title: Gasless laparoscopically assisted transhiatal esophagectomy for upper esophageal carcinoma.
abstract: BACKGROUND
  Transhiatal esophagectomy frequently is thought to achieve lower morbidity by sacrificing long-term survival at 5 years. With the introduction of the isobaric laparoscopy using abdominal wall lifting, the authors explore gasless laparoscopically assisted transhiatal surgical treatment of upper thoracic or cervical esophageal carcinoma after neoadjuvant chemotherapy. They wish it not only lower morbidity but also similarity to transthoracic esophagectomy, with extended en bloc lymphadenectomy in aspects of median overall, disease-free, and quality-adjusted survival.
  
  
  METHODS
  Between 2011 and 2013, 11 patients with upper thoracic or cervical esophageal carcinoma were treated at the authors' department. Neoadjuvant chemotherapy was administered to these patients. Their clinical data were retrospectively analyzed. The tumor originated from the cervical esophagus in eight of these patients and from upper thoracic esophagus in three of them. None of the patients were receiving preoperation radiotherapy.
  
  
  RESULTS
  No operation-related deaths or conversion to open procedure occurred. The mean operative time was 146.0 ± 22.2 min, and the mean intraoperative blood loss was 192.7 ± 25.5 ml. Anastomotic leakage occurred in three cases, pulmonary complications in one case, cardiac complications in two cases, and herniation of part of the colon into the right thorax in one case. Two patients received postoperative auxiliary radiotherapy. All the patients were followed up for 6 months to 3.5 years. During the follow-up period, three patients experienced pulmonary complications at least once. All the patients reported heartburn and regurgitation from time to time after surgery. The survival rate was 63.6%.
  
  
  CONCLUSIONS
  With neoadjuvant chemotherapy, gasless laparoscopically assisted transhiatal esophagectomy provides a minimally invasive surgical treatment for upper thoracic or cervical esophageal carcinoma. But it seems that the postoperative complications are relatively high. Further study is needed to determine whether it can improve long-term survival.
authors.affiliation: Department of Surgery, Beijing Tongren Surgical Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China, wjx95@hotmail.com.
authors.forename: Ji-xiang
authors.initials: JX
authors.lastname: Wu
authors.forename: Lei
authors.initials: L
authors.lastname: Yu
authors.forename: Jian-ye
authors.initials: JY
authors.lastname: Li
authors.forename: Yun-feng
authors.initials: YF
authors.lastname: Zhang
authors.forename: Ji
authors.initials: J
authors.lastname: Ke
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies