title: Minimally invasive esophagectomy for esophageal cancer: comparative analysis of open and hand-assisted laparoscopic abdominal lymphadenectomy with gastric conduit reconstruction.
abstract: OBJECTIVE
  Esophagectomy for esophageal cancer is an invasive procedure. Minimally invasive approaches such as hand-assisted laparoscopic surgery (HALS) might reduce surgical stress and improve postoperative course.
  
  
  METHODS
  We retrospectively analyzed 216 consecutive patients who underwent esophagectomy for esophageal cancer through either HALS (109 patients) or open laparotomy (107 patients), through an abdominal approach. The peri- and postoperative outcomes were compared between the two groups.
  
  
  RESULTS
  No significant difference was observed in physical and tumor status between the two groups. The mean operating time (HALS: 452 ± 65, Open: 456 ± 69 min) and mean number of resected lymph nodes (HALS: 19.3 ± 7.1, Open: 20.8 ± 8.3) were similar, while total blood loss was lower in HALS (HALS: 695 ± 369, Open: 1,101 ± 540 ml; P = 0.0001). The postoperative course showed marginally lower incidences of pulmonary (HALS: 6.4%, Open: 14.0%; P = 0.062) and overall complications (HALS: 23.9%, Open: 35.5%; P = 0.11), lower C-reactive protein level at postoperative days 1, 3, and 7, and shorter duration of systemic inflammatory response syndrome (HALS: 2.3 days, Open: 3.5 days; P = 0.0002) in HALS than in OPEN. The disease-free survival rates at 2 years were 65% in HALS and 53% in Open.
  
  
  CONCLUSIONS
  The findings suggest that HALS is feasible and useful for patients with esophageal cancer.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan. myamasaki@gesurg.med.osaka-u.ac.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamasaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyata
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Nakajima
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Kurokawa
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D058733:Hand-Assisted Laparoscopy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome