Skip to main content

Advertisement

Log in

Decreasing morbidity and mortality in 100 consecutive minimally invasive esophagectomies

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Esophagectomy is a complex invasive procedure that requires exploration of multiple body cavities for removal and subsequent restoration of gastrointestinal continuity. In many institutions, esophagectomy morbidity and mortality rates remain high despite improvement of intensive care treatment. We reviewed our minimally invasive esophagectomy (MIE) experience of a consecutive series of 100 patients to analyze trends in morbidity and mortality as we transitioned from open to MIE.

Methods

A total of 105 consecutive patients who underwent operative exploration for esophagectomy from August 2007 to January 2011 were reviewed. The preoperative evaluation, operative technique, and postoperative care of these cases were evaluated and analyzed for 100 patients who have had a MIE and compared with 32 open esophagectomies 2 years prior.

Results

During the time frame of the study, 105 patients underwent an exploration for attempted esophagectomy. Resection was completed in 100 patients and was done for malignant disease in 95 patients and benign disease in 5 patients. There was one in hospital mortality due to a pulmonary embolism. There was no significant difference in postoperative complications consisting of transient left recurrent nerve injury (7 vs. 12.5%) or pneumonia (9 vs. 15.6%) in those who underwent MIE compared with open resection. However, wound infections were significantly less in patients who underwent MIE compared with open esophagectomy (1 vs. 12.5%, respectively, p = 0.01). Anastomotic leak (4 vs. 12.5%, p = 0.05) also was lower in those who underwent MIE. Median length of stay (LOS) was significantly less in patients who underwent MIE compared with open esophagectomy (7.5 vs. 14 days, p < 0.05). Finally, there was a trend toward improvement in median LOS in the 30 patients who underwent MIE during the most recent time period compared with the initial 17 patients who underwent MIE (7.5 vs. 10 days, p = 0.05)

Conclusions

Our results support the continued safe use of esophagectomy for selected esophageal diseases, including malignancy. Morbidity, especially wound infection, anastomotic leak, and length of stay is decreasing with the incorporation of minimally invasive techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Atkins BZ, Shah AS, Hutcheson KA, Mangum JH, Pappas TN, Harpole DH Jr, D’Amico TA (2004) Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 78:1170–1176 (discussion 1170–1176)

    Article  PubMed  Google Scholar 

  2. Collard JM, Lengele B, Otte JB, Kestens PJ (1993) En bloc and standard esophagectomies by thoracoscopy. Ann Thorac Surg 56:675–679

    Article  PubMed  CAS  Google Scholar 

  3. Millikan KW, Silverstein J, Hart V, Blair K, Bines S, Roberts J, Doolas A (1995) A 15-year review of esophagectomy for carcinoma of the esophagus and cardia. Arch Surg 130:617–624

    Article  PubMed  CAS  Google Scholar 

  4. Orringer MB, Marshall B, Chang AC, Lee J, Pickens A, Lau CL (2007) Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg 246:363–372 (discussion 372–364)

    Article  PubMed  Google Scholar 

  5. Brooks JA, Kesler KA, Johnson CS, Ciaccia D, Brown JW (2002) Prospective analysis of quality of life after surgical resection for esophageal cancer: preliminary results. J Surg Oncol 81:185–194

    Article  PubMed  Google Scholar 

  6. Ku GY, Ilson DH (2009) Role of neoadjuvant therapy for esophageal adenocarcinoma. Surg Oncol Clin N Am 18:533–546

    Article  PubMed  Google Scholar 

  7. Lv J, Cao XF, Zhu B, Ji L, Tao L, Wang DD (2009) Effect of neoadjuvant chemoradiotherapy on prognosis and surgery for esophageal carcinoma. World J Gastroenterol 15:4962–4968

