535 EVALUATION OF THORACOSCOPIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER FROM 650 CASES IN A SINGLE INSTITUTE

Abstract

Abstract Minimally invasive surgery (MIS) for esophageal cancer has been wide-spreading in worldwide since the first report in 1992. In Japan, we firstly introduced thoracoscopic esophagectomy as a MIS for esophageal cancer in 1994 and performed more than 650 cases over the last two decades. The aim of the present study is to evaluate an oncological feasibility and less invasiveness of this operation from short and long term results. Methods Thoracoscopic esophagectomy was performed in almost all resectable thoracic esophageal cancer patient, briefly indication for this operation is cT1-T3 tumors and lymph node involvement within the regional lesion. We performed thoracoscopic esophagectomy with one lung ventilation in left lateral decubitus position (Group L) up to 2011. From 2012, prone thoracoscopic esophagectomy with bilateral ventilation and artificial pneumothorax (Group P) has been undergone. We analyzed the long-term outcome in all patients who received thoracoscopic esophagectomy with or without neoadjuvant treatment. Furthermore, we evaluated the less invasiveness from the results of short-term outcome and operation-related morbidity between Group L and Group P. Results The 5-year survival rates in no treatment before surgery cases were 61.9% overall, and 86.9%, 71.5%, 68.1%, 40.9%, 37.4% for pathological stages I, IIA, IIB, III and IVa, respectively (TNM classification 6th edition). 30 days mortality in this series was 0.6%. 5-year survival in cStage II and III with neoadjuvant chemotherapy was 65.7%. 3-year survival in salvage esophagectomy after failure of definitive chemoradiotherapy with R0 resection was 43.0%. Total amount of blood loss, rate of postoperative pulmonary complications and the postoperative inflammatory response were significantly lower in Group P than in Group L. Conclusion Thoracoscopic esophagectomy is safety and oncologically feasible. From the view point of less invasiveness benefits, prone esophagectomy has advantages than lateral decubitus procedure and this operation is recommended in almost all patients with a resectable esophageal cancer.