[Thoracoscopic techniques in treatment of esophageal diseases]

Some malignant and benign diseases of the esophagus are generally treated through a thoracotomic approach. While this may be justified in the curative treatment of cancer, thoracotomy may be avoided for benign diseases if good functional results can be obtained through a minimally invasive approach. Long-term results with careful clinical and manometric monitoring of patients operated on for epiphrenic diverticula have to be considered to define the possible role of thoracoscopic approach to this disease since a laparoscopic approach, which includes transhiatal diverticulectomy, myotomy, and fundoplication, seems to have excellent results. As for leiomyomas thoracoscopy represents the first choice approach since it allows a complete removal of the benign tumor with a limited access. In case of malignant diseases, thoracoscopic esophagectomy has in our opinion few indications. Extent of lymphnodal dissection appears to be the major limiting factor of the technique. Moreover, high-risk patients need anyway a double-lumen intubation and a prolonged single-lung ventilation. Modifications of respiratory function after thoracoscopy have to be compared with those occurring after thoracotomy and after transhiatal esophagectomy. Studies on lymphadenectomy and on respiratory physiopathology will help in define a possible role of this approach.