Minimally Invasive Esophagectomy for Cancer: A Safe Procedure in Oncological Surgery

Abstract

Introduction: Minimally invasive surgery (MIS) in the surgical management of esophageal cancer is now accepted as a valid technique. The aim of this study is to show our initial experience with this approach.
Material and Methods: Observational study using data collected prospectively from a database, which includes 23 patients operated by MIS. Esophageal dissection was performed by videothoracoscopy, followed by laparotomy or laparoscopy. An Akiyama gastroplasty was made up, and pulled up through the posterior mediastinum and an side-to-side esophagogastric cervical anastomosis was then performed.
Results: Most of the patients (19) were male and the average age was 63.3 years. Most tumors were located underneath the carina. 17 were adenocarcinomas and 6 squamous cell type. 19 patients received neoadjuvant therapy. The average operating time was 377.5 minutes and in 5 patients it was necessary to make a thoracotomy to finish the esophageal dissection. An average of 18 lymph node were removed and the most frequent pathological stage was the IIA. The morbidity was 47.8%, 5 patients with respiratory complications and 7 patients presenting a anastomosis leakage or fistula. 3 patients died postoperatively. The average follow-up was 23.5 months and the estimated 5-year overall survival was 61.8%.
Conclusion:This study confirms previous reports about MIS which seems to be a valid technique if made by experienced teams. Our results support a satisfactory oncological outcome and a low rate of respiratory complications.