title: Minimally invasive esophagectomy for esophageal cancer: the first experience from Pakistan.
abstract: BACKGROUND
  Two common procedures for esophageal resection are Ivor Lewis esophagectomy and transhiatal esophagectomy. Both procedures have high morbidity rates of 20-46%. Minimally invasive esophagectomy has been introduced to decrease morbidity. We report initial experience of MIE to determine the morbidity and mortality associated with this procedure during learning phase.
  
  
  METHODS
  Patients undergoing MIE at our institute from January 2011 to May 2013 were reviewed. Record was kept for any morbidity and mortality. Descriptive statistics were presented as frequencies and continuous variables were presented as median. Survival analysis was performed using Kaplan Meier curves.
  
  
  RESULTS
  We performed 51 minimally invasive esophagectomies. Perioperative morbidity was in 16 (31.37%) patients. There were 3 (5.88%) anastomotic leaks. We encountered 1 respiratory complication. Reexploration was required in 3 (5.88%) patients. Median operative time was 375 minutes. Median hospital stay was 10 days. The most frequent long-term morbidity was anastomotic narrowing observed in 5 (9.88%) patients. There were no perioperative mortalities. Our mean overall survival was 37.66 months (95% confidence interval 33.75 to 41.56 months). Mean disease-free survival was 24.43 months (95% CI 21.26 to 27.60 months).
  
  
  CONCLUSIONS
  Minimally invasive esophagectomy, when performed in the learning phase, has acceptable morbidity and mortality.
authors.affiliation: Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital, House No. 164, Lane No. 7, J-3 Block Wapda Town Phase 1, Lahore 54000, Pakistan.
authors.forename: Farrukh Hassan
authors.initials: FH
authors.lastname: Rizvi
authors.affiliation: Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital, House No. 164, Lane No. 7, J-3 Block Wapda Town Phase 1, Lahore 54000, Pakistan.
authors.forename: Syed Shahrukh Hassan
authors.initials: SS
authors.lastname: Rizvi
authors.affiliation: Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital, House No. 164, Lane No. 7, J-3 Block Wapda Town Phase 1, Lahore 54000, Pakistan.
authors.forename: Aamir Ali
authors.initials: AA
authors.lastname: Syed
authors.affiliation: Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital, House No. 164, Lane No. 7, J-3 Block Wapda Town Phase 1, Lahore 54000, Pakistan.
authors.forename: Shahid
authors.initials: S
authors.lastname: Khattak
authors.affiliation: Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital, House No. 164, Lane No. 7, J-3 Block Wapda Town Phase 1, Lahore 54000, Pakistan.
authors.forename: Ali Raza
authors.initials: AR
authors.lastname: Khan
mesh_terms: D000328:Adult; D000368:Aged; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009017:Morbidity / Q000639:trends; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult