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Later with adjuvant therapy, slow recovery, or heavy physical work."},"complication_rate_pct":{"min":40,"max":60,"unit":"percent","qualifier":"Any complication within 30 days, including arrhythmias and pneumonia. Severity varies with fitness and center."},"contraindications":["Metastatic disease or unresectable invasion of aorta or trachea","Severe cardiopulmonary disease making major surgery prohibitive","Poor performance status or severe frailty","Severe uncorrected malnutrition (relative; usually optimized first)","Uncontrolled sepsis, or severe liver disease with portal hypertension (relative)","Prior gastric surgery or radiation affecting the stomach conduit (relative)"],"days_in_clinic":{"min":7,"max":14,"unit":"nights","qualifier":"Counted from surgery day, including brief ICU/HDU monitoring. 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Shorter without neoadjuvant therapy; surgery usually follows it by several weeks."}},{"code":"surgery_and_early_recovery","label":"Hospital stay with early walking and breathing exercises","after":{"min":0,"max":0,"unit":"days","qualifier":"Starts on surgery day; discharge usually 7-14 days later."}},{"code":"oral_diet_progression","label":"Staged return from nil by mouth or feeding tube to small oral meals","after":{"min":3,"max":14,"unit":"days","qualifier":"After surgery: timing depends on surgeon protocol and leak assessment; jejunostomy feeding may continue after discharge."}},{"code":"first_review","label":"First planned postoperative review with pathology discussion","after":{"min":7,"max":21,"unit":"days","qualifier":"After hospital discharge."}},{"code":"nutrition_oncology_review","label":"Review of nutrition, swallowing and adjuvant treatment planning","after":{"min":42,"max":90,"unit":"days","qualifier":"After surgery; adjuvant therapy depends on stage and pathology."}}],"qualifier":"Plan for uncomplicated cases; timing varies with neoadjuvant therapy, pathology and recovery."},"success":{"metric":"Complete tumor removal with negative margins (R0 resection)","value":92,"unit":"percent","horizon":"Final pathology after surgery","population":"Adults with resectable distal esophageal or GE-junction cancer, usually after neoadjuvant therapy","evidence_status":"limited"},"techniques":[{"name":"Minimally invasive Ivor Lewis esophagectomy (laparoscopic abdomen, thoracoscopic right chest) with gastric conduit and intrathoracic anastomosis","suits_whom":"Resectable distal esophageal or GEJ cancer in patients fit for one-lung ventilation, treated at experienced centers.","recovery":"Hospital stay about 7-14 nights; walking within the first days; ordinary diet over weeks."},{"name":"Open Ivor Lewis esophagectomy","suits_whom":"Larger or more complex tumors, prior surgery, or when minimally invasive surgery is not feasible or conversion is needed.","recovery":"Often more pain and a longer recovery than the minimally invasive approach."},{"name":"Robotic-assisted Ivor Lewis esophagectomy","suits_whom":"Suitable patients at centers with robotic expertise.","recovery":"Broadly similar to minimally invasive surgery."},{"name":"McKeown three-field or transhiatal esophagectomy","suits_whom":"Mid or upper tumors (McKeown), or selected patients avoiding thoracotomy (transhiatal); neck anastomosis.","recovery":"Different risk profile, including more recurrent laryngeal nerve injury and neck anastomotic leak."}],"treatment_conditions":["inpatient"],"treatment_duration_hours":{"min":5,"max":8,"unit":"hours","qualifier":"Operating time with reconstruction; longer if converted to open surgery or findings are complex."},"initial_assessment_documents":["Endoscopy report with biopsy pathology","Staging CT scan of chest and abdomen","PET-CT report","Endoscopic ultrasound report (if available)","Neoadjuvant chemoradiotherapy records (if available)","Recent cardiac and lung function tests"],"travel_trips":{"min":1,"max":2,"one_trip_possible":true,"qualifier":"Single operation; stay about 4-6 weeks including hospital. Second trip possible if neoadjuvant therapy is done at home."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Check the qualifications of the clinician performing the procedure and the facility’s credentials, because complication risk depends on both","scope":"treatment_abroad","source":{"url":"https://wwwnc.cdc.gov/travel/page/medical-tourism","host":"wwwnc.cdc.gov","quote":"Check the qualifications of the clinician who will be doing the procedure and the credentials of the facility where the procedure will be done.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"C2","text":"Check how communication with the clinician and caregivers will be handled if language differs","scope":"treatment_abroad","source":{"url":"https://wwwnc.cdc.gov/travel/page/medical-tourism","host":"wwwnc.cdc.gov","quote":"If you go to a country where you do not speak the language, determine ahead of time how you will communicate with your clinician and others who will be 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raise concerns.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F2","text":"Forceful persuasion or cheap, time-limited offers pushing you into a quick decision","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Don’t be pressured into quick decisions either through forceful persuasion or cheap, time limited offers.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F3","text":"A price that sounds too good to be true probably is","scope":"treatment_abroad","source":{"url":"https://www.plasticsurgery.org/news/articles/will-economic-uncertainty-drive-more-patients-overseas-for-plastic-surgery-what-to-consider-and-how-to-stretch-your-dollar-back-home","host":"plasticsurgery.org","quote":"If the price sounds too good to be true, it probably 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