Minimally invasive esophagectomy: a comparative study of transhiatal laparoscopic approach versus laparoscopic right transthoracic esophagectomy.
BACKGROUND
The development of minimally invasive surgery gave birth to an interest in a mini-invasive approach to esophageal cancer; however, it is still considered to be one of the most complex gastrointestinal surgical operations, and many questions still remain unanswered, regarding the oncologic results of a mini-invasive approach in long-term follow-ups. Here, the authors report on the short-term and long-term results of a series of laparoscopic esophagectomies.


METHODS
From January 2002 to March 2006, 22 nonrandomized patients were recruited to undergo an esophagectomy for neoplastic disease. The esophagectomy and esophagogastroplasty were carried out using the laparoscopic transhiatal technique in 9 patients; whereas, a combined laparoscopic and right-transthoracic incision was performed in the other 13 patients.


RESULTS
The mean follow-up was 21+/-3.23 months (mean+/-SD); range, 2 to 46 months. The overall survival rate resulted 84.0% at 12 months, 61.3% at 24 months, and 51.0% at 36 months. The proportions of cumulative survival showed significant differences when the following variables were considered: site of neoplasm (lower esophagus), American Society of Anesthesiologists 2, chronic obstructive pulmonary disease, type of surgical procedure, and inclusion in neoadjuvant protocol and staging. Recurrence rates were 3 (25%) in the radio-chemotherapy-treated group, and 5 (50%) in the primary surgery group (P=n.s.).


CONCLUSIONS
The two-year survival rates (61.3%) recorded in our series are comparable with those reported in other series of both laparoscopic and open surgeries. The logical conclusion was that a less invasive procedure did not imply a less curative one.
Benzoni
Enrico
E
Department of General Surgery, School of Medicine, University of Udine, Italy. enricobenzoni@yahoo.it
Bresadola
Vittorio
V
Terrosu
Giovanni
G
Uzzau
Alessandro
A
Cedolini
Carla
C
Intini
Sergio
S
Noce
Luigi
L
Bresadola
Fabrizio
F
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome