Minimally invasive transhiatal and transthoracic esophagectomy

Standard esophagectomy requires either a laparotomy with transhiatal removal of the esophagus or a combination of laparotomy and thoracotomy. Currently, it still is associated with a high rate of morbidity and mortality. Complications leading to greater morbidity and mortality are rarely seen after minimally invasive surgery. The authors present their experience with 25 minimally invasive esophageal resections.

Between August 1st, 2003 and November 30th, 2005, the authors performed 25 minimally invasive esophageal resections for 4 woman and 21 men. Data were acquired prospectively.

In this series, a laparoscopic transhiatal approach was performed in 9 cases, a combined laparoscopic-thoracoscopic procedure in 12 cases, and laparoscopic creation of a gastric tube combined with thoracotomy in 4 cases. No conversion became necessary. The mean operation time was 165 min (range, 150-180 min) for the laparoscopic transhiatal approach and 300 min (range, 240-360 min) for both combination approaches. Using the combined laparoscopic-thoracoscopic procedure, 23 lymph nodes (range, 19-26 lymph nodes) were removed, and using the laparoscopic transhiatal approach, 14 lymph nodes (range, 12-17 lymph nodes) were removed. The median stay in the intensive care unit was 1.5 days (range, 1-22 days), and the overall postoperative stay was 10 days (range, 7-153 days). Two intraoperative complications and two cervical anastomotic leakages were observed. The 30-day mortality rate was 0%.

The findings demonstrate that laparoscopic transhiatal and combined laparoscopic/thoracoscopic esophagectomy are feasible and can be performed with low rates of morbidity and mortality. Due to an equal extent of lymph node dissection, there should be no difference in long-term survival between minimally invasive surgery and open surgery.