Early experience and lessons learned in a new minimally invasive esophagectomy program

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Minimally invasive esophagectomy (MIE) is increasingly adopted for esophageal cancer.
• MIE offers comparable oncologic outcomes to open surgery with patient benefits like reduced hospital stay and pain.
• Developing an MIE program requires substantial surgical skill development.

Purpose of the Study:

• To evaluate the outcomes and learning curve associated with establishing a minimally invasive esophagectomy program.
• To analyze the impact of evolving anastomotic techniques on patient outcomes.
• To assess the feasibility and safety of the Ivor Lewis approach in MIE.

Main Methods:

• The study employed a minimally invasive Ivor Lewis approach for esophagectomy.
• Abdominal phase included celiac lymphadenectomy and gastric tube creation.
• Thoracoscopic phase involved lymphadenectomy and anastomosis in left lateral decubitus.

Main Results:

• 52 patients underwent MIE between October 2011 and January 2015.
• Anastomotic techniques evolved, with the final technique showing a reduced leak rate of 4% compared to an overall rate of 14%.
• Median length of stay was 9 days, with adequate lymph node retrieval.

Conclusions:

• Establishing a MIE program involves a significant learning curve before achieving consistent results.
• Refining and mastering specific surgical techniques are crucial to realizing the full benefits of MIE.
• The study highlights the importance of technique evolution in improving MIE safety and efficacy.