Thoracoscopic and laparoscopic esophagectomy: initial experience and outcomes

Area of Science:

• Surgical Oncology
• Gastroenterology
• Minimally Invasive Surgery

Background:

• Esophageal cancer surgery, while preferred, carries high risks.
• Minimally invasive techniques may reduce perioperative morbidity.
• This study evaluates a specific minimally invasive esophagectomy approach.

Purpose of the Study:

• To investigate the outcomes of a minimally invasive esophagectomy.
• To compare outcomes between open and hand-assisted laparoscopic abdominal mobilization.
• To assess the feasibility and safety of thoracoscopic esophageal mobilization.

Main Methods:

• Prospective data collection from 36 patients undergoing minimally invasive esophagectomy.
• A three-stage approach: thoracoscopic esophageal mobilization, open or hand-assisted laparoscopic gastric mobilization, and cervical anastomosis.
• Comparison between open abdominal (15 patients) and hand-assisted laparoscopic (21 patients) abdominal mobilization.

Main Results:

• Mean operating time: 263 minutes; median hospital stay: 16 days.
• In-hospital mortality: 5.5%; perioperative morbidity: 41%.
• Similar outcomes for open and hand-assisted laparoscopic approaches; hand-assisted showed shorter operating time and less blood loss. Four-year survival for invasive malignancy: 44%.

Conclusions:

• Minimally invasive esophagectomy with thoracoscopic mobilization yields outcomes comparable to open surgery.
• These minimally invasive approaches are feasible with acceptable perioperative morbidity.
• Continued application and data scrutiny of these techniques are recommended.