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Oncologic efficacy is not compromised, and may be improved with minimally invasive esophagectomy.
MedLine Citation:
PMID:  21463789     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Major morbidity and mortality rates continue to be high in large series of transthoracic esophagectomies. Minimally invasive approaches are being increasingly used. We compare our growing series of minimally invasive (combined thoracoscopic and laparoscopic) esophagectomies (MIEs) with a series of open transthoracic esophagectomies.
STUDY DESIGN: We identified 65 patients who underwent an MIE with thoracoscopy/laparotomy (n = 11), Ivor Lewis (n = 2), or 3-hole approach (n = 52). These patients were compared with 53 patients who underwent open Ivor-Lewis esophagectomy (n = 15) or 3-hole esophagectomy (n = 38) over the past 10 years.
RESULTS: The MIE and open groups were similar regarding gender and average age. The majority of patients in the open group underwent neoadjuvant chemoradiation therapy (81%); a significantly smaller (43%) number of patients in the MIE group underwent neoadjuvant therapy (p < 0.0001). Regarding oncologic efficacy, 97% and 94% of patients in both groups underwent R0 resections. Patients undergoing MIE had a significant increase in the number of harvested lymph nodes (median 20 vs 9; p < 0.0001). Length of stay was significantly decreased in patients who underwent MIE (8.5 days vs 16 days; p = 0.002). Finally, there were significantly fewer serious complications (grades 3-5) in the MIE group (19% vs 48%; p = 0.0008).
CONCLUSIONS: In this initial report of a single-institution series of MIE, we demonstrate that oncologic efficacy is not compromised and may actually be improved with a significantly increased number of harvested LNs. We also demonstrate that this approach is associated with fewer serious complications and a significant decrease in the length of postoperative hospital stay.
Adam C Berger; Aaron Bloomenthal; Benny Weksler; Nathaniel Evans; Karen A Chojnacki; Charles J Yeo; Ernest L Rosato
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  212     ISSN:  1879-1190     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-04-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  560-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Department of Surgery, Thomas Jefferson University, Philadelphia, PA.
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