Outcomes After Minimally Invasive Esophagectomy

• DOI: 10.1097/sla.0b013e3182590603
• Publication Date: 2012-06-05T15:53:52Z
• Authors: James D. Luketich; Arjun Pennathur; Omar Awais; Ryan M. Levy; Samuel Keeley; Manisha Shende; Neil A. Christie; Benny Weksler; Rodney J. Landreneau; Ghulam Abbas; Matthew J. Schuchert; Katie S. Nason
• Keywords: Male; Thoracic Surgery, Video-Assisted; Anastomosis, Surgical; Kaplan-Meier Estimate; Middle Aged; 3. Good health; Esophagectomy; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Humans; Female; Laparoscopy; Aged; Retrospective Studies

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.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]).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.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).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.