Abstract
Background
Minimally invasive techniques are now increasingly adopted for the treatment of esophageal cancers. Benefits such as earlier functional recovery and less need for transfusion and intensive care stay should be balanced by a determination to avoid compromise to the oncologic integrity of the procedure, especially in the early phase of transition from open to laparoscopic surgery. This study aimed to compare primary outcomes including oncologic clearance, complications, and functional recovery between open and laparoscopic esophagectomy in a single center.
Methods
This prospective study recruited 75 consecutive patients undergoing Ivor-Lewis esophagectomy, all treated by a single surgeon. These patients were divided into three groups. The 24 patients in group A underwent open Ivor-Lewis esophagectomy. The remaining patients underwent laparoscopic Ivor-Lewis esophagectomy in two groups: 25 patients in an early cohort (group B) and 26 patients in a later cohort (group C). All the patients were treated according to the same protocol.
Results
The three groups were adequately matched. The findings showed trends toward a reduction in median operative time, with group A requiring 260 min, group B requiring 249 min, and group C requiring 223 min (p = 0.06), and a significant reduction in the requirement for perioperative blood transfusion between groups A (65%) and C (27%) (p = 0.02). The median lymph node yield was significantly less in group B (n = 13) than in group A (n = 24) or group C (n = 22) (p = 0.003). There was no significant difference between the three groups in the length of hospital stay (median stay, 14–16 days) or the requirement for critical care beds (median stay, 3–4 days). The in-hospital mortality rate was zero, and the morbidity rate did not differ between the three groups.
Conclusions
This study shows that laparoscopic Ivor-Lewis esophagectomy is associated with a reduced need for blood transfusion, a shorter operative time, and an adequate lymph node harvest. Oncologic principles are not compromised during the transition phase from open to laparoscopic esophagectomy.
Similar content being viewed by others
References
Forshaw MJ, Gossage JA, Stephens J, Strauss D, Botha AJ, Atkinson S, Mason RC. (2006) Centralisation of oesophagogastric cancer services: can specialist units deliver? Ann R Coll Surg Engl 88:566–570
Blazeby JM, Farndon JR, Donovan J, Alderson D (2000) A prospective longitudinal study examining the quality of life of patients with oesophageal carcinoma. Cancer 88:1781–1787
Cuschieri A, Shimi S, Banting S (1992) Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 37:7–11
Gemmill EH, McCulloch P (2007) Systematic review of minimally invasive resection for gastro-oesophageal disease. Br J Surg 94(12):1461–1467
Siewert JR, Stein HJ (1999) Lymph node dissection in squamous cell oesophageal cancer: who benefits? Langebecks Arch Surg 384:141–148
Altorki N, Girardi L, Skinner DB (1997) En bloc oesophagectomy improves survival for stage III oesophageal cancer. J Thorac Cardiovasc Surg 114:948–9456
Nishihira T, Hirayama K, Mori S (1998) A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic oesophagus. Am J Surg 175:47–51
Dutkowski P, Hommel G, Boettger T (2002) How many lymph nodes are needed for an accurate pN classification in oesophageal cancer? Evidence for a new threshold value. Hepatogastroenterology 49:176–180
Dresner SM, Lamb PJ, Bennett MK, Hayes N, Griffin SM (2001) The pattern of metastatic lymph node dissemination from adenocarcinoma of the oesophagastric junction. Surgery 129:103–109
Palanivelu R, Prakash A, Senthilkumar R, Senthilnathan P, Parthasarathi R, Rajan PS, Venkatachlam S (2006) Minimally invasive oesophagectomy: thoracoscopic mobilization of the oesophagus and mediastinal lymphadenectomy in prone position: experience of 130 patients. J Am Coll Surg 203:7–16
Nguyen NT, Roberts P, Follette DM, Rivers R, Wolfe BM (2003) Thoracoscopic and laparoscopic oesophagectomy for benign and malignant disease: lessons learned from 46 consecutive procedures. J Am Coll Surg 197:902–913
Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC (2002) Minimally invasive oesophagectomy: outcomes in 222 patients. Ann Surg 238:486–494
Smithers BM, Gotley DC, Martin I, Thomas JM (2007) Comparison of the outcomes between open and minimally invasive oesophagectomy. Ann Surg 245:232–240
Berrisford RG, Wajed SA, Sander D, Rucklidge MWM (2008) Short term outcomes following minimally invasive oesophagectomy. Br J Surg 95:602–610
Wormuth JK, Heitmiller RF (2006) Oesophageal conduit necrosis. Thorac Surg Clin 16:11–22
Disclosure
Drs. A. H. Hamouda, M. J. Forshaw, K. Tsigritis, G. E. Jones, A. S. Noorani, A. Rohatgi, and A. J. Botha have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hamouda, A.H., Forshaw, M.J., Tsigritis, K. et al. Perioperative outcomes after transition from conventional to minimally invasive Ivor-Lewis esophagectomy in a specialized center. Surg Endosc 24, 865–869 (2010). https://doi.org/10.1007/s00464-009-0679-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-009-0679-9