Laparoscopic esophagectomy in the palliative treatment of advanced esophageal cancer after radiochemotherapy

Abstract

The laparoscopic approach seems to be effective for the palliative treatment of advanced esophageal cancer. Further trials will be necessary to evaluate the advantages of this technique.

Minimally Invasive Esophagectomy

“…To the best of our knowledge, very few series have reported a longer follow-up period than ours: Del Genio et al, 26 at a mean follow-up of 20.2 months (range: 10 to 40 mo), reported an incidence of mortality of 31.6%; Avital et al 28 recorded an average follow-up of 30 months (range: 12 to 48 mo), an overall survival of 61%, and a disease-free survival of 39%; Kent and coworkers, 45 in a reanalysis of the dataset of the 222 patients who underwent minimally invasive esophagectomy, demonstrated 1-year, 3-year, and 5-year survivals of 69%, 45%, and 36%, respectively; Leibman et al 32 recorded a median follow-up of 32 months (range: 2 to 55 mo), with 60% of the patients developing recurrence of cancer after the surgery, the median time to recurrence being 11 months, and the overall median survival, 32 months (range: 1 to 46 mo); more recently, Smithers et al 46 recorded a inhospital operative mortality rate of 2.6% for the open approach, 2.2% for the thoracoscopic-assisted group, no deaths in the total minimally invasive esophagectomy (MIE) group, and no difference in the time to recurrence between the 3 groups for patients with invasive cancer; this study showed the overall survival to be 24%, that of the total MIE group to be 25%, and the 3-year and 5-year survival rates to be 30% and 16%, respectively, for the overall group, and 33% and 22%, respectively, for the ng total MIE group.…”

“…Subsequently, several authors have demonstrated the feasibility and safety of the laparoscopic approach to esophageal cancer. [26][27][28][29][30][31][32] In contrast, no advantages were recorded for the application of thoracoscopic techniques. 16,24,33,34 Although laparoscopic surgery for benign esophageal disease has met with widespread acceptance, minimally invasive esophagectomy did not meet with the same approval, on the ground of malignant disease.…”

“…[26][27][28][29][30][31][32]44 In addition to the known benefits of laparoscopic procedures on postoperative resumption, we recognized an oncologic outcome comparable with that obtained through open surgery: a mean overall survival of 21 ± 14.8 months ( ± SD), a median of 19 months, a range of 2 to 46 months, and a proportion of cumulative overall survival of 84.0% at 12 months, 61.3% at 24 months, and 51.0% at 36 months.…”

Comparison of esophagectomy with and without thoracotomy in a low-resource tertiary care center in a developing country

“…Looking across studies that used minimally invasive esophageal mobilization for esophagectomy, average duration of thoracoscopy part varied between 104–226 min, and average hospital stay was between 8 and 26 days 9,12–21 . Thirty‐day mortality rate varied between 0% and 13.6%.…”