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. 2003 Oct;238(4):486-94; discussion 494-5.
doi: 10.1097/01.sla.0000089858.40725.68.

Minimally invasive esophagectomy: outcomes in 222 patients

James D Luketich  1 , Miguel Alvelo-Rivera, Percival O Buenaventura, Neil A Christie, James S McCaughan, Virginia R Litle, Philip R Schauer, John M Close, Hiran C Fernando
Affiliations

Minimally invasive esophagectomy: outcomes in 222 patients

James D Luketich et al. Ann Surg. 2003 Oct.

Abstract

Objective: To assess our outcomes after minimally invasive esophagectomy (MIE).

Summary background data: Esophagectomy has traditionally been performed by open methods. Results from most series include mortality rates in excess of 5% and hospital stays frequently greater than 10 days. MIE has the potential to improve these results, but only a few small series have been reported. This report summarizes our experience of 222 cases.

Methods: From 1996 to 2002, MIE was performed in 222 patients. Indications for operation included high-grade dysplasia (n = 47) and cancer (n = 175). Neoadjuvant chemotherapy was used in 78 (35.1%) and radiation in 36 (16.2%). Initially, a laparoscopic transhiatal approach was used (n = 8), but subsequently our approach evolved to include thoracoscopic mobilization (n = 214).

Results: There were 186 men and 36 women. Median age was 66.5 years (range, 39-89). Nonemergent conversion to open procedure was required in 16 patients (7.2%). MIE was successfully completed in 206 (92.8%) patients. The median intensive care unit stay was 1 day (range, 1-30); hospital stay was 7 days (range, 3-75). Operative mortality was 1.4% (n = 3). Anastomotic leak rate was 11.7% (n = 26). At a mean follow-up of 19 months (range, 1-68), quality of life scores were similar to preoperative values and population norms. Stage specific survival was similar to open series.

Conclusions: MIE offers results as good as or better than open operation in our center with extensive minimally invasive and open experience. In this single institution experience, we observed a lower mortality rate (1.4%) and shorter hospital stay (7 days) than most open series. Given these results, we are now developing an intergroup trial (ECOG 2202) to assess MIE in a multicenter setting.

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Figures

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FIGURE 1. Video-assisted thoracoscopic surgical port sites.
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FIGURE 2. Penrose drain around thoracic esophagus.
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FIGURE 3. Abdominal port sites for laparoscopy.
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FIGURE 4. Laparoscopic pyloroplasty.
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FIGURE 5. Laparoscopic gastric tubularization.
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FIGURE 6. Completed reconstruction using gastric tube.
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FIGURE 7. Kaplan-Meier Survival Curve after MIE based on cancer stage
See this image and copyright information in PMC

References

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