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"Dr. Arya wanted me to be fully informed about both options when I made my decision," Thomas says. "He gave me the facts, arranged for me to consult with Dr. Yun and allowed me to make a well-informed decision." Thomas saw Dr. Yun in early July 2015, shortly after his discharge from the Hospital. "The traditional technique for esophagogastric cancer removal is more invasive than ESD, as it requires an incision and takes wider margins, meaning we remove part of the stomach and part of the lower end of the esophagus," Dr. Yun says. "The advantage of this approach over ESD is that we can also remove some of the lymph nodes and examine them for the spread of cancer." After considering both options, Thomas opted for ESD, and Dr. Arya scheduled the procedure for August 5, 2015. SURGERY WITH A SCOPE When Thomas arrived at the Hospital for his procedure, he felt restless but also reassured. "I was a little nervous, but I'd been through enough already to know that I was in good hands," he says. With Thomas under general anesthesia, Dr. Arya and an assistant guided a camera-outfitted endoscope down his throat to the esophagogastric junction, which they could view on a monitor. After injecting a solution to raise the tumor and make it more accessible, Dr. Arya used special surgical instruments to detach it from the surrounding tissue. "We spent a lot of time controlling bleeding," Dr. Arya says. "It was a small field in which to work, so even the slightest amount of blood could potentially obscure our vision. The tight space and inability to have hands in it added to the challenge, but everything went smoothly." A little more than three hours after the surgery began, Thomas woke up in a recovery room. "When Dr. Arya came to see me, he leaned down, put his arm around my shoulders and told me the procedure went fine," Thomas says. "I felt that everything would be okay." SO FAR, SO GOOD Thomas spent two days recovering at the Hospital, where he had no trouble keeping his spirits up. "The nurses were so kind and competent," he says. "They were humorous, upbeat and answered all of my questions." The final pathology results from Thomas' procedure indicated that the tissue that had surrounded the tumor was free of cancer. This good news and the fact that Thomas' preoperative imaging and exams showed no signs of the cancer spreading made Dr. Arya confident that lymph nodes were not involved. To be certain, he referred Thomas for a post-surgical oncology consultation. The oncologist opted not to offer chemotherapy given the complete resection of the tumor. Diagnosing and removing the cancer at an early stage was the key to being able to move ahead without additional therapy. An annual positron emission tomography (PET) scan and endoscopic exam help Dr. Arya monitor Thomas for signs of a cancer recurrence. "Surveillance and follow-up is an essential part of this," Dr. Arya says. "Once a patient makes it five years cancer-free, the risk for recurrence is significantly diminished." Two years into that five-year timeframe, Thomas has not experienced signs of the cancer returning. He has fully recuperated and is back in the gym for regular workouts. He credits his recovery to Dr. Arya, the Hospital staff, and the prayers of his church congregation. Now that he and Sheila have reached their golden anniversary, he is looking forward to more milestones with her. "We're still in love, and we're still negotiating life's twists," Thomas says. "I'm grateful to have that opportunity." P H Y S I C I A N RE F E R R A L / / 718 . 49 9. C A RE 15