Abstract
BackgroundTo achieve decreased invasiveness and lower morbidity, minimally invasive esophagectomy (MIE) was introduced in 1997 for localized esophageal cancer. The combined thoracoscopic-laparoscopic esophagectomy (left neck anastomosis, defined as the McKeown MIE procedure) has been performed since 2007 at our institution. From 2007 to 2011, our institution subsequently evolved as a high-volume MIE center in China. We aim to share our experience with MIE, and have evaluated the outcomes of 142 patients.MethodsWe retrospectively reviewed 142 consecutive patients who had presented with esophageal cancer undergoing McKeown MIE from July 2007 to December 2011. The procedure, surgical outcomes, disease-free and overall survival of these cases were assessed.ResultsThe average total procedure time was 270.5±28.1 min. The median operation time for thoracoscopy was 81.5±14.6 min and for laparoscopy was 63.8±9.1 min. The average blood loss associated with thoracoscopy was 123.8±39.2 ml, and for laparoscopic procedures was 49.9±14.3 ml. The median number of lymph nodes retrieved was 22.8. The 30 day mortality rate was 0.7%. Major surgical complications occurred in 24.6% and major non-surgical complications occurred in 18.3% of these patients. The median DFS and OS were 36.0±2.6 months and 43.0±3.4 months respectively.ConclusionsSurgical and oncological outcomes following McKeown MIE for esophageal cancer were acceptable and comparable with those of open-McKeown esophagectomy. The procedure was both feasible and safe – properties that can be consolidated by experience.
Highlights
Surgical resection remains the primary treatment for localized esophageal cancer
Medicare data from the United States of America, has shown that the mortality rates following esophagectomy ranged from approximately 8% in high-volume centers to about 23% in centers performing a low volume of cases for this complex operation [4]
We report on a retrospective study and surgical outcomes that were obtained by treating 142 consecutive patients with the McKeown minimally invasive esophagectomy (MIE) procedure
Summary
Surgical resection remains the primary treatment for localized esophageal cancer. It increases the probability of cure and alleviates the symptoms of dysphagia as compared with nonoperative approaches. Traditional open esophagectomy carries significantly high risks of operative morbidity and mortality. Medicare data from the United States of America, has shown that the mortality rates following esophagectomy ranged from approximately 8% in high-volume centers to about 23% in centers performing a low volume of cases for this complex operation [4]. Regardless of the surgical approach, the aim of esophageal surgery is to obtain acceptable outcomes and to decrease procedural-related morbidity and mortality. To achieve decreased invasiveness and lower morbidity, minimally invasive esophagectomy (MIE) was introduced in 1997 for localized esophageal cancer. We aim to share our experience with MIE, and have evaluated the outcomes of 142 patients
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