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Ann Thorac Surg 2000;70:906-911
© 2000 The Society of Thoracic Surgeons

Original articles: general thoracic

Minimally invasive esophagectomy

James D. Luketich, MDa, Philip R. Schauer, MDa, Neil A. Christie, MDa, Tracey L. Weigel, MDa, Siva Raja, BSa, Hiran C. Fernando, MDa, Robert J. Keenan, MDa, Ninh T. Nguyen, MDa

a Section of Thoracic Surgery and the Minimally Invasive Surgery Center, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA

Presented at the Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Ft Lauderdale, FL, Jan 31–Feb 2, 2000.

Background. Open esophagectomy can be associated with significant morbidity and delay return to routine activities. Minimally invasive surgery may lower the morbidity of esophagectomy but only a few small series have been published.

Methods. From August 1996 to September 1999, 77 patients underwent minimally invasive esophagectomy. Initially, esophagectomy was approached totally laparoscopically or with mini-thoracotomy; thoracoscopy subsequently replaced thoracotomy.

Results. Indications included esophageal carcinoma (n = 54), Barrett’s high-grade dysplasia or carcinoma in situ (n = 17), and benign miscellaneous (n = 6). There were 50 men and 27 women with an average age of 66 years (range 30 to 94 years). Median operative time was 7.5 hours (4.5 hours with > 20 case experience). Median intensive care unit stay was 1 day (range 0 to 60 days); median length of stay was 7 days (range 4 to 73 days) with no operative or hospital mortalities. There were four nonemergent conversions to open esophagectomy; major and minor complication rates were 27% and 55%, respectively.

Conclusions. Minimally invasive esophagectomy is technically feasible and safe in our center, which has extensive minimally invasive and open esophageal experience. Open surgery should remain the standard until future studies conclusively demonstrate advantages of minimally invasive approaches.


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Discussion
Ann. Thorac. Surg. 2000 70: 911-912. [Extract] [Full Text] [PDF]



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