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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 that tests confirm the condition can be successfully treated with surgery","scope":"procedure","source":{"url":"https://www.plymouthhospitals.nhs.uk/display-pil/pil-oesophagectomy--4148","host":"plymouthhospitals.nhs.uk","quote":"Firstly there are tests to check that the condition you have can be successfully treated with surgery.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C2","text":"Check that assessments confirm you are well enough to undergo major surgery","scope":"procedure","source":{"url":"https://www.plymouthhospitals.nhs.uk/display-pil/pil-oesophagectomy--4148","host":"plymouthhospitals.nhs.uk","quote":"Secondly there are assessments to see if you are well enough to undergo major surgery.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C3","text":"Check that a consultant anesthetist gives you a surgical risk profile report and discusses it with you","scope":"procedure","source":{"url":"https://www.plymouthhospitals.nhs.uk/display-pil/pil-oesophagectomy--4148","host":"plymouthhospitals.nhs.uk","quote":"This is performed by a consultant anaesthetist who will produce, and discuss with you, a report detailing your risk profile for surgery.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C4","text":"Confirm the surgeon is trained and experienced in the exact procedure you are considering, not just in surgery generally","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Verify that the surgeon is trained and experienced in performing the procedure you are considering.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C5","text":"Ask for certification information and the name of the body that certified the surgical setting","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Ask for certification information and the name of the certifying body when assessing a surgical setting.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"An advert or information that guarantees complete success should raise concerns","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Any advert or information that guarantees complete success should 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 is.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"warning_signs":{"status":"ok","items":[{"id":"W1","text":"Chest 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incisions.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W4","text":"Fever","urgency":"contact_clinic","general":true,"source":{"url":"https://my.clevelandclinic.org/services/thoracic-surgery","host":"my.clevelandclinic.org","quote":"Keep an eye out for chest pain, shortness of breath, bleeding, fever or problems with your incisions.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"take_home":{"status":"ok","items":[{"id":"T1","text":"The home doctor needs the report describing the disease removed during surgery","document":"histopathology report","source":{"url":"https://www.plymouthhospitals.nhs.uk/display-pil/pil-living-well-after-your-oesophagectomy-4140/","host":"plymouthhospitals.nhs.uk","quote":"At this first appointment after your operation your surgeon will have the report from the histopathologist which will give a clearer picture of how the operation went and may enable the surgeon to tell you more about the stage of the disease removed.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"T2","text":"Ask for written details of the procedure before you leave the hospital","document":"written procedure details","source":{"url":"https://rcseng.ac.uk/patient-care/cosmetic-surgery/after-surgery/","host":"rcseng.ac.uk","quote":"After your surgery, before you leave the hospital, ask for written information about the procedure you've had.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T3","text":"Home doctor needs the dates for required blood tests and follow-up appointments","document":"written aftercare plan","source":{"url":"https://sbuhb.nhs.wales/about-us/individual-patient-commissioning/ipc-folder/advice-on-accessing-treatment-abroad","host":"sbuhb.nhs.wales","quote":"This should include any medication and doses, as well as any dates that blood tests and follow-up appointments must be carried out.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T4","text":"Home doctor needs the clinic's follow-up recommendations in a written discharge summary","document":"discharge summary","source":{"url":"https://sbuhb.nhs.wales/about-us/individual-patient-commissioning/ipc-folder/advice-on-accessing-treatment-abroad","host":"sbuhb.nhs.wales","quote":"When you have treatment abroad, you must ask the treatment provider for their follow-up recommendations documented within a written discharge summary in English.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T5","text":"Ask for copies of all prescriptions before you leave","document":"prescription copies","source":{"url":"https://travelhealthpro.org.uk/news/699/travelling-abroad-for-treatment","host":"travelhealthpro.org.uk","quote":"Remember to ask for copies of all your treatment records, including prescriptions, scans and x-rays before you 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