Comparative experience of open and minimally invasive esophagogastric resection.
BACKGROUND
A minimally invasive approach to esophagogastric cancer resection offers an attractive alternative to traditional open surgery; however, concerns regarding feasibility, safety, cost, and outcomes have restricted widespread acceptance of these procedures. This study outlines our comparative experiences of both open and minimally invasive esophagectomy over a 4-year period.


METHODS
Surgical outcomes were analyzed and compared between 30 consecutive patients who underwent open (Ivor Lewis) transthoracic esophagectomy (TTO) between January 2002 and December 2003 and 50 consecutive patients who underwent minimally invasive esophagectomy (MIO) from January 2004 to July 2006.


RESULTS
Inpatient mortality and overall surgical morbidity were identical for each cohort (TTO versus MIO: mortality 3% versus 2%; morbidity 50% versus 48%). Pulmonary-related complications were higher in the open series (23% versus 8%; p = 0.05). The incidence of gastric-conduit-related complications was similar between the two cohorts (13% versus 18%; p = 0.52). Survival at 1 and 2 years was 86% and 58% in the TTO group and 94% and 74% in the MIO group. No significant difference in calculated cost was observed (7,017 pounds sterling versus 7,885 pounds sterling).


CONCLUSIONS
Transition from open to minimally invasive techniques of esophagogastric resection for cancer is possible without compromising patient safety or incurring excessive financial expenses, and the minimally invasive procedure results in similar or potentially better outcomes.
Parameswaran
Rajeev
R
Department of Thoracic and Upper Gastrointestinal Surgery, The Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK. drrajeev_p@yahoo.com
Veeramootoo
Darmarajah
D
Krishnadas
Rakesh
R
Cooper
Martin
M
Berrisford
Richard
R
Wajed
Shahjehan
S
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome