Complications following Video-Assisted Transhiatal Esophagectomy for Esophageal Cancer

Abstract

Background: The aim of the study was to evaluate the clinical safety and usefulness of esophageal dissection under laparoscopic monitoring during transhiatal esophagectomy for esophageal cancer. Patients and Methods: The study group of 115 patients included 102 men and 13 women. The mean age was 57 (range 32-79) years. Tumor histology showed a squamous cell carcinoma in 75% and an adenocarcinoma in 25% of cases. According to the American Joint Committee on Cancer classification, 3 patients were classified as stage I, 19 as stage IIA, 24 as stage IIB, 64 as stage III, and 5 as stage IVA. Mean operating time was 4.5 ± 1 h. Results: Ten significant intraoperative complications were observed (9 hemorrhages, 1 death). The mean blood loss was 900 (range 300-2,100) ml. Postoperative complications occurred in 61% of the patients; the most frequent were pulmonary complications (27%), recurrent laryngeal nerve injury (17.4%), anastomotic stricture (14%), and anastomotic leak (10.4%). Early re-laparotomy was performed in 6% of the patients. Hospital mortality rate was 9%. Mean hospital stay was 34 (range 5-64) days. Conclusion: Video-assisted transhiatal esophagectomy is a useful method, but does not allow a vision-guided removal of the upper esophagus. The method does not prevent or diminish the number of intra- and postoperative complications of esophageal resection.