    Article  PubMed  CAS  Google Scholar 

  8. Roof KS, Coen J, Lynch TJ, Wright C, Fidias P, Willett CG, Choi NC (2006) Concurrent cisplatin, 5-FU, paclitaxel, and radiation therapy in patients with locally advanced esophageal cancer. Int J Radiat Oncol Biol Phys 65:1120–1128

    Article  PubMed  CAS  Google Scholar 

  9. Butler N, Collins S, Memon B, Memon MA (2011) Minimally invasive oesophagectomy: current status and future direction. Surg Endosc 25:2071–2083

    Article  PubMed  Google Scholar 

  10. Biere SS, Cuesta MA, van der Peet DL (2009) Minimally invasive versus open esophagectomy for cancer: a systematic review and meta-analysis. Minerva Chir 64:121–133

    PubMed  CAS  Google Scholar 

  11. Sgourakis G, Gockel I, Radtke A, Musholt TJ, Timm S, Rink A, Tsiamis A, Karaliotas C, Lang H (2010) Minimally invasive versus open esophagectomy: meta-analysis of outcomes. Dig Dis Sci 55:3031–3040

    Article  PubMed  Google Scholar 

  12. Ben-David K, Sarosi GA, Cendan JC, Hochwald SN (2010) Technique of minimally invasive Ivor Lewis esophagogastrectomy with intrathoracic stapled side-to-side anastomosis. J Gastrointest Surg 14:1613–1618

    Article  PubMed  Google Scholar 

  13. DePaula AL, Hashiba K, Ferreira EA, de Paula RA, Grecco E (1995) Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc 5:1–5

    PubMed  CAS  Google Scholar 

  14. Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238:486–494 (discussion 494–485)

    PubMed  Google Scholar 

  15. Swanstrom LL (2002) Minimally invasive surgical approaches to esophageal cancer. J Gastrointest Surg 6:522–526

    Article  PubMed  Google Scholar 

  16. Rice TW (2006) Pro: esophagectomy is the treatment of choice for high-grade dysplasia in Barrett’s esophagus. Am J Gastroenterol 101:2177–2179

    Article  PubMed  Google Scholar 

  17. Siewert JR, Lordick F, Ott K, Stein HJ, Weber WA, Becker K, Peschel C, Fink U, Schwaiger M (2007) Induction chemotherapy in Barrett cancer: influence on surgical risk and outcome. Ann Surg 246:624–628 (discussion 628–631)

    Article  PubMed  Google Scholar 

  18. Ben-David K, Rossidis G, Zlotecki RA, Grobmyer SR, Cendan JC, Sarosi GA, Hochwald SN (2011) Minimally invasive esophagectomy is safe and effective following neoadjuvant chemoradiation therapy. Ann Surg Oncol. Apr 9. [Epub ahead of print]

  19. Lopes J, Hochwald SN, Lancia N, Dixon LR, Ben-David K (2010) Autoimmune esophagitis: IgG4-related tumors of the esophagus. J Gastrointest Surg 14:1031–1034

    Article  PubMed  Google Scholar 

  20. Rossidis G, Kissane N, Hochwald SN, Zingarelli W, Sarosi GA, Ben-David K (2011) Overcoming challenges in implementing a minimally invasive esophagectomy program at a Veterans Administration Medical Center. Am J Surg. May 10. [Epub ahead of print]

  21. Allum WH, Stenning SP, Bancewicz J, Clark PI, Langley RE (2009) Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol 27:5062–5067

    Article  PubMed  Google Scholar 

  22. Juergens RA, Forastiere A (2008) Combined modality therapy of esophageal cancer. J Natl Compr Canc Netw 6:851–860 (quiz 861)

    PubMed  CAS  Google Scholar 

  23. Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349:2117–2127

    Article  PubMed  CAS  Google Scholar 

  24. Boudourakis LD, Wang TS, Roman SA, Desai R, Sosa JA (2009) Evolution of the surgeon-volume, patient-outcome relationship. Ann Surg 250:159–165

