Minimally invasive esophagectomy for stage I and II esophageal cancer

To evaluate whether thoracoscopic and video-assisted dissections are appropriate modalities, we assessed the mortality, morbidity, and survival of patients who underwent a thoracoscopic esophagectomy for esophageal cancer.

Between November 1995 and December 2004, thoracoscopic and video-assisted esophagectomies were performed on 112 (72.7%) patients out of 154 who underwent surgical resection for thoracic and abdominal esophageal cancer. The histologic type of cancer was squamous cell carcinoma in 109 (97.4%) patients and adenocarcinoma in 3 (2.6%).

Intraoperative complications occurred in 4 (3.6%) patients: tracheal injury in 3 (2.7%) and azygos vein injury in 1 (0.8%). The 30-day mortality rate was 0.8%. Early postoperative complications occurred in 29 (25.9%) patients including the following: recurrent nerve palsy in 10 (8.9%), respiratory complication in 7 (6.3%), anastomotic leakage in 9 (8.0%) with major leakage requiring reanastomosis in 4 (3.6%) of these 9, and chylothorax in 3 (2.7%). Induction chemoradiotherapy, preoperative concomitant disease, and reconstruction using the colon did not increase morbidity. Port site recurrence occurred in 3 (2.7%) patients. The overall 5-year survival rate was 52%. For stage I disease, the 5-year survival rate of patients was 87.2%. In stage II disease, it was 70.2%.

Thoracoscopic and video-assisted esophagectomy are considered feasible and safe options for the treatment of esophageal cancer, but further investigation is necessary. The survival of patients with stage I and II disease is satisfactory at the present time.