Laparoscopic esophagogastrectomy without thoracic or cervical access for adenocarcinoma of the gastroesophageal junction

Abstract

In selected cases of adenocarcinoma of the GE junction, laparoscopic esophagogastrectomy offers as good as or better results than open operation in our institution with extensive advance endoscopic and open experience. This study shows that laparoscopic esophagogastrectomy has potential to meet oncologic criteria of clearance and provide the benefits of minimally invasive surgery as well.

Minimally invasive oesophagectomy: current status and future direction

“…Nine case series [3,5,8,13,15,25,28,29,31] directly reported results on a purely minimally invasive approach to transthoracic oesophagectomy. Selected results from these series were as follows: median operation time 330 min (range = 220-413 min) (n = 9); median blood loss 279 ml (range = 65-700 ml) (n = 9); median incidence of anastomotic leak 5.6% (range = 0-40.0%) (n = 7); median incidence of respiratory complications 7.8% (range = 3.1-60.0%) (n = 9); median incidence of chylothorax 3.0% (range = 1.0-4.0%) (n = 9); median duration of ICU stay 1 day (range = 1-19 days) (n = 8); median duration of hospital stay 9 days (range = 7-14 days) (n = 9); median 30-day mortality 1.0% (range = 0-3%) (n = 9).…”

Minimally invasive esophagectomy for cancer: laparoscopic transhiatal procedure or thoracoscopy in prone position followed by laparoscopy?

“…Several minimally invasive approaches for esophagectomy have been described: thoracoscopy in prone position [5][6][7], thoracolaparoscopy [4,8,9], thoracoscopically assisted technique [10,11], videomediastinoscopic technique [12], endoscopic Ivor-Lewis technique [13][14][15], laparoscopic transhiatal technique [16][17][18], laparoscopic esophagogastrectomy [19][20], and laparoscopically assisted transhiatal technique [21]. The choice between these approaches is, to a degree, one of personal preference.…”

“…All the specimens were free of disease. The median number of mediastinal/periesophageal lymph nodes was 3 (range, 1-10) for group A and 4 (range, 2-13) for group B (NS), and the median number of celiac/perigastric lymph nodes was 11 (range, 2-31) for group A and 10 (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] for group B (NS). After a median follow-up period of 42.4 months (range, 2-84 months) for group A and 19.1 months (range, 1.5-34 months) for group B, 12 patients in group A died after a median period of 22 months (range, 2-55 months), and 7 patients in group B died after a median time of 15 months (range, 1.5-23 months).…”

Thoracoscopic esophagectomy in the prone position

“…Early results of this technique were disappointing, which may explain its poor uptake and relative unpopularity [28][29][30]. More recent non-randomised studies have associated it with a lower rate of major complications than open surgery [20][21][22][31][32][33][34][35][36][37] but a large systematic review has reiterated that evidence is still lacking to confirm any real benefit in terms of long-term outcome, safety, and oncological quality [38,39].…”

“…During PP the enhanced operative view is such that some surgeons have been able to operate without the use of one-lung ventilation via a double-lumen endotracheal tube [35,48]. This potentially avoids repeated deflation and reinflation of the lungs which cause the production of inflammatory mediators [71].…”