Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Jul;256(1):95-103.
doi: 10.1097/SLA.0b013e3182590603.

Outcomes after minimally invasive esophagectomy: review of over 1000 patients

James D Luketich  1 , Arjun Pennathur, Omar Awais, Ryan M Levy, Samuel Keeley, Manisha Shende, Neil A Christie, Benny Weksler, Rodney J Landreneau, Ghulam Abbas, Matthew J Schuchert, Katie S Nason
Affiliations

Outcomes after minimally invasive esophagectomy: review of over 1000 patients

James D Luketich et al. Ann Surg. 2012 Jul.

Abstract

Background: Esophagectomy is a complex operation and is associated with significant morbidity and mortality. In an attempt to lower morbidity, we have adopted a minimally invasive approach to esophagectomy.

Objectives: Our primary objective was to evaluate the outcomes of minimally invasive esophagectomy (MIE) in a large group of patients. Our secondary objective was to compare the modified McKeown minimally invasive approach (videothoracoscopic surgery, laparoscopy, neck anastomosis [MIE-neck]) with our current approach, a modified Ivor Lewis approach (laparoscopy, videothoracoscopic surgery, chest anastomosis [MIE-chest]).

Methods: We reviewed 1033 consecutive patients undergoing MIE. Elective operation was performed on 1011 patients; 22 patients with nonelective operations were excluded. Patients were stratified by surgical approach and perioperative outcomes analyzed. The primary endpoint studied was 30-day mortality.

Results: The MIE-neck was performed in 481 (48%) and MIE-Ivor Lewis in 530 (52%). Patients undergoing MIE-Ivor Lewis were operated in the current era. The median number of lymph nodes resected was 21. The operative mortality was 1.68%. Median length of stay (8 days) and ICU stay (2 days) were similar between the 2 approaches. Mortality rate was 0.9%, and recurrent nerve injury was less frequent in the Ivor Lewis MIE group (P < 0.001).

Conclusions: MIE in our center resulted in acceptable lymph node resection, postoperative outcomes, and low mortality using either an MIE-neck or an MIE-chest approach. The MIE Ivor Lewis approach was associated with reduced recurrent laryngeal nerve injury and mortality of 0.9% and is now our preferred approach. Minimally invasive esophagectomy can be performed safely, with good results in an experienced center.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Schematic representation of construction of the gastric conduit. Reproduced with permission from the UPMC Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
FIGURE 2
FIGURE 2
Schematic representation of the construction of minimally invasive Ivor Lewis anastomosis. Reproduced with permission from the UPMC Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
FIGURE 3
FIGURE 3
Kaplan–Meier plot of the estimated overall survival of patients who did not receive induction therapy, stratified by stage.
FIGURE 4
FIGURE 4
The rise in minimally invasive esophagectomy publications in United States National Library of Medicine service, PubMed.
See this image and copyright information in PMC

Comment in

References

    1. Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med. 2003;349:2241–2252. - PubMed
    1. Pennathur A, Luketich JD. Resection for esophageal cancer: strategies for optimal management. Ann Thorac Surg. 2008;85:S751–S756. - PubMed
    1. Pennathur A, Farkas A, Krasinskas AM, et al. Esophagectomy for T1 esophageal cancer: outcomes in 100 patients and implications for endoscopic therapy. Ann Thorac Surg. 2009;87:1048–1054. Discussion 1054–1055. - PMC - PubMed
    1. Birkmeyer JD, Siewers AE, Finlayson EVA, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–1137. - PubMed
    1. Luketich JD, Alvelo-Rivera M, Buenaventura PO, et al. Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg. 2003;238:486–494. Discussion 494–495. - PMC - PubMed