Minimally invasive surgical treatment of esophageal carcinoma.
Surgical resection has proven successful in eradicating cancer of the esophagus, and it remains one of the main treatment modalities available for the curative management of patients with this disease. Unfortunately, patient morbidity is high because of the extensive nature of the surgery, which traditionally involves opening the chest and abdomen. Most time-honored techniques used to resect the esophagus and reconstruct the alimentary passage use the stomach as the replacement conduit, and a major abdominal dissection is therefore involved. Hoping to decrease the perioperative morbidity associated with esophagectomy, a number of thoracic surgeons have started to experiment with resection of the esophagus using aminimally invasive approach in select groups of patients. In minimally invasive esophagectomy (MIE), body cavities are accessed using a camera and fine, narrow instruments inserted through small incisions. Experience with abdominal surgery over the past decade suggests that a number of operative variables are improved using minimally invasive procedures, such as blood loss, rate of perioperative complications, and length of hospital stay. Data also suggest that the minimally invasive approach is comparable to or more advantageous than open procedures, in terms of both short- and long-term outcomes. Similarly, based on the limited data available today, shortterm outcomes after MIE are at least comparable with outcomes associated with open procedures. Minimally invasive resection of the esophagus for the management of esophageal cancer is feasible and safe. Whether MIE is better than traditional open techniques remains to be determined.
Mehran
Reza John
RJ
Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas.