title: Assisted laparoscopic transhiatal esophagectomy for the treatment of esophageal cancer.
abstract: BACKGROUND
  Esophageal resection for the treatment of esophageal cancer is usually associated with high morbido-mortality risks, that can be reduced using laparoscopy. Laparoscopic transhiatal esophagectomy (LTE) has the potential to improve these results but, to-date, only a few limited series of cases have been reported. This report summarizes our experience in 24 cases.
  
  
  OBJECTIVE
  To assess the outcomes following LTE.
  
  
  METHODS
  Between 1998 and 2005, LTE was performed in 24 patients; 18 men and 6 women with an overall mean age of 63 years (range: 36-85). Indication for surgery was lower third esophageal cancer; 11 squamous cell carcinoma and 13 adenocarcinoma. Neoadjuvant chemotherapy and radiotherapy were used in 18 patients (75%). A laparoscopic transhiatal approach was used to perform an esophagectomy with curative intent. A cervical esophagogastric anastomosis was created.
  
  
  RESULTS
  No reversion to conventional open surgery was required. Mean anesthesia time was 293.8 min (range: 255-360). Major complications occurred in 7 patients (29.2%). Two patients (8.3%) had leakage from the cervical anastomosis. Surgical mortality was 8.3%. The median stay in Intensive Care Unit was 5 days (range: 1-29). Median hospital stay was 11.5 days (range: 7-54). At a mean follow-up of 24.9 months, 8 patients (36.4%) had disease recurrence (36.4%), global survival rate was 62.5%, and diseasefree survival rate was 50%.
  
  
  CONCLUSIONS
  Assisted laparoscopic transhiatal esophagectomy for lower third esophageal cancer is a potentially safe and effective method when performed by surgeons with expertise in the field. Benefits from this approach need to be confirmed by further randomized studies.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Dr. Peset, S.V.S. Valencia, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Delgado Gomis
authors.forename: Segundo A
authors.initials: SA
authors.lastname: Gómez Abril
authors.forename: Manuel
authors.initials: M
authors.lastname: Martínez Abad
authors.forename: José M
authors.initials: JM
authors.lastname: Guallar Rovira
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies