title: Updated experiences with minimally invasive McKeown esophagectomy for esophageal cancer.
abstract: OBJECTIVE
  To update our experiences with minimally invasive McKeown esophagectomy for esophageal cancer.
  
  
  METHODS
  We retrospectively reviewed the medical records of 445 consecutive patients who underwent minimally invasive McKeown esophagectomy between January 2009 and July 2015 at the Cancer Hospital of Chinese Academy of Medical Sciences and used 103 patients who underwent open McKeown esophagectomy in the same period as controls. Among 375 patients who underwent total minimally invasive McKeown esophagectomy, 180 in the early period were chosen for the study of learning curve of total minimally invasive McKeown esophagectomy. These 180 minimally invasive McKeown esophagectomies performed by five surgeons were divided into three groups according to time sequence as group 1 (n = 60), group 2 (n = 60) and group 3 (n = 60).
  
  
  RESULTS
  Patients who underwent total minimally invasive McKeown esophagectomy had significantly less intraoperative blood loss than patients who underwent hybrid minimally invasive McKeown esophagectomy or open McKeown esophagectomy (100 mL vs 300 mL vs 200 mL, P = 0.001). However, there were no significant differences in operation time, number of harvested lymph nodes, or postoperative morbidity including incidence of pulmonary complication and anastomotic leak between total minimally invasive McKeown esophagectomy, hybrid minimally invasive McKeown esophagectomy and open McKeown esophagectomy groups. There were no significant differences in 5-year survival between these three groups (60.5% vs 47.9% vs 35.6%, P = 0.735). Patients in group 1 had significantly longer duration of operation than those in groups 2 and 3. There were no significant differences in intraoperative blood loss, number of harvested lymph nodes, or postoperative morbidity including incidence of pulmonary complication and anastomotic leak between groups 1, 2 and 3.
  
  
  CONCLUSIONS
  Total minimally invasive McKeown esophagectomy was associated with reduced intraoperative blood loss and comparable short term and long term survival compared with hybrid minimally invasive McKeown esophagectomy or open Mckeown esophagectomy. At least 12 cases are needed to master total minimally invasive McKeown esophagectomy in a high volume center.
authors.affiliation: Ju-Wei Mu, Shu-Geng Gao, Qi Xue, You-Sheng Mao, Da-Li Wang, Jun Zhao, Yu-Shun Gao, Jin-Feng Huang, Jie He, Department of Thoracic Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Ju-Wei
authors.initials: JW
authors.lastname: Mu
authors.affiliation: Ju-Wei Mu, Shu-Geng Gao, Qi Xue, You-Sheng Mao, Da-Li Wang, Jun Zhao, Yu-Shun Gao, Jin-Feng Huang, Jie He, Department of Thoracic Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Shu-Geng
authors.initials: SG
authors.lastname: Gao
authors.affiliation: Ju-Wei Mu, Shu-Geng Gao, Qi Xue, You-Sheng Mao, Da-Li Wang, Jun Zhao, Yu-Shun Gao, Jin-Feng Huang, Jie He, Department of Thoracic Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Xue
authors.affiliation: Ju-Wei Mu, Shu-Geng Gao, Qi Xue, You-Sheng Mao, Da-Li Wang, Jun Zhao, Yu-Shun Gao, Jin-Feng Huang, Jie He, Department of Thoracic Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: You-Sheng
authors.initials: YS
authors.lastname: Mao
authors.affiliation: Ju-Wei Mu, Shu-Geng Gao, Qi Xue, You-Sheng Mao, Da-Li Wang, Jun Zhao, Yu-Shun Gao, Jin-Feng Huang, Jie He, Department of Thoracic Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Da-Li
authors.initials: DL
authors.lastname: Wang
authors.affiliation: Ju-Wei Mu, Shu-Geng Gao, Qi Xue, You-Sheng Mao, Da-Li Wang, Jun Zhao, Yu-Shun Gao, Jin-Feng Huang, Jie He, Department of Thoracic Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Ju-Wei Mu, Shu-Geng Gao, Qi Xue, You-Sheng Mao, Da-Li Wang, Jun Zhao, Yu-Shun Gao, Jin-Feng Huang, Jie He, Department of Thoracic Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Yu-Shun
authors.initials: YS
authors.lastname: Gao
authors.affiliation: Ju-Wei Mu, Shu-Geng Gao, Qi Xue, You-Sheng Mao, Da-Li Wang, Jun Zhao, Yu-Shun Gao, Jin-Feng Huang, Jie He, Department of Thoracic Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Jin-Feng
authors.initials: JF
authors.lastname: Huang
authors.affiliation: Ju-Wei Mu, Shu-Geng Gao, Qi Xue, You-Sheng Mao, Da-Li Wang, Jun Zhao, Yu-Shun Gao, Jin-Feng Huang, Jie He, Department of Thoracic Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Jie
authors.initials: J
authors.lastname: He
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002681:China; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Esophagectomy; Learning curve; Minimally invasive; Outcome; Surgical procedures