title: Minimally invasive oesophagectomy in Wales.
abstract: BACKGROUND
  The uptake of minimally invasive oesophagectomy remains low in the UK. As the only centre in Wales which offers this approach, our aim was to determine the short-term outcomes following endoscopic 2-stage oesophagectomy with stapled intra-thoracic anastomosis.
  
  
  METHODS
  Details of 50 consecutive patients [88% (44) male, median age (range) 66 (42-83) years] with operable mid to distal oesophageal and gastro-oesophageal junctional cancer who underwent endoscopic 2-stage oesophagectomy were analysed prospectively between June 2009 to November 2013. Primary outcome measures were overall and disease free survival from diagnosis. Secondary outcome measures were length of hospital stay, morbidity, mortality, lymph node harvest and margin involvement.
  
  
  RESULTS
  Median follow-up was 25 months. Seventy per cent (n = 35) of patients had stage II or greater disease and underwent neoadjuvant chemotherapy. The median length of hospital stay was 10 (range 8-104) days. There was a trend towards a decreasing length of stay as experience increased. Overall 30-day operative morbidity was 40% (n = 20) and there was no 30, 60, 90-day or in-patient mortality. Anastomotic leak occurred in 6 patients (12%). The median lymph node harvest was 20 (range 7-35) nodes. Nine patients (18%) had involvement of the circumferential resection margin (all T3). Overall and disease free 2-year survival was 84.2 and 80.9% respectively.
  
  
  CONCLUSIONS
  Endoscopic 2-stage oesophagectomy can be performed safely and effectively with good early oncological and surgical outcomes.
authors.affiliation: North Wales Upper GI Cancer Unit, Wrexham Maelor Hospital, Wrexham, Wales LL13 7TD, United Kingdom. Electronic address: dcsy23@gmail.com.
authors.forename: David S Y
authors.initials: DS
authors.lastname: Chan
authors.affiliation: North Wales Upper GI Cancer Unit, Wrexham Maelor Hospital, Wrexham, Wales LL13 7TD, United Kingdom. Electronic address: Andrew.Baker@wales.nhs.uk.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Baker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D061214:Patient Safety; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014852:Wales
keywords: Minimally invasive oesophagectomy; Oesophageal cancer