Medical doctor

Niamh P., a former program coordinator at the University of Pittsburgh School of Medicine, struggled with acid reflux for years. Despite taking medicine to control her heartburn and avoiding certain foods, the problem persisted. When she started having problems swallowing in late 2019, her primary care doctor, Yaqin Xia, MD, recommended an endoscopy.

The endoscopy showed Niamh had Barrett’s esophagus — a precancerous condition caused by repeated exposure to stomach acid. But her gastroenterologist, Kevin McGrath, MD, also spotted a suspicious area near her stomach and called her back for a second endoscopy and biopsy.

“It was esophageal cancer,” says Niamh, 56. “He told me I needed surgery — and sooner, rather than later.”

She and her husband, Michael, began searching for the best available treatment. After researching and talking to people they knew in the medical community, she made an appointment with Ryan Levy, MD, chief of thoracic surgery at UPMC Passavant (pictured below).

Combining Technology and Surgical Expertise

At UPMC Passavant–McCandless, highly skilled thoracic surgeons are using leading-edge technology to perform delicate, minimally invasive, and life-saving surgery.

The standard treatment for esophageal cancer is an esophagectomy — removal of the esophagus and uppermost part of the stomach. It is the most complex thoracic oncologic reconstruction that is done, according to Dr. Levy.

Surgeons at UPMC pioneered the next level of treatment with minimally invasive esophagectomy, which results in:

  • Fewer complications.
  • Less pain.
  • A shorter hospital stay than a traditional open procedure.

“It’s a very unique situation,” says Dr. Levy. “We do more esophagectomies a year at UPMC Passavant than many major academic hospitals. It’s a testament to the team we’ve built — and the results.”

Life-Saving Operation

Although Niamh was already aware of the surgery required, she appreciated the time Dr. Levy took to explain the procedure, the complexity, and the risks involved.

“He was very clear about the course of action needed. It would be life-changing, but life-saving, surgery,” Niamh says. “There was no other alternative. I had to accept it, trust him, and have faith that everything would go OK — and Dr. Levy delivered.”

In mid-January 2020 — just one month after her cancer diagnosis — Niamh underwent a minimally invasive esophagectomy performed by Dr. Levy and assisted by Nicholas Baker, MD, another thoracic surgeon at UPMC Passavant (pictured at left). An ear, nose, and throat specialist also was present to monitor the nerves in Niamh’s neck during surgery.

Using a dozen dime-sized incisions to access the cavity in her abdomen, chest, and neck, Dr. Levy removed 75% of Niamh’s esophagus, 25% of her stomach, and 37 lymph nodes. He then rebuilt her esophagus with the remaining stomach tissue (leaving a small reservoir to process food) and reconnected the “new” esophagus in her neck area. The entire surgery took about 10 hours.

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Postoperative Care

Niamh spent the next several days in the intensive care unit (ICU) at UPMC Passavant, where she was cared for by a pulmonary critical care team of experienced doctors, nurses, respiratory therapists, physical therapists, and nutritionists.

“With an esophagectomy, every detail matters,” Dr. Levy explains. “This team understands the needs of our patients. It’s why we have such good results.”

According to Niamh, her postoperative care was difficult. But she was thankful to have such wonderful support from Dr. Levy and his team.

“The ICU staff was fantastic. They had me up and walking the day after surgery. They took care of my every need.”

Additional Treatment

Niamh meets with Dr. Levy and Dr. Baker at UPMC Passavant.

Initially, the preoperative PET scans and CT scans indicated Niamh’s cancer had been caught at stage I. A closer look at the 37 lymph nodes Dr. Levy removed showed one to be cancerous — indicating a stage III cancer. That meant she would need chemotherapy.

“Her case illustrates why it’s important to do an aggressive lymph node dissection,” says Dr. Levy. “Without it, she may have ended up with the wrong treatment plan.”

A month and a half after her surgery, Niamh began six months of chemotherapy treatments at UPMC Hillman Cancer Center. She’ll have follow-up CT scans every four months for the first three years, then every six months in years four and five. Her most recent scan showed no sign of cancer.

“So far, everything looks good,” says Dr. Levy. “Her long-term prognosis is very good.”

The Road to Recovery

According to Niamh, her ongoing recovery has been encouraging. She had to relearn how to swallow and adapt to a smaller stomach — eating smaller meals and avoiding high-fat foods. Her voice is growing stronger, she has started to sing again, and her Irish lilt has returned.

Seven months after the surgery, Niamh’s daughter smiled and said, “Today is the first day you sound like yourself.”

“I can’t say enough good things about Dr. Levy. I feel very lucky to have had him as my surgeon,” says Niamh. “He and his team saved my life, and I’m very grateful.”

Learn more about the esophageal and lung surgery services offered at UPMC Passavant.

About Pulmonology

For people with breathing problems, allergies, and other lung conditions or diseases, the UPMC Division of Pulmonary, Allergy, and Critical Care Medicine can help. Our Comprehensive Lung Center provides cutting-edge diagnosis and treatment for a variety of diseases. We also operate specialty centers for cystic fibrosis, asthma, COPD and emphysema, pulmonary hypertension, lung transplants, interstitial lung diseases, and sleep disorders. U.S. News & World Report ranks UPMC Presbyterian Shadyside as one of the top hospitals nationwide for pulmonary care.

About UPMC Hillman Cancer Center

UPMC Hillman Cancer Center provides world-class cancer care, from diagnosis to treatment, to help you in your cancer battle. We are the only comprehensive cancer center in our region, as designated by the National Cancer Institute. We have more than 70 locations throughout Pennsylvania, Ohio, New York, and Maryland, with more than 200 oncologists. Our internationally renowned research team is striving to find new advances in prevention, detection, and treatment.