Making Surgical History at Suburban Hospital

Date: June 19, 2017

Permanente Surgeons Perform Successful Removal of Tumor from Esophagus

In early 2016, Ronald Aho, 52, began experiencing pain in his back and chest. A trip to the hospital showed he wasn’t suffering from a heart attack. But after a short time, he also began having trouble swallowing. “I’d be eating lunch, and the food would get stuck and come up again,” he says.

Aho, who lives in Clinton, Maryland, with his partner, Sean, went to Largo Medical Center, a Kaiser Permanente facility in Upper Marlboro, Maryland. Jemilat Badamas, M.D., a gastroenterologist from the Mid-Atlantic Permanente Medical Group (MAPMG)—the physicians who care exclusively for patients insured by Kaiser Permanente—performed an upper endoscopy, whereby a thin scope with a light and camera is used to examine the upper digestive tract.

The test found a tumor at the junction of his esophagus and stomach, which then required an advanced endoscopic ultrasound by her colleague Dia Copeland, M.D., to stage the cancer.

“It was decided that with my type of cancer, radiation and chemo combined with surgery would be the most effective treatment,” says Aho. So, beginning that May, Aho went through three months of chemotherapy and five weeks of radiation every weekday, to shrink the tumor.

The next step was surgery. Aho needed an esophagectomy, a procedure in which the tumor is removed along with portions of the esophagus and stomach. The upper portion of the esophagus is then connected to the remaining part of the stomach, and part of the stomach is pulled up into the chest to become the new esophagus.

“This is a technically complex operation that requires extra training and experience,” says Jeffrey Pelton, M.D., of MAPMG. Dr. Pelton performed esophagectomies at his previous position in the Air Force. He often operates with Nyen Chong, M.D., an experienced thoracic surgeon whom MAPMG recruited to lead a new program in thoracic oncology. Dr. Chong previously established a robotic thoracic program at St. Joseph’s Hospital in Washington State.

“Our vision was to build a regional Kaiser Permanente/Mid-Atlantic Permanente Medical Group Thoracic Oncology Center of Excellence at Suburban Hospital, where Dr. Chong could perform his surgeries,” says Allyson Mirabella, M.D., MAPMG assistant physician-in-chief of Access and Service and chief of Pulmonology and Sleep.

In the fall of 2016, Aho became the first patient at Suburban to have an esophagectomy.

Before he could undergo surgery, Aho first had to regain some of the strength he lost during chemotherapy. This is important because after an esophagectomy, the risk of complications (such as pneumonia and blood clots) can be as high as 25 to 30 percent. Waiting six to eight weeks after chemotherapy ends to perform surgery minimizes some of those post-surgical risks, Dr. Chong says.

On the day of Aho’s surgery, the surgical team—which included Dr. Chong and Dr. Pelton; MAPMG anesthesiologists Yun Wang, M.D., and Johnetta Washington, D.O.; a physician assistant; and several Suburban Hospital nurses—met with Aho to explain their roles in the procedure. Aho remembers that Dr. Washington held his hand briefly and said, “I’ll be watching you the whole time.” Afterward, Aho thought, “I don’t have to worry. I’m in good hands.”

Because of the location of Aho’s tumor, the surgeons had to go in through both his stomach and his chest, meaning that Aho essentially had two operations under the same anesthesia. First, the surgeons used a laparoscopic approach to make small incisions in Aho’s belly. Then they “mobilized” his stomach, separating it from the structures that surrounded it so it could be moved later in the surgery. The surgeons also put a feeding tube in his small intestine, where nourishment would be directly delivered in the days following the surgery.

In his right chest, the anesthesiology team inserted a special type of breathing tube through a small incision, allowing them to deflate the right lung and making it easier for the surgeons to work on the esophagus. They completed the esophagectomy and removed the tumor, along with several lymph nodes, then used a stapling device to reconnect Aho’s stomach to his esophagus. The entire operation took about six hours.

Five weeks after his surgery, Aho met with Dr. Chong for a follow-up visit. Dr. Chong showed him two CT scan images side by side. The first, which had a large black spot and several smaller black spots, showed the cancer in Aho’s esophagus and surrounding lymph nodes before the surgery. Then Dr. Chong pointed to the scan taken after the surgery. “He said, ‘You can see that the black spots no longer exist. We don’t see any indication that there is cancer,’” remembers Aho, who didn’t need any further chemotherapy. “That’s what I really liked about Dr. Chong. He always explained things clearly.”

After surgery, Aho stayed at Suburban Hospital for about two weeks, and his feeding tube came out within a month. Because his stomach is smaller now, he eats smaller portions of the foods he loves. A business analyst/tester with Pragmatics, Aho began telecommuting shortly after the surgery and returned to his office full time at the end of 2016.

Looking back on his surgery and hospital experience, Aho praises everyone involved in his care. “Dr. Chong and the entire surgical team really cared about me and Suburban is an excellent hospital.”

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