title: The use of a tailored surgical technique for minimally invasive esophagectomy.
abstract: OBJECTIVE
  Uncertainty exists among surgeons as to whether minimally invasive esophagectomy (MIE) is a comparable operation to open esophagectomy (OE). The surgical technique and oncologic dissection should not be degraded when using a minimally invasive approach.
  
  
  METHODS
  We reviewed a single hospital's experience with both OE and MIE. From 2000 to 2010, 257 patients underwent esophagectomy by 1 of 3 surgical techniques: transhiatal, Ivor Lewis, or 3-hole.
  
  
  RESULTS
  Of the 257 patients (median age, 67 years; range, 58-74), 92 underwent MIE. Both groups were comparable in terms of gender, age, comorbidities, surgical technique, and induction chemotherapy and radiotherapy. The overall median follow-up was 29.5 months (range, 9.9-61.5). The MIE group had a significantly shorter operative time (MIE vs OE, 330 vs 365 minutes, P = .04), length of stay (MIE vs OE, 9 vs 12 days, P < .01), intensive care unit admission rate (MIE vs OE, 55% vs 81%, P < .01), intensive care unit length of stay (MIE vs OE, 1 vs 2 days, P < .01), and estimated blood loss (MIE vs OE, 100 vs 400 mL, P < .01). More lymph nodes were harvested in the MIE group than in the OE group (17 vs 11 nodes, P < .01). There were insignificant differences in 30-day mortality (MIE vs OE, 2.2% vs 3.0%; P = .93) and overall survival (P = .19), as well as in the rates of all complications, except pneumonia (MIE vs OE, 2% vs 13%; P = .01).
  
  
  CONCLUSIONS
  A thoracic surgeon can safely tailor the MIE to a patient's anatomy and oncologic demands while maintaining equivalent survival.
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, Herbert Irving Pavilion, Suite 301, New York, NY 10032, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Javidfar
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Yang
authors.forename: Joanna
authors.initials: J
authors.lastname: Miller
authors.forename: Frank
authors.initials: F
authors.lastname: D'Ovidio
authors.forename: Mark E
authors.initials: ME
authors.lastname: Ginsburg
authors.forename: Lyall A
authors.initials: LA
authors.lastname: Gorenstein
authors.forename: Marc
authors.initials: M
authors.lastname: Bessler
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Sonett
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009519:New York City; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome