title: Initial experience of total thoracoscopic and laparoscopic Ivor Lewis esophagectomy.
abstract: BACKGROUND
  Morbidity and mortality remain relatively high for transthoracic esophagectomy with open thoracotomy. The literature is limited in describing the total combined laparoscopic and thoracoscopic Ivor Lewis esophagectomy. The aim of this study is to evaluate the outcomes of combined thoracoscopic and laparoscopic Ivor Lewis esophagectomy for the treatment of esophageal carcinoma.
  
  
  METHODS
  This is a retrospective review of 15 patients diagnosed with esophageal carcinoma who underwent thoracoscopic and laparoscopic Ivor Lewis esophagectomy from August 2009 to August 2011. Eleven patients (73.3%) were diagnosed with adenocarcinoma, and 4 patients were diagnosed with squamous cell carcinoma. In total, 8 patients (53.3%) received induction chemoradiation. The mean follow-up time was 10.5 ± 1.9 months. Postoperative morbidity and mortality were reported.
  
  
  RESULTS
  The median age was 71 years old. Fifteen patients underwent total thoracoscopic laparoscopic and Ivor Lewis esophagectomy. The operative mortality rate was 0%. The mean operative time and estimated blood loss were 468 ± 54 minutes and 182 ± 67 mL, respectively. The median intensive care unit days and ventilator days were 1.0 and 0.0, respectively. The median length of stay was 10 days. In total, 3 patients developed complications: One contained anastomotic leak managed with an esophageal stent, one chylous effusion managed nonoperatively, and one case of postoperative atrial fibrillation. The median number of lymph nodes dissected was 11. All of the patients had an R0 resection.
  
  
  CONCLUSIONS
  Total thoracoscopic and laparoscopic Ivor Lewis esophagectomy is technically feasible, and we were able to achieve relatively good initial outcomes without major morbidity and mortality.
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California 94305-5407, USA. rmerritt@stanford.edu
authors.forename: Robert E
authors.initials: RE
authors.lastname: Merritt
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome