Abstract
Background
Minimally invasive esophagectomy (MIE) is an evolving surgical alternative to traditional open esophagectomy. Despite considerable technical challenges, it was hypothesized that MIE could be performed effectively by surgeons experienced in open esophageal resection and advanced laparoscopic surgery. The authors report their experience with 25 patients who underwent MIE for esophageal disease.
Methods
A multidisciplinary esophageal cancer team evaluated all the patients enrolled in this institutional review board–approved retrospective review study. Over an 18-month period, 25 consecutive patients (22 men and 3 women; mean age, 62 years; range, 48–77 years) with resectable esophageal cancer underwent MIE. Six patients were treated with neoadjuvant chemoradiotherapy. The preoperative diagnoses were adenocarcinoma (64%, n = 16), high-grade dysplasia (20%, n = 5), and squamous cell cancer (16%, n = 4). The outcomes evaluated included operative course, hospital and intensive care unit lengths of stay, pathologic stage, morbidity, and mortality.
Results
Two patients required conversion to open esophagectomy. Operative mortality was 4% (n = 1). The mean operative time was 350 min (range, 300–480), and the average blood loss was 200 ml. The patients remained ventilated for a median of 12 h, and the median intensive care unit utilization was 1 day. The median hospital length of stay was 9 days (range, 6–33 days). Major complications occurred in 32% of the patients. The anastomotic leak rate was 12%. Minor pulmonary complications occurred in 32% and atrial fibrillation in 16% of the patients. An anastomotic stricture developed in 24% of all the patients. One patient showed a positive proximal margin in the final pathology results.
Conclusions
Minimally invasive esophagectomy is a technically challenging procedure that can be performed safely at the Virginia Piper Cancer Institute. Optimal results require appropriate patient selection and a multidisciplinary team experienced in the management of esophageal cancer.
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References
Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. New Engl J Med 346: 1128–1137
Branicki FJ, Law SY, Fok M, Poon R, Chu KM, Wong J (1998) Quality of life in patients with cancer of the esophagus and gastric cardia: a case for palliative resection. Arch Surg 133: 316–322
Briel JW, Tamhankar AP, Hagen JA, DeMeester SR, Johansson J, Choustoulakis E, Peters JH, Bremner CG, DeMeester TR (2004) Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg 198: 536–542
Enziger PC, Mayer RJ (2003) Medical progress: esophageal cancer. New Engl J Med 349: 2241–2252
Law S, Wong J (1999) Does lymphadenectomy add anything to the treatment of esophageal cancer? Adv Surg 33: 311–327
Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238: 486–495
Nguyen NT, Follette DM, Wolfe BM, Schneider PD, Roberts P, Goodnight JE (2000) Comparison of minimally invasive esophagectomy with transthoracic and transhiatal esophagectomy. Arch Surg 135: 920–925
Nguyen NT, Roberts P, Follette DM, Rivers R, Wolfe BM (2003) Thoracoscopic and laparoscopic esophagectomy for benign and malignant disease: lessons learned from 46 consecutive procedures. J Am Coll Surg 197: 902–913
Orringer MB, Marshall B, Iannettoni MD (1999) Transhiatal esophagectomy: clinical experience and refinements. Ann Surg 230: 392–400
Osugi H, Takemura M, Higashino N, Takada N, Lee S, Ueno M, Tanaka Y, Fukuhara K, Hashimoto Y, Fujiwara Y, Kinoshita H (2003) Learning curve of video-assisted thoracoscopic esophagetomy and extensive lymphadenectomy for squamous cell cancer of the thoracic esophagus and results. Surg Endosc 17: 515–519
Schuchert MJ, Luketich JD, Fernando HC (2004) Complications of minimally invasive esophagectomy. Semin Thorac Cardiovasc Surg 16: 133–141
Shiozaki H, Imamoto H, Shigeoka H, Imano M, Yano M (2003) Minimally invasive esophagectomy with 10 cm thoracotomy assisted thoracoscopy for the thoracic esophageal cancer. Gan to Kagaku Ryoho 30: 923–928
Acknowlegments
The authors thank Dr. Timothy Sielaff for his help with this project.
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Collins, G., Johnson, E., Kroshus, T. et al. Experience with minimally invasive esophagectomy. Surg Endosc 20, 298–301 (2006). https://doi.org/10.1007/s00464-005-0093-x
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DOI: https://doi.org/10.1007/s00464-005-0093-x