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Laparoscopic Transhiatal Esophagectomy for Invasive Esophageal Adenocarcinoma

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Esophagectomy is a fundamental step to achieve long-term disease-free survival in esophageal cancer. While various approaches have been described, there is no consensus on the single best technique to optimize operative and oncologic outcomes. We aim to report the modern experience with laparoscopic transhiatal esophagectomy (LTHE) for invasive adenocarcinoma.

Methods

We reviewed all patients who underwent LTHE with extended lymph node dissection for distal esophageal adenocarcinoma (EAC) at our institution between 2007 and 2016. Pre-operative characteristics, operative details, postoperative complications, and long-term outcomes were tracked by review of the electronic medical record and patient surveys. Survival rates were calculated with Kaplan-Meier curves.

Results

Eighty-two EAC patients underwent LTHE during the study period (84% male, mean age 65, mean BMI 27.8, large). Most patients were clinical stage III (42.7%) and 68.3% had received neoadjuvant chemoradiation (nCRT). Laparoscopy was successful in 93.9%, with five cases requiring conversion to open (6.1%). The median lymph node harvest was 19. Overall complication rate (major and minor) was 45.5% and ninety-day mortality was 4%. Overall 5-year survival was 52% (77% for stage 1, 57% for stage 2, 37% for stage 3).

Conclusions

Laparoscopic transhiatal esophagectomy has an important role in current esophageal cancer treatment and can be performed with curative intent in patients with distal esophageal tumors. In addition to the well-known advantages of laparoscopy, the increased mediastinal visibility and a modern focus on oncologic principles seem to have a positive impact on cancer survival compared to the open transhiatal approach.

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Authors and Affiliations

  1. The Ohio State University, Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, USA

    Kelly R. Haisley

  2. Providence Portland Medical Center, 4805 NE Glisan St, Portland, OR, 97213, USA

    Kelly R. Haisley, Walaa F. Abdelmoaty & Christy M. Dunst

  3. The Foundation for Surgical Innovation and Education, 4805 NE Glisan St #6N60, Portland, OR, 97213, USA

    Walaa F. Abdelmoaty & Christy M. Dunst

  4. The Oregon Clinic, Division of Gastrointestinal & Minimally Invasive Surgery, 4805 NE Glisan St Suite 6N60, Portland, OR, 97213, USA

    Christy M. Dunst

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  1. Kelly R. Haisley
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Correspondence to Christy M. Dunst.

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Haisley, K.R., Abdelmoaty, W.F. & Dunst, C.M. Laparoscopic Transhiatal Esophagectomy for Invasive Esophageal Adenocarcinoma. J Gastrointest Surg 25, 9–15 (2021). https://doi.org/10.1007/s11605-019-04506-4

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