Publication:

Minimally invasive esophageal surgery-standard of care-our experience

Background Surgery is the most effective treatment for the resectable esophageal cancer of the middle & lower third and gastro-esophageal junction (GEJ) tumors. We hereby scrutinise our experience in minimally invasive esophageal surgery (MIES) to evaluate its safety and efficacy as an oncosurgical procedure.

Methods The study included99consecutive patients. Depending on the location of the tumor, either thoracoscopic transthoracic esophagectomy (TTE) in prone position or laparoscopic transhiatal esophagectomy (THE) was planned. 2 field comprehensive nodal dissection were part of both the surgical procedures.

Results 05 patients were excluded, 18 were inoperable and 12 had open surgery.64 underwent MIES (THE-37, TTE-27), Male: Female-31:33. Nodal Harvest (nodes): THE-14.27, TTE-14.77. Margins (cm): THE-proximal (P) - 6.70, distal (D) -2.51, TTE: (P)-5.41, (D)-5.11.30 days Morbidity (26): cervical leak-05, left vocal cord palsy-05, tracheostomy-03, respiratory insufficiency-03, aspiration-01, chyle leak-01, exploratory laparotomy-01, cardiac-02, stroke-01, surgical emphysema -01, abdominal wound Infection -0330 days Mortality (1) –pulmonary embolus. Operative time (minutes): THE-234, TTE-322. Blood loss (ml/patient): THE-265, TTE-380. Hospital stays (days): THE-7.3, TTE-10.

Conclusions 79% of properly selected & evaluated cases underwent MIES, with one Mortality and 26 events of morbidity.  6% required conversion. The procedure detected inoperability in 16% cases. The nodal yield, status of margins, operative time, blood loss and hospital stay indicates that MIES has a future to become a standard of care in the treatment of esophageal cancers.