title: Laparoscopic assisted versus open gastric pull-up following thoracoscopic esophagectomy: A cohort study.
abstract: BACKGROUND
  Thoracolaparoscopic esophagectomy (TLE) is a type of minimally invasive esophagectomy (MIE) for esophageal cancer which consists of thoracoscopic resection and laparoscopic reconstruction. The aim of the present study was to evaluate the technical and oncological feasibility of alimentary tract reconstruction with laparoscopically assisted gastric pull-up (LAG) following thoracoscopic esophagectomy in the prone position (TSEP) in comparison with reconstruction with open laparotomy gastric pull-up (OLG) following TSEP, to establish TLE with extended lymph node dissection as a standard operation for esophageal cancer.
  
  
  METHODS
  Sixty-four patients with esophageal cancer underwent TSEP with 3-field lymphadenectomy from 2008 through 2010: for reconstruction after TSEP, 31 patients underwent LAG, and 33 patients underwent OLG. We retrospectively evaluated the technical and oncological feasibility of TLE with 3-field lymphadenectomy and compared surgical outcomes after reconstruction with OLG and that with LAG.
  
  
  RESULTS
  TLE with 3-field lymphadenectomy was successfully completed in 30 of 31 (97%) patients, and no surgery-related postoperative deaths occurred. No significant difference was found between LAG and OLG in the mean number of dissected abdominal lymph nodes, amount of blood loss, incidence of postoperative complications, mean postoperative hospital stay, restoration rate of respiratory function, or rate of complete resection or locoregional control, but the mean duration of abdominal procedures was significantly longer with LAG than with OLG.
  
  
  CONCLUSIONS
  This study demonstrates that the quality and safety of surgery and the oncological effectiveness of LAG for esophageal cancer. TLE consisting of LAG following TSEP with extended lymph-node dissection is a feasible surgical technique for thoracic esophageal carcinoma.
authors.affiliation: Department of Surgery, National Cancer Center Hospital East, Chiba, Japan. Electronic address: hdaikou@east.ncc.go.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daiko
authors.affiliation: Department of Surgery, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Fujita
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013906:Thoracoscopy / Q000379:methods*
keywords: Esophageal cancer; Laparoscopic surgery; Thoracoscopic surgery