Minimally invasive transhiatal esophagectomy: lessons learned

Area of Science:

• Gastroenterology
• Surgical Oncology
• Thoracic Surgery

Background:

• Minimally invasive esophagectomy (MIE) offers reduced morbidity compared to open procedures.
• The transhiatal approach is well-suited for MIE.
• This study reports institutional experience and lessons learned from MIE using the transhiatal technique.

Purpose of the Study:

• To evaluate the feasibility and outcomes of minimally invasive transhiatal esophagectomy (MITE).
• To identify complications and areas for technique refinement in MITE.

Main Methods:

• Retrospective analysis of patients undergoing MITE.
• Assessment of patient demographics, tumor pathology, operative details, postoperative course, and survival.
• Data collected included operative time, complications, length of stay, and follow-up outcomes.

Main Results:

• Eighteen patients underwent MITE (median age 69).
• Seventeen cases were for cancer (adenocarcinoma or squamous cell carcinoma), one for high-grade dysplasia.
• Zero 30-day mortality, but high rates of complications including respiratory issues (7/18) and recurrent laryngeal nerve injuries (10/18).
• Two anastomotic leaks and six cases of stenosis requiring dilatation were observed. Median hospital stay was 15 days.

Conclusions:

• Minimally invasive transhiatal esophagectomy (MITE) is a feasible technique with acceptable mortality.
• High rates of anastomotic stenosis prompted a switch to a semimechanical, side-to-side isoperistaltic anastomosis.
• High recurrent laryngeal nerve injury rates led to avoiding metal retractors at the tracheo-esophageal groove.