Outcomes After Minimally Invasive Esophagectomy

Abstract

Background Esophagectomy is a complex operation and is associated with significant morbidity and mortality. In an attempt to lower morbidity, we have adopted a minimally invasive approach to esophagectomy. Objectives Our primary objective was to evaluate the outcomes of minimally invasive esophagectomy (MIE) in a large group of patients. Our secondary objective was to compare the modified McKeown minimally invasive approach (videothoracoscopic surgery, laparoscopy, neck anastomosis [MIE-neck]) with our current approach, a modified Ivor Lewis approach (laparoscopy, videothoracoscopic surgery, chest anastomosis [MIE-chest]). Methods We reviewed 1033 consecutive patients undergoing MIE. Elective operation was performed on 1011 patients; 22 patients with nonelective operations were excluded. Patients were stratified by surgical approach and perioperative outcomes analyzed. The primary endpoint studied was 30-day mortality. Results The MIE-neck was performed in 481 (48%) and MIE-Ivor Lewis in 530 (52%). Patients undergoing MIE-Ivor Lewis were operated in the current era. The median number of lymph nodes resected was 21. The operative mortality was 1.68%. Median length of stay (8 days) and ICU stay (2 days) were similar between the 2 approaches. Mortality rate was 0.9%, and recurrent nerve injury was less frequent in the Ivor Lewis MIE group (P < 0.001). Conclusions MIE in our center resulted in acceptable lymph node resection, postoperative outcomes, and low mortality using either an MIE-neck or an MIE-chest approach. The MIE Ivor Lewis approach was associated with reduced recurrent laryngeal nerve injury and mortality of 0.9% and is now our preferred approach. Minimally invasive esophagectomy can be performed safely, with good results in an experienced center.

Uniportal video-assisted thoracic surgery Ivor Lewis esophagectomy

“…Most publications demonstrate a multiport approach to the thoracic step (3). However, this step can be performed by only one incision.…”

Technical details of video‐assisted transcervical mediastinal dissection for esophageal cancer and its perioperative outcome

“…Progress has been made in the surgical technique of esophagectomy and its surgical mortality has drastically decreased 1, 2, 3. Minimally invasive esophagectomy such as video‐assisted surgery can reduce chest wall trauma and has been reported to reduce surgical mortality, preserve pulmonary function and improve patients’ postoperative quality of life 1, 4, 5.…”

“…Minimally invasive esophagectomy such as video‐assisted surgery can reduce chest wall trauma and has been reported to reduce surgical mortality, preserve pulmonary function and improve patients’ postoperative quality of life 1, 4, 5. However, video‐assisted transthoracic esophagectomy is technically demanding and its perioperative outcome depends on the skill of the surgeon 6, 7…”

Technique of robotic assisted minimally invasive esophagectomy (RAMIE)

“…To maximize the benefit of the procedure while minimizing its risks, surgeons have sought to refine the procedure. Minimally invasive approaches to esophagectomy were first described in the 1990's, and recent works have demonstrated oncologic equivalence and safety in total laparoscopic/thoracoscopic trans-thoracic minimally invasive esophagectomy (MIE) compared to open operations (4,5).…”