with Barrett’s Esophagus, also known as Barrett’s Syndrome, several years ago. This condition is caused when the esophagus becomes damaged by acid reflux, leaving the lining of the esophagus thickened, red, and irritated. Hunt says he was diligent about routinely monitoring his condition and was told it could eventually turn cancerous.

“Esophageal cancer is quite aggressive,” said Dr. Antonio Lassaletta, a thoracic surgeon at Tufts Medical Center. “Few patients end up being a candidate for surgery due to having advanced disease at the time of presentation.”

Hunt says he was eating a steak sub last September and had a tough time swallowing it. “I was thinking that I was eating too quickly and had scratched my lining,” recalled Hunt. “A couple of weeks later I knew it shouldn’t still bother me, so I called my primary care physician.”

After an endoscopy at MelroseWakefield Hospital where the physician told him he saw “something concerning,” Hunt was sent for a series of tests including bloodwork, a CT scan and a PET scan. Then came the diagnosis.

“When I got the word ‘you have cancer’ – well I’m the person who usually puts out the fires,” said Hunt. “To me, cancer is a death sentence. I had no idea they could treat this, never much less cure it because it was so aggressive.”

Hunt’s next stop would be a course of chemotherapy and radiation.

“This cancer is usually diagnosed very late stage,” said Dr. Lassaletta. “Most do get chemotherapy and radiation, but not many end up being surgical candidates. Mr. Hunt was fortunate that his tumor shrunk considerably, and we were able to operate.”

Dr. Lassaletta scheduled Hunt for a robotic esophageal resection – while considered minimally invasive because it’s robotic, the doctor admits it’s a “big surgery” which can take more than 6 hours to complete. The cancer was in Hunt’s esophagus and extended into his stomach.

“We did everything robotically through the chest and the abdomen,” said Dr. Lassaletta. “I first remove the esophagus and top of the stomach, which leaves a gap. I then turn the stomach into a tube and connect that tube to the remaining esophagus higher in the chest.”

A temporary feeding tube was inserted, and Hunt would spend a few nights in the ICU before being transferred to a regular surgical floor.  He was home within a week of his surgery and was fortunate he didn’t need the feeding tube permanently, which was removed during a post-operative office visit as he was back to eating regular food.

The hospital does a few dozen of these robotic types of surgery for esophageal cancer each year. “Traditionally, the procedure has been done through large incisions in the abdomen, chest, and neck, requiring an extensive recovery. The robotic platform allows us to perform the same major operation on the inside, but using much smaller incisions, and avoids incisions in the neck altogether. For the patient this means a more comfortable experience, a shorter hospital stay, and a quicker recovery,” explains Dr. Lassaletta.

The term “cutting-edge” can also be applied to the type of post-operative care Hunt is receiving. “He will get immunotherapy care coordinated with Dr. Jiyuan Sun at the Tufts Cancer Center in Stoneham,” said Dr. Lassaletta. “David’s the first esophageal cancer patient I’ve had that’s a candidate for immunotherapy. This offers such a great long-term prognosis for him given how aggressive esophageal cancer was.”

A study published in the National Library of Medicine just last year said the prognosis for patients with esophageal cancer was “dismal”  and there were “limited treatment options”, but also states that immunotherapy will “change the face of modern cancer treatment” and has achieved “revolutionary response rates.”

“This protocol was developed last year in April of 2021,” said Dr. Jiyuan Sun. “Usually a patient like Mr. Hunt has residual cancer. It’s good that he had very small residual disease. He meets the guidelines for immunotherapy. Usually if you have some residual disease, we can expect the cancer to recur between eleven and twenty-two months later. But with immunotherapy, the recurrence time will be prolonged.”

Dr. Sun says there hasn’t been enough time since immunotherapy was approved last year to calculate the five-year survival rate and that the most common side-effect from immunotherapy is fatigue. More serious complications are rare.

Meanwhile, Hunt says he is grateful to have received such ground-breaking treatment – both in the OR and now post-operatively.

“There is no question that I wouldn’t be alive today if it wasn’t for the people at Tufts MC,” said Hunt. “If it wasn’t for the advances in their technology and every doctor, nurse and med tech that was there with me every step of the way. Everyone, at every level, collaborates to make this work.”