title: Radical thoracoscopic esophagectomy for cancer.
abstract: BACKGROUND
  Much of the morbidity of conventional esophagectomy for cancer is thought to relate to the thoracotomy wound and while transhiatal esophagectomy removes the need for a thoracotomy, it is not oncologically sound. Videothoracoscopy could potentially provide an oncologically sound means for resecting the thoracic esophagus without the need for a thorcotomy.
  
  
  METHODS
  Between June 1991 and June 1994, thoracoscopic mobilization of the thoracic esophagus combined with radical lymphadenectomy was attempted in 24 patients as part of three-stage esophagectomy for cancer (5 squamous and 19 adenocarcinomas). Mean age was 59 years (range 43-76). Eight patients were ASA grade I, 10 were ASA II, and 6 ASA III. Two patients had early lesions (T1N0) but all other cancers were T2 or T3. Dissection of the thoracic esophagus was attempted via a right-sided approach, followed by a laparotomy and a cervical incision.
  
  
  RESULTS
  The thoracoscopic procedure was successful in 22 patients; it was abandoned in one patient with dense pleural adhesions and in another with inoperable tumor. Mean duration of the thoracic component was 184 min(120-330). There were three post-operative deaths. Ten further patients had major complications. Median post-operative stay was 18 days(9-129). Mean node harvest was 13 nodes(6-28). Two-year survival (cancer specific) was 33%.
  
  
  CONCLUSIONS
  Radical thoracoscopic mobilization of the esophagus is feasible, but the potential for complications remains high and requires further study.
authors.affiliation: Leeds Institute for Minimally Invasive Therapy, The General Infirmary at Leeds, Great Britain.
authors.forename: S P
authors.initials: SP
authors.lastname: Dexter
authors.forename: I G
authors.initials: IG
authors.lastname: Martin
authors.forename: M J
authors.initials: MJ
authors.lastname: McMahon
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000601:surgery*; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016629:Esophagectomy / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology*; D011379:Prognosis; D015996:Survival Rate; D020708:Thoracoscopes; D013906:Thoracoscopy / Q000379:methods