title: Oncologic efficacy is not compromised, and may be improved with minimally invasive esophagectomy.
abstract: BACKGROUND
  Major morbidity and mortality rates continue to be high in large series of transthoracic esophagectomies. Minimally invasive approaches are being increasingly used. We compare our growing series of minimally invasive (combined thoracoscopic and laparoscopic) esophagectomies (MIEs) with a series of open transthoracic esophagectomies.
  
  
  METHODS
  We identified 65 patients who underwent an MIE with thoracoscopy/laparotomy (n = 11), Ivor Lewis (n = 2), or 3-hole approach (n = 52). These patients were compared with 53 patients who underwent open Ivor-Lewis esophagectomy (n = 15) or 3-hole esophagectomy (n = 38) over the past 10 years.
  
  
  RESULTS
  The MIE and open groups were similar regarding gender and average age. The majority of patients in the open group underwent neoadjuvant chemoradiation therapy (81%); a significantly smaller (43%) number of patients in the MIE group underwent neoadjuvant therapy (p < 0.0001). Regarding oncologic efficacy, 97% and 94% of patients in both groups underwent R0 resections. Patients undergoing MIE had a significant increase in the number of harvested lymph nodes (median 20 vs 9; p < 0.0001). Length of stay was significantly decreased in patients who underwent MIE (8.5 days vs 16 days; p = 0.002). Finally, there were significantly fewer serious complications (grades 3-5) in the MIE group (19% vs 48%; p = 0.0008).
  
  
  CONCLUSIONS
  In this initial report of a single-institution series of MIE, we demonstrate that oncologic efficacy is not compromised and may actually be improved with a significantly increased number of harvested LNs. We also demonstrate that this approach is associated with fewer serious complications and a significant decrease in the length of postoperative hospital stay.
authors.affiliation: Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA. adam.berger@jefferson.edu
authors.forename: Adam C
authors.initials: AC
authors.lastname: Berger
authors.forename: Aaron
authors.initials: A
authors.lastname: Bloomenthal
authors.forename: Benny
authors.initials: B
authors.lastname: Weksler
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Evans
authors.forename: Karen A
authors.initials: KA
authors.lastname: Chojnacki
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Rosato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013906:Thoracoscopy; D016896:Treatment Outcome