Updated experiences with minimally invasive McKeown esophagectomy for esophageal cancer

Abstract

Aim: To update our experiences with minimally invasive McKeown esophagectomy for esophageal cancer.

Methods: We retrospectively reviewed the medical records of 445 consecutive patients who underwent minimally invasive McKeown esophagectomy between January 2009 and July 2015 at the Cancer Hospital of Chinese Academy of Medical Sciences and used 103 patients who underwent open McKeown esophagectomy in the same period as controls. Among 375 patients who underwent total minimally invasive McKeown esophagectomy, 180 in the early period were chosen for the study of learning curve of total minimally invasive McKeown esophagectomy. These 180 minimally invasive McKeown esophagectomies performed by five surgeons were divided into three groups according to time sequence as group 1 (n = 60), group 2 (n = 60) and group 3 (n = 60).

Results: Patients who underwent total minimally invasive McKeown esophagectomy had significantly less intraoperative blood loss than patients who underwent hybrid minimally invasive McKeown esophagectomy or open McKeown esophagectomy (100 mL vs 300 mL vs 200 mL, P = 0.001). However, there were no significant differences in operation time, number of harvested lymph nodes, or postoperative morbidity including incidence of pulmonary complication and anastomotic leak between total minimally invasive McKeown esophagectomy, hybrid minimally invasive McKeown esophagectomy and open McKeown esophagectomy groups. There were no significant differences in 5-year survival between these three groups (60.5% vs 47.9% vs 35.6%, P = 0.735). Patients in group 1 had significantly longer duration of operation than those in groups 2 and 3. There were no significant differences in intraoperative blood loss, number of harvested lymph nodes, or postoperative morbidity including incidence of pulmonary complication and anastomotic leak between groups 1, 2 and 3.

Conclusion: Total minimally invasive McKeown esophagectomy was associated with reduced intraoperative blood loss and comparable short term and long term survival compared with hybrid minimally invasive McKeown esophagectomy or open Mckeown esophagectomy. At least 12 cases are needed to master total minimally invasive McKeown esophagectomy in a high volume center.

Keywords: Esophagectomy; Learning curve; Minimally invasive; Outcome; Surgical procedures.

Figure 1

Kaplan-Meier analysis of three types of operation. There were no significant differences in 5-yr survival between total minimally invasive McKeown esophagectomy, hybrid minimally invasive McKeown esophagectomy and open Mckeown esophagectomy (60.3% vs 47.9% vs 35.3%, P = 0.579). MIME: Minimally invasive McKeown esophagectomy.

Figure 2

Learning curve of total minimally invasive McKeown esophagectomy of five surgeons. Durations of operation for five surgeons in three periods are as follows: surgeon A (340 ± 57 min vs 395 ± 105 min vs 310 ± 61 min, P = 0.037); surgeon B (413 ± 109 min vs 387 ± 110 min vs 272 ± 58 min, P = 0.002); surgeon C (418 ± 65 min vs 339 ± 116 min vs 367 ± 74 min, P = 0.098); surgeon D (383 ± 105 min vs 359 ± 82 min vs 317 ± 116 min, P = 0.287); and surgeon E (355 ± 123 min vs 337 ± 77 min vs 320 ± 159 min, P = 0.789).