Esophagus Transplant

After 62-year-old cancer patient Gilbert Hudson had his esophagus surgically removed, he was forced to rely on a feeding tube implanted in his abdomen. He also had to wear a colostomy bag.

Self-conscious about his feeding tube and physical appearance, Hudson avoided seeing friends and doing ordinary things like going out to eat. Not surprisingly, he began to feel hopeless and to abandon thoughts of ever living a normal life again.

After his third surgery failed, Hudson’s surgeons referred him to Stanford Hospital & Clinics in Palo Alto, Calif., where a team of surgeons successfully transplanted some of his small intestine to replace his esophagus.

Stanford’s team included cancer surgeon Jeffrey Norton, chief of surgical oncology; Joseph Shrager, chief of thoracic surgery; and Gordon K. Lee, MD, director of microsurgery (Stanford Plastic Surgery).

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A Radical Procedure

The esophagus is the muscular tube that transfers food from your mouth to your stomach. To treat aggressive cancers of the esophagus, a surgeon will usually remove part or almost all of it.

“It’s a very radical procedure,” Lee told Healthline. “But it’s the only reasonable way of removing the tumor. When you do that, the connection between the mouth and the stomach is forever gone, in the absence of reconstruction.”

Lee explained that 40 or 50 years ago, patients would have to eat through a feeding tube that went directly to their stomach.

“Doctors would put a small hole, an opening, in their neck, so saliva and food could go from their mouth into a bag. It’s a very unpleasant way to live, but it treated the cancer,” he said.

A variety of surgeries have also been performed to try to restore the connection between the mouth and the stomach. One involves pulling the stomach from the abdomen up to the chest or the neck.

“It’s a gastric, or stomach, pull up. There are problems with that surgery. Sometimes it can’t possibly be done, particularly if the tumor involves the stomach," Lee explained. "The other problem is that the stomach doesn’t belong in your chest, so when you do that it creates a variety of problems for the patient, such as problems with indigestion and acid reflux into the mouth.”

A further complication is that performing the surgery involves cutting off the blood supply to the stomach; in some cases, this can cause the stomach to die—a “catastrophic complication,” in the words of Lee.

Another surgical option involves using a piece of the large intestine to connect the chest to the mouth; however, this surgery can also present problems.

“The large intestine, which is important to make stool, wasn’t supposed to be pulled up into your chest," said Lee. "The colon is not an ideal tube. The colon can have problems such as colon cancer, diverticulosis, or diverticulitis, which is an inflammation of the colon, and Crohn’s disease."

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A New Option for Esophageal Replacement

The third replacement option, which Lee performs with a highly collaborative team, uses the small intestine to restore continuity between the mouth and the stomach.

“You have 30-plus feet of bowels rung through your stomach and abdomen to absorb all the nutrients in food. I’m taking a segment of that long tube, and I’m basically doing surgical origami to bring that piece of intestine up through the chest to reconnect the remaining esophagus and mouth, and hooking it back down to the stomach again," he explained. "It’s like a piece of pipe, a conduit we are passing through to restore continuity. It’s a complicated procedure—it’s about choosing the proper segment of the small intestine that’s appropriate.”

The small intestine is much more suitable as a conduit than the large intestine because, like the name implies, it’s smaller. This makes it a better size match for the esophagus.

“The only downside,” Lee said, “is that you need to disconnect one of the blood vessels to the intestine in order to release it, so it can go up to the patient’s neck, and that blood vessel has to be reconnected to blood vessels in order to have a blood supply. That disconnection and reconnection of blood vessels is where the microsurgeon comes in. It’s been a very successful procedure for many patients."

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Leaving the Hospital in About a Week

After a successful surgery, most patients need to stay in the hospital for seven to 10 days.

“It’s a life-changing procedure. All of us take for granted the ability to eat and drink, and once that ability is taken away, it is amazing what patients are willing to give to be able to eat and drink again. The look on a patient’s face when they swallow that sip of water is amazing," Lee said.

So what does it feel like to be able to give a patient back his life?

“It’s the greatest feeling in the world," said Lee. "I went into plastic surgery because I enjoy restoring form and function. My colleague in France who did the face transplant said it best when he said, ‘The procedures we do in plastic surgery may not be life-saving, but they are certainly life-giving.' And for Hudson—who was at the end of his line in terms of his depressive symptoms—to be able to restore his ability to eat is definitely life-giving… To be a physician and be part of that as a plastic surgeon is an incredible feeling.”    

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‘Alive and Kicking’

And what are Hudson and his wife, Kathy, up to these days?

Speaking to Healthline on his mobile phone from a gourmet California market where he was doing some food shopping, Hudson recalled, “When they disconnected my esophagus, I had a colostomy bag on my neck. It was very bad for me. I began to lose a pound a day, going from 205 to 145 pounds."

"I had the transplant surgery last March, and without it, I wouldn’t be alive," he said. "I was in the hospital for five days. I could eat right away. When you haven’t eaten for six months it’s great. The first thing I ate was chicken noodle soup and mashed potatoes and gravy. Hospital food has a reputation for not being the greatest, but this stuff tasted awesome. I loved it.

"I said, ‘This is the greatest thing in the world.’ Now, I’m alive and kicking and getting out in the world and doing things. I can eat burritos and hot sauce. You name it, I can eat it.”