No obvious advantages for thoracoscopic two-stage oesophagectomy

Abstract

Thoracoscopically assisted Ivor-Lewis oesophagectomy potentially combines the pulmonary advantages of transhiatal oesophageal dissection, with the visibility and control permitted by thoracotomy. This study reviewed 17 patients who underwent this procedure with an intrathoracic anastomosis. Five patients required conversion to thoracotomy, four because of technical difficulties with the anastomosis. After operation 13 patients had radiological evidence of atelectasis, six developed a left pleural effusion and five had clinically significant pneumonia. Three patients developed an anastomotic leak, two of whom died giving an in-hospital mortality rate of 12 per cent. Median postoperative hospital stay was 12 days. Four patients developed benign anastomotic strictures requiring dilatation. The 1- and 2-year survival rates were 73 per cent (11 of 15 patients) and 63 per cent (five of eight) respectively. The use of minimal access techniques in this context does not appear to reduce the postoperative incidence of either pulmonary or anastomotic complications.

Surgical Treatment for Esophageal Cancer

“…Many have described the feasibility of the technique, and a few have reported an advantage over open surgery. However, initial results with the thoracoscopic approach did not show a real benefit over the open approach, in particular due to a high number of pulmonary complications [31,32,33,34,35,36,37]. …”

Multimodal Treatment for Cancer of the Esophagus

“…This procedure proved to be feasible and even superior to open surgery. Nevertheless, the irst outcomes using this approach were not signiicantly beter than those obtained with the open approach, mainly as a result of the great number of pulmonary complications [36][37][38]. However, a few medical research centers in Japan found a new stimulus.…”

Video-assisted thoracic surgery—The past, present status and the future

“…According to some reported series (Dexter et al, 1996;Law et al, 1997), the survival rate for patients with esophageal carcinoma undergoing VATS esophagectomy has results similar to those for patients undergoing transthoracic esophagectomy. However, some other series reported that the pulmonary complications cannot be effectively decreased by using VATS approach (Nagawa et al, 1994;Robertson et al, 1996;Gossot et al, 1995). Therefore the interest in VATS esophagectomy seems to decline throughout the USA and Europe, but is still actively tried in some series in Japan and Asia (Akaishi et al, 1996).…”