Minimally Invasive Esophagectomy for Esophageal Cancer: The First Experience from Pakistan

Abstract

Background. Two common procedures for esophageal resection are Ivor Lewis esophagectomy and transhiatal esophagectomy. Both procedures have high morbidity rates of 20–46%. Minimally invasive esophagectomy has been introduced to decrease morbidity. We report initial experience of MIE to determine the morbidity and mortality associated with this procedure during learning phase. Material and Methods. Patients undergoing MIE at our institute from January 2011 to May 2013 were reviewed. Record was kept for any morbidity and mortality. Descriptive statistics were presented as frequencies and continuous variables were presented as median. Survival analysis was performed using Kaplan Meier curves. Results. We performed 51 minimally invasive esophagectomies. Perioperative morbidity was in 16 (31.37%) patients. There were 3 (5.88%) anastomotic leaks. We encountered 1 respiratory complication. Reexploration was required in 3 (5.88%) patients. Median operative time was 375 minutes. Median hospital stay was 10 days. The most frequent long-term morbidity was anastomotic narrowing observed in 5 (9.88%) patients. There were no perioperative mortalities. Our mean overall survival was 37.66 months (95% confidence interval 33.75 to 41.56 months). Mean disease-free survival was 24.43 months (95% CI 21.26 to 27.60 months). Conclusion. Minimally invasive esophagectomy, when performed in the learning phase, has acceptable morbidity and mortality.

Morbidity analysis in minimally invasive esophagectomy for oesophageal cancer versus conventional over the last 10 years, a single institution experience

“…The median length of hospital stay (median 9 days) is comparable or less than most of the series but without significant difference between groups. [ 9 12 16 22 ] Larger series by Schoppmann et al . (MIE 12 vs. OE 24) and Kauppi et al .…”

“…Our institute being the largest cancer centre of the country has also seen a shift from conventional to minimally invasive techniques for resectable oesophageal cancer over the past decade. [ 16 ] Moreover, during the same period our surgical oncology program has evolved into a high volume centre for the management of this disease. With the start of our first minimally invasive hybrid esophagectomy in 2011, it has grown into a standard treatment modality over recent few years, limiting the conventional open approach mainly for emergency esophagectomies.…”