Minimally invasive esophagectomy for carcinoma esophagus- outcome of surgical management: a single centre experience

C. K. Jakhmola; Vikram Trehan; S. Santosh Kumar

doi:10.18203/2349-2902.isj20181132

Authors

C. K. Jakhmola Department of Surgery, Base Hospital Delhi Cantt, New Delhi, India
Vikram Trehan Department of Surgery, Base Hospital Delhi Cantt, New Delhi, India
S. Santosh Kumar Department of Surgery, Base Hospital Delhi Cantt, New Delhi, India

DOI:

https://doi.org/10.18203/2349-2902.isj20181132

Keywords:

Carcinoma esophagus surgery, Minimally invasive esophagectomy, Thoracoscopic mobilization, Total thoracolaparoscopic esophagectomy

Abstract

Background: Minimally invasive esophagectomy (MIE) has shown an increasing trend, especially in the last decade, in the management of esophageal malignancy. The aim of the present study was to present a cohort of patients who underwent MIE between June 2008 to June 2016 at a single tertiary care centre.

Methods: A total of 103 esophagectomies were performed for esophageal malignancy which included 69 patients by minimally invasive technique. The procedure was performed by thoracoscopic mobilization of esophagus initially followed by reconstruction part done by either by minilaparotomy or by laparoscopic approach i.e. total thoracolaparoscopic esophagectomy (TLE).

Results: The MIE was successfully completed in 65 (94.2%) patients. Operative time ranged from 275 to 420 min (average 356 min). The number of dissected lymph nodes were 5–15 (9 on average). The postoperative period was uneventful - without any complications in 36 (52.17%) patients. The most common postoperative complications were respiratory complications which were observed in 22 (31.88%) patients. Other complications included post-operative bowel obstruction (1 patient), anastomotic leak (4 patients), and necrosis of the gastroplasty (1 patient). One patient had chyle leak while cardiac complication was seen in three cases. The overall morbidity of patients underwent MIE was 47.8%. Thirty-day mortality was 5.79%.

Conclusions: Esophagectomy performed by minimally invasive technique is a widely accepted surgical procedure for patients with middle and lower esophageal malignancy. The biggest benefit of MIE is avoidance of thoracotomy / laparotomy associated pain with resultant decrease in morbidity. The success of MIE requires a dedicated surgical team well trained in both MIE as well as in open surgical procedure.

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References

Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917.

Devesa SS, Blot WJ, Fraumeni JF Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 1998;83:2049-53.

Kelsen DP, Ginsberg R, Pajak TF, et al. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 1998;339:1979-84.

Duda M, Adamčík L, Dušek L, et al. Malignant tumors of the esophagus in the Czech republic. Rozhl Chir 2012;3:132-40.

Atkins BZ, Shan AS, Kelley A, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 2004;78:1170-6.

Ferguson MK, Durkin AE. Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorax Cardiovasc Surg 2002;123:661-9.

Cooke DT, Lin GC, Lau CL, et al: Analysis of cervical esopha¬gogastric anastomotic leaks after transhiatal esophagectomy: Risk factors, presentation, and detection. Ann Thorac Surg 2009; 88:177

Cuschieri A, Shimi S, Banting S. Endoscopic esophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 1992;37:7-11

Luketich JD, Alvelo-Rivera M, Buenaventura PO, et al. Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 2003;238:486-94.

Nguyen NT, Hinojosa MW, Smith BR, et al. Minimally invasive esophagectomy: lessons learned from 104 operations. Ann Surg 2008;248:1081-91.

Decker G, Coosemans W, De Leyn P, et al. Minimally invasive esophagestomy for cancer. Eur J Cardiothorax Surg 2009;35:13-20

Osugi H, Takemura M, Higashino M, et al. Learning curve of video- assisted thoracoscopic esophagectomy and extensit lymphadenectomy for squamous cell cancer of the thoracic esophagus and results. Surg Endosc 2003;17:515-9

DePaula AL, Hashiba K, Ferreira EA, et al. Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc 1995; 5:1-5

Fabian T, Martin JT, McKelvey JA, Federico JA. Minimally invasive esophagectomy: a teaching hospital’s first year experience. Dis Esophagus 2008;21:220-5.

Aujesky R, Neoral C, Kral V, et al. Video-assisted laparoscopic resection of the esophagus for carcinoma after neoadjuvant therapy. Hepatogastroenterology 2009;56:1035-8.

Fabian T, Mckelvey DM, Kent MS, et al. Prone thoracoscopic esophageal mobilization for minimally invasive esophagectomy. Surg Endosc 2007;21:1667-70

Song SY, Na KJ, Oh SG, Ahn BH. Learning curves of minimally invasive esophageal cancer surgery. Eur J Cardiothorac Surg 2009;35:689-93.

Ott K, Bader FG, Lordick F, et al. Surgical factors influence the outcome after Ivor-Lewis esophagectomy with intrathoracic anastomosis for adenocarcinoma of the esophagogastric junction: a consecutive series of 240 patient at an experienced center. Ann Surg Oncol 2009;16:1017-25.

Ferguson MK, Durkin AE. Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorax Cardiovasc Surg 2002;123:661-9.

Dumont P, Wihlm JM, Hentz JG, et al. Respiratory complications after surgical treatment of esophageal cancer. A study of 309 patients according to the type of resection. Eur J Cardiothorax Surg 1995;9:539-43

Ursehel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg 1995;169:634-40.

Wormuth JK, Heitmiler RF. Esophageal conduit necrosis.Thorac Surg Clin 2006;16:11-22.

Briel JW, Tamhankar AP, Hagen JA, et al. Prevalence and risk factors for ischemia, leak, and strictures of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg 2004; 198:536-41

Whooly BP, Law S, Murthy SC, et al. Analysis of reduced death and complication rates after esophageal resection. Ann Surg 2001;233:338-44

Rindani R, Martin CK, Cox MR: Transhiatal versus Ivor Lewis esophagectomy: Is there a difference? Aust NZ J Surg 1999;69:187

Hulscher JB, Tijssen JG, Hugo O, et al: Transthoracic versus transhiatal resection for carcinoma of the esophagus: A meta-analysis. Ann Thorac Surg 2001; 72:306 McGraw-Hill Education; 2013:796.