title: Perioperative outcomes after transition from conventional to minimally invasive Ivor-Lewis esophagectomy in a specialized center.
abstract: BACKGROUND
  Minimally invasive techniques are now increasingly adopted for the treatment of esophageal cancers. Benefits such as earlier functional recovery and less need for transfusion and intensive care stay should be balanced by a determination to avoid compromise to the oncologic integrity of the procedure, especially in the early phase of transition from open to laparoscopic surgery. This study aimed to compare primary outcomes including oncologic clearance, complications, and functional recovery between open and laparoscopic esophagectomy in a single center.
  
  
  METHODS
  This prospective study recruited 75 consecutive patients undergoing Ivor-Lewis esophagectomy, all treated by a single surgeon. These patients were divided into three groups. The 24 patients in group A underwent open Ivor-Lewis esophagectomy. The remaining patients underwent laparoscopic Ivor-Lewis esophagectomy in two groups: 25 patients in an early cohort (group B) and 26 patients in a later cohort (group C). All the patients were treated according to the same protocol.
  
  
  RESULTS
  The three groups were adequately matched. The findings showed trends toward a reduction in median operative time, with group A requiring 260 min, group B requiring 249 min, and group C requiring 223 min (p = 0.06), and a significant reduction in the requirement for perioperative blood transfusion between groups A (65%) and C (27%) (p = 0.02). The median lymph node yield was significantly less in group B (n = 13) than in group A (n = 24) or group C (n = 22) (p = 0.003). There was no significant difference between the three groups in the length of hospital stay (median stay, 14-16 days) or the requirement for critical care beds (median stay, 3-4 days). The in-hospital mortality rate was zero, and the morbidity rate did not differ between the three groups.
  
  
  CONCLUSIONS
  This study shows that laparoscopic Ivor-Lewis esophagectomy is associated with a reduced need for blood transfusion, a shorter operative time, and an adequate lymph node harvest. Oncologic principles are not compromised during the transition phase from open to laparoscopic esophagectomy.
authors.affiliation: Department of Upper Gastrointestinal Surgery, St. Thomas' Hospital, 1st Floor, North Wing, Westminster Bridge Road, London, SE1 7EH, UK. ahmedhamouda@hotmail.com
authors.forename: Ahmed H
authors.initials: AH
authors.lastname: Hamouda
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Forshaw
authors.forename: Kostas
authors.initials: K
authors.lastname: Tsigritis
authors.forename: Greg E
authors.initials: GE
authors.lastname: Jones
authors.forename: Aliya S
authors.initials: AS
authors.lastname: Noorani
authors.forename: Ash
authors.initials: A
authors.lastname: Rohatgi
authors.forename: Abraham J
authors.initials: AJ
authors.lastname: Botha
mesh_terms: D001803:Blood Transfusion / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D020127:Recovery of Function; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome