Abstract
Background
Standard esophagectomy requires either a laparotomy with transhiatal removal of the esophagus or a combination of laparotomy and thoracotomy. Currently, it still is associated with a high rate of morbidity and mortality. Complications leading to greater morbidity and mortality are rarely seen after minimally invasive surgery. The authors present their experience with 25 minimally invasive esophageal resections.
Methods
Between August 1st, 2003 and November 30th, 2005, the authors performed 25 minimally invasive esophageal resections for 4 woman and 21 men. Data were acquired prospectively.
Results
In this series, a laparoscopic transhiatal approach was performed in 9 cases, a combined laparoscopic-thoracoscopic procedure in 12 cases, and laparoscopic creation of a gastric tube combined with thoracotomy in 4 cases. No conversion became necessary. The mean operation time was 165 min (range, 150–180 min) for the laparoscopic transhiatal approach and 300 min (range, 240–360 min) for both combination approaches. Using the combined laparoscopic-thoracoscopic procedure, 23 lymph nodes (range, 19–26 lymph nodes) were removed, and using the laparoscopic transhiatal approach, 14 lymph nodes (range, 12–17 lymph nodes) were removed. The median stay in the intensive care unit was 1.5 days (range, 1–22 days), and the overall postoperative stay was 10 days (range, 7–153 days). Two intraoperative complications and two cervical anastomotic leakages were observed. The 30-day mortality rate was 0%.
Conclusion
The findings demonstrate that laparoscopic transhiatal and combined laparoscopic/thoracoscopic esophagectomy are feasible and can be performed with low rates of morbidity and mortality. Due to an equal extent of lymph node dissection, there should be no difference in long-term survival between minimally invasive surgery and open surgery.
Similar content being viewed by others
References
Badessi F, Gusai GP, Fais D, Huscher C (2003) Traditional esophagectomy and esophagogastrectomy vs laparoscopic surgery: evaluation and results. Tumori 98(4 Suppl): 80–83
Bartels H, Stein HJ, Siewert JR (1998) Preoperative risk analysis and postoperative mortality of esophagectomy for resectable oesophageal cancer. Br J Surg 85: 840–844
Bartels H, Stein HJ, Siewert JR (2000) Risk analysis in esophageal surgery: recent results. Cancer Res 155: 89–96
Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346: 1128–1137
Böttger Th (2004) Die laparoskopische stumpfe Ösophagusdissektion zur Behandlung des Barrett-Karzinoms. Zentralblatt Chirurgie 129: 435–530
Collard JM (1995) Role of video-assisted surgery in the treatment of oesophageal cancer. Ann Chirurg Gynaecol 84: 209–214
De Paula AL, Hashiba K, Ferreira EAB, De Paula RA, Grecco E (1995) Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc 5: 1–5
Fernando HC, Luketich JD (2004) Quality of life after esophageal surgery. Thorac Surg Clin 14: 367–374
Gockel I, Exner C, Junginger TH (2005) Morbidity and mortality after esophagectomy for esophageal carcinoma: a risk analysis. World J Surg Oncol 21: 37
Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeiser PF, Ten Kate FJ, van Dekken H, Obertop H, Tilanus HW, van Lanschot JJ (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347: 1662–1669
Hulscher JBF, Tijssen JGP, Obertop H, van Lanschot JJB (2001) Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thorac Surg 72: 306–313
Junginger Th, Gockel I, Heckhoff S (2006) The influence of transhiatal and transthoracic resection on the prognosis in patients with squamous cell carcinoma of the esophagus: results of a prospective long term study in 229 patients. Eur J Surg Oncol 32(7):749–755
Katariya K, Harvey JC, Pina E, Beattie EJ (1994) Complication of transhiatal esophagectomy. J Surg Oncol 57: 157–163
Luketich JD, Alvelo-Riviera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC (2003) Minimal invasive esophagectomy: outcomes in 222 patients. Ann Surg 238: 486–495
Luketich JD, Landreneau RJ (2004) Minimally invasive resection and mechanical cervical esophagogastric anastomotic techniques in the management of esophageal cancer. J Gastroint Surg 8: 927–929
Müller JM, Erasmi H, Stelzner M, Zieren U, Pichlmaier H (1990) Surgical therapy of esophageal carcinoma. Br J Surg 77: 845–857
Nguyen NT, Follette DM, Lemoine PH, Roberts PF, Goodnight JE (2001) Minimal invasive Ivor Lewis esophagectomy. Ann Thorac Surg 72: 593–596
Saad S, Goh P, Nagelschmidt M (2004) The technique of laparoscopic–thoracoscopic esophageal resection for esophageal cancer: first experiences. Zentralbl Chir 129: 497–501
Swanstrom LL, Hansen P (1997) Laparoscopic total esophagectomy. Arch Surg 132: 943–947; discussion 947–949
Swisher SG, Deford L, Merriman KW, Walsh GL, Smythe R, Vaporicyan A, Ajani JA, Brown T, Komaki R, Roth JA, Putnam JB (2000) Effect of operative volume on morbidity, mortality, and hospital use after esophagectomy for cancer. J Thorac Cardiovasc Surg 119: 1126–1132
Wong SKH, Chan ACW, Lee DWH, To EWH, Ng EKW, Chung SCS (2003) Minimal invasive approach of gastric and esophageal mobilization in total pharyngolaryngoesophagectomy: total laparoscopic and hand-assisted laparoscopic technique. Surg Endosc 17: 798–802
Zaninotto G, Parenti AR, Ruol A, Costantini M, Merigliano S, Ancona E (2000) Oesophageal resection for high-grade dysplasia in Barrett´s oesophagus. Br J Surg 87: 1102–1105
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Böttger, T., Terzic, A., Müller, M. et al. Minimally invasive transhiatal and transthoracic esophagectomy. Surg Endosc 21, 1695–1700 (2007). https://doi.org/10.1007/s00464-006-9178-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-006-9178-4