title: Application of a modified McKeown procedure (thoracoscopic esophageal mobilization three-incision esophagectomy) in esophageal cancer surgery: initial experience with 30 cases.
abstract: Early efforts with minimally invasive esophagectomy (MIE) were hybrid approaches. No conclusive benefit was seen with this approach compared with the standard open procedure. Total MIE has demonstrated its advantages in single institution series. The drawbacks of total MIE include the steep learning curve and the high cost of the disposable instrumentation. We sought to determine the feasibility of modifying the surgical technique involved in the hybrid approach in an effort to decrease the cost of the surgery without compromising the outcome. From December 2007 to September 2008, the modified McKeown procedure (thoracoscopic esophageal mobilization three-incision esophagectomy) was performed in 30 cases. The median operative time was 225 minutes (range, 195 -290 minutes) and the median average time of VATS was 70 minutes (range, 50 -130 minutes). Median lymph node retrieval was 25.6 +/- 4.8 nodes (15.1 +/- 3.4 intrathoracic) per patient. The median postoperative hospital stay was 17.1 +/- 6.3 days. There was no in-hospital (30 days) mortality. Postoperative complications occurred in 9 patients (30%), including 2 (6.7%) pneumonia, 1 (3.3%) chylothorax, 1 (3.3%) delayed gastric emptying, 1 (3.3%) vocal cord palsy, 2 (6.7%) neck anastomotic leaks, and 2 (6.7%) arrhythmias. This procedure is technically feasible and safe with lower mortality and mobility. The short-term surgical outcomes are comparable with most of the total MIE reports. Performing the gastric mobilization and spontaneous neck anastomosis first greatly facilitate and simplifies the VATS maneuver.
authors.affiliation: Department of Thoracic Surgery, The Cancer Hospital of Fudan University, Shanghai, China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Zhou
authors.forename: Haiquan
authors.initials: H
authors.lastname: Chen
authors.forename: Jiade J
authors.initials: JJ
authors.lastname: Lu
authors.forename: Jiaqing
authors.initials: J
authors.lastname: Xiang
authors.forename: Yawei
authors.initials: Y
authors.lastname: Zhang
authors.forename: Hong
authors.initials: H
authors.lastname: Hu
authors.forename: Xian
authors.initials: X
authors.lastname: Zhou
authors.forename: Xiaoyang
authors.initials: X
authors.lastname: Luo
authors.forename: Fu
authors.initials: F
authors.lastname: Yang
authors.forename: John
authors.initials: J
authors.lastname: Tam
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013536:Suture Techniques; D020775:Thoracic Surgery, Video-Assisted