title: Minimally invasive esophagectomy: outcomes in 222 patients.
abstract: OBJECTIVE
  To assess our outcomes after minimally invasive esophagectomy (MIE).
  
  
  BACKGROUND
  Esophagectomy has traditionally been performed by open methods. Results from most series include mortality rates in excess of 5% and hospital stays frequently greater than 10 days. MIE has the potential to improve these results, but only a few small series have been reported. This report summarizes our experience of 222 cases.
  
  
  METHODS
  From 1996 to 2002, MIE was performed in 222 patients. Indications for operation included high-grade dysplasia (n = 47) and cancer (n = 175). Neoadjuvant chemotherapy was used in 78 (35.1%) and radiation in 36 (16.2%). Initially, a laparoscopic transhiatal approach was used (n = 8), but subsequently our approach evolved to include thoracoscopic mobilization (n = 214).
  
  
  RESULTS
  There were 186 men and 36 women. Median age was 66.5 years (range, 39-89). Nonemergent conversion to open procedure was required in 16 patients (7.2%). MIE was successfully completed in 206 (92.8%) patients. The median intensive care unit stay was 1 day (range, 1-30); hospital stay was 7 days (range, 3-75). Operative mortality was 1.4% (n = 3). Anastomotic leak rate was 11.7% (n = 26). At a mean follow-up of 19 months (range, 1-68), quality of life scores were similar to preoperative values and population norms. Stage specific survival was similar to open series.
  
  
  CONCLUSIONS
  MIE offers results as good as or better than open operation in our center with extensive minimally invasive and open experience. In this single institution experience, we observed a lower mortality rate (1.4%) and shorter hospital stay (7 days) than most open series. Given these results, we are now developing an intergroup trial (ECOG 2202) to assess MIE in a multicenter setting.
authors.affiliation: Division of Thoracic Surgery and Foregut Surgery, University of Pittsburgh Medical Center, Pittsburgh 15213, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: Miguel
authors.initials: M
authors.lastname: Alvelo-Rivera
authors.forename: Percival O
authors.initials: PO
authors.lastname: Buenaventura
authors.forename: Neil A
authors.initials: NA
authors.lastname: Christie
authors.forename: James S
authors.initials: JS
authors.lastname: McCaughan
authors.forename: Virginia R
authors.initials: VR
authors.lastname: Litle
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.forename: John M
authors.initials: JM
authors.lastname: Close
authors.forename: Hiran C
authors.initials: HC
authors.lastname: Fernando
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome