Perhaps no other set of questions is more significant than those you ask of your tentative choice for a surgeon. Simply put, the best thoracic surgeons in the best teaching hospitals have an EC surgical survival rate which is many times better than the same surgery done by general surgeons in local hospitals. These statistics are overwhelming. Quite literally your life depends on the answers.

Assume that your lead doctor has put you in contact with an excellent teaching hospital and referred you to one of their best thoracic surgeons. You will want to ask this surgeon some rather pointed questions, if you can't get the answers in a less direct manner.

Surgeons who won't answer these types of questions, particularly those which deal with the surgeon's own record probably should be avoided. Similarly surgeons whose answers are forthright but indicate a relative lack of experience should also be avoided.

1. How frequently do you perform EC surgeries? What are your mortality and morbidity rates?
2. There are many forms of surgery for EC which are common. In addition there are a number of variations of these surgical procedures that resolve co-morbidity problems (etc.). It is best to have the doctor describe the specific surgery that is being considered for you. You will want to understand how many incisions will be made, where, and how the digestive track will be connected after surgery. The following lists some of the more common forms of EC surgery
• Colonic interposition
• Ivor Lewis procedure
• Minimally invasive esophogectomy [MIE]
• Trans hiatal esophogectomy [THE]
• Trans thoracic esophogectomy [TTE]
3. What type of surgery do you think I should have? Why do you think that this type of surgery is correct for me? What are the details of the surgery? How much of my digestive track will be removed? Where will the remainder of the digestive track be attached? How many incisions will I have and where?
4. Will I have chemotherapy and/or radiation along with surgery? Will they be before or after surgery? Where? When and why?
5. You may have questions about why such dramatic surgery is needed. If so ask the doctor why partial esophogectomy [equivalent to a breast lumpectomy] is/is not possible. Ask any questions you may have about minimally invasive surgery or ablation/lasers (etc.) for early EC and possibly questions you may have about using parts of the lower digestive track as a "pseudo" esophagus.
6. How will my co-morbidity, general health, age, vitality affect my surgery.
7. When I awaken, what machines, pumps, monitors, and tubes will I have attached to me? [This question may be handled by an assistant or a nurse.]
8. Will you or another doctor tend me in the hospital?
9. How long before I can expect to go home?
10. How will my pain be managed?
11. What tests will I have prior to surgery? Which ones may preclude surgery? When will I find out the results? What tests will I have after surgery?
12. How quickly can I expect to recover from
• Actual surgery?
• Incisions?
• Removal of supplemental feeding tubes?
• Adjust to my modified body?
13. After surgery, assuming that I have no long term complications, when and how often will I be seeing you?
14. Can you give me some idea about the risks of:
• Heart problems?
• Lung problems?
• Other organs?
• Leaks and fistulas?
• What happens if EC has spread, and it is discovered during surgery?
• Loss of bodily functions?
15. What do you expect my prognosis will be short term, in the intermediate term and in the very long term?
16. What questions do you think I should have asked but didn't?