Œsophagectomie mini-invasive : évaluation prospective de la gastrolyse cœlioscopique

Abstract

Objective. – Esophagectomy carries high morbidity, mainly due to respiratory complications. In digestive surgery, postoperative outcome is generally improved by minimally invasive surgery. A prospective study was conducted to evaluate feasibility and postoperative outcome of minimally invasive esophagectomy (MIE). Methods. – From July 2001 to June 2004, 20 patients underwent esophagectomy with laparoscopic gastric mobilization (LGM) for squamous cell carcinoma ( N = 11), adenocarcinoma ( N = 7), Barrett's esophagus with high-grade dysplasia ( N = 1), and long peptic stricture ( N = 1). Tumours ( N = 19) were located on the cardia ( N = 5), on the lower third of the oesophagus ( N = 10), on the median third ( N = 3), and on the upper third ( N = 1). Following LGM, transthoracic ( N = 19) or transhiatal ( N = 1) oesophagectomy was performed. Results. – Complete LGM was achieved in all cases. Mean operative time for LGM was 197 ± 48 minutes. In the 19 patients operated for tumours, 18 underwent R0 resection. Eleven patients (55%) developed postoperative complications, mainly (30%) respiratory. Intrathoracic anastomotic leakage occurred in 2 patients, with favourable outcome. Pylorospasm ( N = 1) was the only intraabdominal complication. One patient died (5%). Conclusion. – Esophagectomy with LGM is feasible with few specific complications. However, no decrease in morbidity could be observed with this technique. Further studies are required to evaluate if thoracoscopy could improve the postoperative course after LGM and to validate oncologic safety of MIE.