title: Perioperative outcomes of laparoscopic transhiatal esophagectomy with antegrade esophageal inversion for high-grade dysplasia and invasive esophageal cancer.
abstract: BACKGROUND
  We examined the safety and effectiveness of antegrade laparoscopic inversion esophagectomy (LIE) for patients with multifocal high-grade dysplasia and distal esophageal cancer.
  
  
  METHODS
  We reviewed our experience with antegrade LIE, using an institutional research board-approved prospective database.
  
  
  RESULTS
  Thirty-six patients with an average age of 64 years underwent LIE. Indications included multifocal high-grade dysplasia (n = 4), adenocarcinoma (n = 30), and squamous cell carcinoma (n = 2); 11 patients had undergone neoadjuvant chemoradiation. LIE was completed successfully in 34 (94%) patients, whereas 2 required a conversion to open transhiatal esophagectomy. LIE required 221 minutes to perform, with a median blood loss of 100 mL. R0 resection was achieved in 97% of cases with a median lymph node harvest 15. Median hospital stay was 8 days, and 61% of patients were discharged to their home. Postoperative complications included anastomotic leak (n = 11) and stricture (n = 18), atrial arrhythmia (n = 5), pneumonia (n = 4), and tracheoesophageal fistula (n = 2). Operative outcomes after neoadjuvant therapy did not differ from those for primary operative resection.
  
  
  CONCLUSIONS
  Antegrade LIE is a safe treatment approach for patients with high-grade dysplasia and distal esophageal cancer. Complete resection with an adequate lymph node harvest can be achieved consistently for primary operative resection or after neoadjuvant chemoradiation.
authors.affiliation: Division of General and Gastrointestinal Surgery, The Ohio State University, Columbus, OH. Electronic address: kyle.perry@osumc.edu.
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Perry
authors.forename: Luke M
authors.initials: LM
authors.lastname: Funk
authors.forename: Peter
authors.initials: P
authors.lastname: Muscarella
authors.forename: W Scott
authors.initials: WS
authors.lastname: Melvin
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D016896:Treatment Outcome