title: Minimally invasive esophagectomy for cancer: prospective evaluation of laparoscopic gastric mobilization.
abstract: BACKGROUND
  Esophagectomy carries high morbidity, mainly respiratory. Minimally invasive surgery has been demonstrated to improve postoperative outcome in digestive surgery, without impairment of oncological results. A prospective study was conducted to evaluate feasibility, postoperative outcome, and mid-term oncological results of minimally invasive esophagectomy (MIE) in cancer.
  
  
  METHODS
  From July 2001 to August 2005, 25 patients underwent esophagectomy with laparoscopic gastric mobilization (LGM) for epidermoid carcinoma (n=15) or adenocarcinoma (n=10). Tumors were located on the cardia (n=6), on the lower third (n=14), or on the median third (n=5) of the esophagus. Following LGM, transthoracic esophagectomy was performed.
  
  
  RESULTS
  Complete LGM was achieved in all patients but 1. Mean operative time for LGM was 191+/-49 minutes. Fifteen patients (60%) developed complications, mainly respiratory. Anastomotic leakage occurred in 2 patients, with a favorable outcome. Pylorospasm (n=1) was the only intra-abdominal complication. Median hospital stay was 18 days. Two patients died (8%). Twenty-three patients underwent R0 resection. A mean of 12+/-4 lymph nodes (range 4-19 nodes) were analyzed. With a mean follow-up of 14 months (1-46 months), actuarial survival at 1 and 2 years was, respectively, 73% and 56%.
  
  
  CONCLUSIONS
  Esophagectomy with LGM is feasible with few specific complications. However, no decrease in morbidity and hospital stay could be observed. Mid-term oncological results seem comparable to those of conventional surgery. Further studies are required to evaluate the extent of lymphadenectomy and the oncologic safety of MIE.
authors.affiliation: Department of Digestive and Endocrine Surgery, Hospital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.
authors.forename: Gaelle
authors.initials: G
authors.lastname: Godiris-Petit
authors.forename: Nicolas
authors.initials: N
authors.lastname: Munoz-Bongrand
authors.forename: Isabelle
authors.initials: I
authors.lastname: Honigman
authors.forename: Pierre
authors.initials: P
authors.lastname: Cattan
authors.forename: Emile
authors.initials: E
authors.lastname: Sarfati
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*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013270:Stomach / Q000601:surgery; D016896:Treatment Outcome