[Minimally Invasive Transthoracic Esophagectomy with a Standardized Technique: 10 Years of Experience]

Minimally invasive esophagectomy (MIE) has been shown to reduce postoperative morbidity. In our previously published initial experience, overall morbidity was 78%, severe morbidity 21%, and mortality 0%.

To describe the postoperative morbidity and mortality using our video assisted thoracoscopic surgery (VATS) MIE technique.

This was a retrospective cohort study based on a prospective database. Patients who had a VATS EMI in the semi-prone position for esophageal cancer between 2013 and 2023 were included. We used the definitions proposed by the Esophagectomy Complications Consensus Group (ECCG).

During the study period 66 VATS MIE (61% men, age 64 years) were performed. 82% of patients had comorbidities. Histology was squamous cell carcinoma in 34 patients (52%) and adenocarcinoma in 31 (45%). 65% of cases had neoadjuvant treatment. MIE was performed using the McKeown technique in 55 patients (83%). Overall postoperative morbidity was 68%, and severe morbidity (Clavien 3 or higher) was 16%. The main complications were respiratory in 24% and esophageal anastomotic leak in 38% of cases. The 30- and 90-day mortality rates were 1.5% and 3%. The median hospital stay was 20 days. Surgery was considered R0 in 57 (86%) patients. The average lymph node count was 27 nodes.

In 10 years of experience, a standardized minimally invasive esophagectomy technique has been performed in the semi-prone position. The main complications were respiratory and anastomotic leak. The rate of severe complications and postoperative mortality is low.