En bloc and standard esophagectomies by thoracoscopy

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Subtotal esophagectomy is a complex procedure for esophageal cancer and caustic stenosis.
• Traditional thoracotomy carries significant morbidity.
• Thoracoscopy offers a minimally invasive alternative, but its feasibility for extensive resections requires evaluation.

Purpose of the Study:

• To evaluate the feasibility and outcomes of subtotal esophagectomy performed via right thoracoscopy.
• To compare thoracoscopic esophagectomy with traditional thoracotomy in terms of extent of resection and complications.
• To assess the oncologic results of thoracoscopic esophagectomy for esophageal cancer.

Main Methods:

• Right thoracoscopic subtotal esophagectomy was attempted in 13 patients (10 with cancer, 3 with stenosis).
• Procedures were converted to thoracotomy in 2 cases due to ventilation issues or vascular injury.
• Esophageal cancer patients underwent en bloc resection with lymph node clearance or standard resection.

Main Results:

• Ten esophagectomies were completed thoracoscopically, including seven en bloc resections with lymph node dissection.
• Postoperative complications included one death (hepatic failure), pneumonitis, and chest wall discomfort.
• Six of seven discharged cancer patients survived up to 20 months post-surgery, with five disease-free.

Conclusions:

• Thoracoscopic subtotal esophagectomy can achieve extensive resections similar to thoracotomy.
• Management of intraoperative injuries may be more challenging with thoracoscopy.
• Standard complications of thoracic surgery can occur following thoracoscopic procedures.