Article Abstract

Results of the introduction of a minimally invasive esophagectomy program in a tertiary referral center

Authors: Rachel L.G.M. Blom, Jean H.G. Klinkenbijl, Markus W. Hollmann, Jacques J.G.H.M. Bergman, Miguel A. Cuesta, Willem A. Bemelman, Olivier R.C. Busch, M.I. van Berge Henegouwen

Abstract

Background: Esophagectomy is accompanied by a high postoperative complication rate. Minimally invasive esophageal
surgery appears to be a promising technique that might be associated with a lower pulmonary morbidity rate. The
objective of this study was to describe the implementation of minimally invasive esophageal surgery in a tertiary referral
center and to compare the results of our first series of minimally invasive esophagectomies (MIE) to conventional open
esophagectomies.

Methods: MIE was implemented after several procedures had been proctored by a surgeon with extensive experience
with MIE. Preoperative characteristics and the postoperative course of patients who underwent a transthoracic
esophagectomy were prospectively registered. Morbidity and overall hospital stay were compared between minimally
invasive and open resections performed in the same period.

Results: A total of 90 consecutive esophageal cancer patients underwent a transthoracic resection, 41 patients by means of
a minimally invasive approach. Preoperative characteristics were comparable for both groups. The duration of surgery was
longer in the MIE group (6.0 vs. 5.2 hours, P<0.001) and median blood loss was lower [100 vs. 500 mL (P<0.001)]. There
was only a trend towards a shorter hospital stay in the MIE group (11 vs. 13 days, P=0.072), pulmonary complications
occurred in 20% of patients in the MIE group vs. 31% in the open group (P=0.229). The overall complication rate was
51% in the MIE group vs. 63% in the open group, P=0.249.

Conclusions: Implementation of MIE in our center was successful and it appears to be a safe technique for patients with
potentially curable esophageal carcinoma.