    Article  PubMed  Google Scholar 

  25. Eloubeidi MA, Mason AC, Desmond RA, El-Serag HB (2003) Temporal trends (1973–1997) in survival of patients with esophageal adenocarcinoma in the United States: a glimmer of hope? Am J Gastroenterol 98:1627–1633

    PubMed  Google Scholar 

  26. Pohl H, Welch HG (2005) The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 97:142–146

    Article  PubMed  Google Scholar 

  27. Forman D (2005) Re: the role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 97:1013–1014 (author reply 1014)

    Article  PubMed  Google Scholar 

  28. Merry AH, Schouten LJ, Goldbohm RA, van den Brandt PA (2007) Body mass index, height and risk of adenocarcinoma of the oesophagus and gastric cardia: a prospective cohort study. Gut 56:1503–1511

    Article  PubMed  Google Scholar 

  29. Falk J, Carstens H, Lundell L, Albertsson M (2007) Incidence of carcinoma of the oesophagus and gastric cardia. Changes over time and geographical differences. Acta Oncol 46:1070–1074

    Article  PubMed  Google Scholar 

  30. Bashash M, Shah A, Hislop G, Brooks-Wilson A, Le N, Bajdik C (2008) Incidence and survival for gastric and esophageal cancer diagnosed in British Columbia, 1990 to 1999. Can J Gastroenterol 22:143–148

    PubMed  CAS  Google Scholar 

  31. Wouters MW, Karim-Kos HE, le Cessie S, Wijnhoven BP, Stassen LP, Steup WH, Tilanus HW, Tollenaar RA (2009) Centralization of esophageal cancer surgery: does it improve clinical outcome? Ann Surg Oncol 16:1789–1798

    Article  PubMed  CAS  Google Scholar 

  32. Wouters MW, Krijnen P, Le Cessie S, Gooiker GA, Guicherit OR, Marinelli AW, Kievit J, Tollenaar RA (2009) Volume- or outcome-based referral to improve quality of care for esophageal cancer surgery in The Netherlands. J Surg Oncol 99:481–487

    Article  PubMed  CAS  Google Scholar 

  33. Rindani R, Martin CJ, Cox MR (1999) Transhiatal versus Ivor-Lewis oesophagectomy: is there a difference? Aust N Z J Surg 69:187–194

    Article  PubMed  CAS  Google Scholar 

  34. Yamasaki M, Miyata H, Fujiwara Y, Takiguchi S, Nakajima K, Kurokawa Y, Mori M, Doki Y (2011) Minimally invasive esophagectomy for esophageal cancer: comparative analysis of open and hand-assisted laparoscopic abdominal lymphadenectomy with gastric conduit reconstruction. J Surg Oncol. doi:10.1002/jso.21991

  35. Singh RK, Pham TH, Diggs BS, Perkins S, Hunter JG (2011) Minimally invasive esophagectomy provides equivalent oncologic outcomes to open esophagectomy for locally advanced (stage II or III) esophageal carcinoma. Arch Surg 146:711–714

    Article  PubMed  Google Scholar 

  36. Berger AC, Bloomenthal A, Weksler B, Evans N, Chojnacki KA, Yeo CJ, Rosato EL (2011) Oncologic efficacy is not compromised, and may be improved with minimally invasive esophagectomy. J Am Coll Surg 212:560–566 (discussion 566–568)

    Article  PubMed  Google Scholar 

Download references

Disclosures

Dr. Kfir Ben-David and Dr. Steven N. Hochwald both serve as consultants for Ethicon. Drs. George A. Sarosi, Juan C. Cendan, Drew Howard, and Georgios Rossidis have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kfir Ben-David.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ben-David, K., Sarosi, G.A., Cendan, J.C. et al. Decreasing morbidity and mortality in 100 consecutive minimally invasive esophagectomies. Surg Endosc 26, 162–167 (2012). https://doi.org/10.1007/s00464-011-1846-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-011-1846-3

Keywords

Navigation