Results of the introduction of a minimally invasive esophagectomy program in a tertiary referral center.
BACKGROUND
Esophagectomy is accompanied by a high postoperative complication rate. Minimally invasive esophageal surgery appears to be a promising technique that might be associated with a lower pulmonary morbidity rate. The objective of this study was to describe the implementation of minimally invasive esophageal surgery in a tertiary referral center and to compare the results of our first series of minimally invasive esophagectomies (MIE) to conventional open esophagectomies.


METHODS
MIE was implemented after several procedures had been proctored by a surgeon with extensive experience with MIE. Preoperative characteristics and the postoperative course of patients who underwent a transthoracic esophagectomy were prospectively registered. Morbidity and overall hospital stay were compared between minimally invasive and open resections performed in the same period.


RESULTS
A total of 90 consecutive esophageal cancer patients underwent a transthoracic resection, 41 patients by means of a minimally invasive approach. Preoperative characteristics were comparable for both groups. The duration of surgery was longer in the MIE group (6.0 vs. 5.2 hours, P<0.001) and median blood loss was lower [100 vs. 500 mL (P<0.001)]. There was only a trend towards a shorter hospital stay in the MIE group (11 vs. 13 days, P=0.072), pulmonary complications occurred in 20% of patients in the MIE group vs. 31% in the open group (P=0.229). The overall complication rate was 51% in the MIE group vs. 63% in the open group, P=0.249.


CONCLUSIONS
Implementation of MIE in our center was successful and it appears to be a safe technique for patients with potentially curable esophageal carcinoma.
Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands;
Rachel L G M
RL
Blom
Jean H G
JH
Klinkenbijl
Markus W
MW
Hollmann
Jacques J G H M
JJ
Bergman
Miguel A
MA
Cuesta
Willem A
WA
Bemelman
Olivier R C
OR
Busch
M I
MI
van Berge Henegouwen