258. A VIDEO-UPDATE OF THE LEARNING CURVE OF THE INTRODUCTION OF MINIMALLY INVASIVE TRANSCERVICAL ESOPHAGECTOMY (MICE)

Abstract

Abstract Background A radical esophagectomy is considered the cornerstone of a curative treatment strategy for esophageal cancer. However, transthoracic approaches are associated with high morbidity rates, even in expert centers. Pulmonary complications and anastomotic leakage are the most frequent and have the most impact. In the pursuit to improve clinical outcomes for patients with esophageal cancer, reducing post-operative complications is essential. Methods Minimally Invasive trans-Cervical Esophagectomy (MICE) is an innovative surgical technique, combining a single-port trans-cervical mediastinal dissection with a laparoscopic transhiatal esophagectomy. This approach facilitates a radical esophagectomy and a two- or three-field lymphadenectomy, while avoiding a thoracoscopy/thoracotomy. Therefore, MICE could reduce pulmonary complications and the consequences of anastomotic leakage, without compromising oncological radicality. Reducing post-operative complications will impact mortality, quality of life, long-term survival, and costs. Results The first MICE procedure in a Dutch esophageal cancer patient was performed at Radboudumc in January 2021, after an extensive pre-clinical trajectory. Subsequently a prospective pilot study was conducted in 20 consecutive patients undergoing MICE. The primary outcome, pulmonary complication rate, was 15% (3/20), which is substantially lower than after transthoracic minimally invasive esophagectomy (TMIE). Recurrent laryngeal nerve palsy (RLNP) occurred in seven (35%) cases, of which six recovered spontaneously, and this is in concordance with the results of Japanese series. Anastomotic leakage occurred in 15% of patients, which is in similar to our national benchmark of 18%. Conclusion We would like to share one of our latest surgical videos of MICE during our learning curve. Probably this will be around consecutive case number 70.