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Journal of Gastrointestinal Surgery

, Volume 16, Issue 9, pp 1768–1774 | Cite as

Refinement of Minimally Invasive Esophagectomy Techniques After 15 Years of Experience

  • Jie Zhang
  • Rui Wang
  • Shilei Liu
  • James D. Luketich
  • Sufeng Chen
  • Haiquan Chen
  • Matthew J. Schuchert
How I do it

Abstract

Intoduction

In an effort to reduce the morbidity and mortality associated with open esophagectomy, a minimally invasive approach to esophagectomy was introduced at the University of Pittsburgh Medical Center (UPMC) in 1996. The objective of this article is to discuss the optimization and refinement of minimally invasive esophagectomy (MIE) techniques over the 15-year experience at UPMC. We also reviewed the literature on technical improvements in MIE.

Method

Literature highlights for MIE and related meta-analyses comparing open esophagectomy and MIE were reviewed. The rationale and outcomes of techniques refinements were discussed in detail.

Results

Most meta-analyses and systematic reviews confirm the feasibility and safety of MIE and suggest similar oncologic outcomes as compared with open esophagectomy. Since 1996, over 1,000 minimally invasive esophagectomies have been performed at UPMC. We have made several refinements to the MIE procedure that we believe significantly improved our surgical outcomes. It included adjustment of width of the gastric conduit, application of omental flap, and conversion from minimally invasive, three-hole esophagectomy to minimally invasive Ivor Lewis esophagectomy.

Conclusion

MIE became a mainstay in the surgical treatment of esophageal cancer at UPMC. The technical improvements detailed above make the UPMC approach to MIE a feasible, safe, and efficient procedure.

Keywords

Esophagectomy Minimally invasive surgery Esophageal neoplasm 

Notes

Acknowledgments

This work is supported, in part, by Pujiang Talent Grant, UICC fellowship ICR/11/033, a Young Investigator Grant from Shanghai Municipal Health Bureau, Zhuo Shi grant from Fudan University, Ministry of Education returned scientific research foundation (to J. Z). We thank Shannon Wyszomierski for her editorial assistance.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Jie Zhang
    • 1
    • 2
    • 3
  • Rui Wang
    • 1
    • 2
  • Shilei Liu
    • 3
  • James D. Luketich
    • 3
  • Sufeng Chen
    • 1
    • 2
  • Haiquan Chen
    • 1
    • 2
  • Matthew J. Schuchert
    • 3
  1. 1.Department of Oncology, Shanghai Medical CollegeCancer Hospital of Fudan UniversityShanghaiChina
  2. 2.Department of Thoracic SurgeryCancer Hospital of Fudan UniversityShanghaiChina
  3. 3.Department of Cardiothoracic SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA

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