Minimally invasive esophagectomy (MIE) is gaining increasing popularity in the treatment of esophageal cancer. In fact, while surgical and oncologic outcomes are not inferior to those achieved through a traditional open approach, patients undergoing MIE benefit from shorter length of stay, lesser pain and prompter recovery. This technique is, however, highly challenging, and the development of a MIE program, even in the setting of a tertiary center, requires time and progressive honing of surgical skills.
We use a minimally invasive Ivor Lewis approach. The abdominal phase of the procedure includes complete celiac lymphadenectomy and tubularization of the stomach, which will constitute the neo-esophagus. The video-assisted thoracoscopic surgery portion of the operation takes place in left lateral decubitus and allows for optimal thoracic lymphadenectomy and anastomosis.
From October 2011 to January 2015, we treated 52 patients with the above-described procedure. The evolution of our anastomotic technique included a first group of circular stapled anastomosis with Orvil™ and 3.5-mm EEA™ (n = 16 patients), subsequently abandoned in favor of a linear anastomosis (n = 12), before going back to the Orvil™ coupled with 4.8-mm EEA™ (n = 22) in more recent times. There were also an additional two anastomoses that did not fall under any of these categories. We experienced two postoperative deaths. The overall leak rate was 14 %, but fell down to 4 % in the last group. Median LOS was 9 days. Lymph node retrieval was adequate throughout the whole series.
Developing a MIE program requires a significant learning curve before the results plateau. Only once a technique of choice is refined and mastered, the advantages granted by MIE become apparent.
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Mr. Edwin Lewis provided generous support for Dr. Lidor’s Department of Surgery Research Fund.
Daniela Molena is a speaker for Novadaq Corporation. Benedetto Mungo, Miloslawa Stem and Anne O. Lidor have no conflicts of interest or financial ties to disclose.
Electronic supplementary material
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Abdominal lymphadenectomy and gastric mobilization (MOV 86476 kb)
Transhiatal esophageal dissection, gastric tubularization and Botox injection in the pylorus (MOV 78585 kb)
VATS dissection, esophageal division and thoracic lymphadenectomy (MOV 84566 kb)
Gastric conduit retrieval into the thorax and gastroesophageal anastomosis (MOV 86796 kb)
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Mungo, B., Lidor, A.O., Stem, M. et al. Early experience and lessons learned in a new minimally invasive esophagectomy program. Surg Endosc 30, 1692–1698 (2016) doi:10.1007/s00464-015-4343-2
- Esophageal cancer
- Barrett’s esophagus