Minimally invasive esophagectomy has the potential to minimize the morbidity of esophageal resection and is particularly suited to the transhiatal approach. This report details our experience with this technique and the lessons we have learned.
A retrospective analysis of patients who underwent minimally invasive transhiatal esophagectomy was performed. Parameters assessed included patient demographics, tumor pathology, operative and postoperative course, and survival.
Eighteen patients underwent minimally invasive transhiatal esophagectomy [median age = 69 years (range = 36–79)]. Seventeen were operated on for cancer, including 13 adenocarcinomas and 4 squamous cell carcinomas (median histological stage = 2, range = 1–3), and 1 for high-grade dysplasia in Barrett’s. One patient had neoadjuvant chemotherapy. Two patients underwent nonemergency conversion to open surgery. The median duration of operation was 300 min (range = 180–450). All anastomoses were end-to-side hand-sewn. No patients received a red cell transfusion. The 30-day mortality was zero. Complications developed in 15 patients, including 7 respiratory and 10 recurrent laryngeal nerve injuries. There were two anastomotic leaks. Six patients developed stenosis requiring dilatation. The median length of stay was 15 days (range = 10–39). The median number of nodes harvested was 10 (range = 2–26). At a median follow-up of 13 months (range = 4–42), 13 patients were alive.
Minimally invasive transhiatal esophagectomy is feasible in our unit, with acceptable mortality. The high rate of anastomotic stenosis has resulted in a change to a semimechanical, side-to-side isoperistaltic technique. The high rate of recurrent laryngeal nerve injuries has resulted in the avoidance of metal retractors at the tracheo-esophageal groove.
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Siewert JR, Stein HJ (1998) Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 85:1457–1459
Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeier PF, ten Kate FJ, van Dekken H, Obertop H, Tilanus HW, van Lanschot JJ (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669
Orringer MB, Marshall B, Iannettoni MD (1999) Transhiatal esophagectomy: clinical experience and refinements. Ann Surg 230:392–400
Baba M, Natsugoe S, Shimada M, Nakano S, Noguchi Y, Kawachi K, Kusano C, Aikou T (1999) Does hoarseness of voice from recurrent nerve paralysis after esophagectomy for carcinoma influence patient quality of life? J Am Coll Surg 188:231–236
Gockel I, Kneist W, Keilmann A, Junginger T (2005) Recurrent laryngeal nerve paralysis (RLNP) following esophagectomy for carcinoma. Eur J Surg Oncol 31:277–281
Hulscher JB, van Sandick JW, Devriese PP, van Lanschot JJ, Obertop H (1999) Vocal cord paralysis after subtotal oesophagectomy. Br J Surg 86:1583–1587
Behzadi A, Nichols FC, Cassivi SD, Deschamps C, Allen MS, Pairolero PC (2005) Esophagogastrectomy: the influence of stapled versus hand-sewn anastomosis on outcome. J Gastrointest Surg 9:1031–1040
Santos RS, Raftopoulos Y, Singh D, DeHoyos A, Fernando HC, Keenan RJ, Luketich JD, Landreneau RJ (2004) Utility of total mechanical stapled cervical esophagogastric anastomosis after esophagectomy: a comparison to conventional anastomotic techniques. Surgery 136:917–925
Casson AG, Porter GA, Veugelers PJ (2002) Evolution and critical appraisal of anastomotic technique following resection of esophageal adenocarcinoma. Dis Esophagus 15:296–302
Urschel JD, Blewett CJ, Bennett WF, Miller JD, Young JE (2001) Handsewn or stapled esophagogastric anastomoses after esophagectomy for cancer: meta-analysis of randomized controlled trials. Dis Esophagus 14:212–217
Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238:486–494
Nguyen NT, Roberts P, Follette DM, Rivers R, Wolfe BM (2003) Thoracoscopic and laparoscopic esophagectomy for benign and malignant disease: lessons learned from 46 consecutive procedures. J Am Coll Surg 197:902–913
Avital S, Zundel N, Szomstein S, Rosenthal R (2005) Laparoscopic transhiatal esophagectomy for esophageal cancer. Am J Surg 190:69–74
Bann S, Moorthy K, Shaul T, Foley R (2005) Laparoscopic transhiatal surgery of the esophagus. JSLS 9:376–381
Smithers BM, Gotley DC, McEwan D, Martin I, Bessell J, Doyle L (2001) Thoracoscopic mobilization of the esophagus. A 6 year experience. Surg Endosc 15:176–182
Swanson SJ, Batirel HF, Bueno R, Jaklitsch MT, Lukanich JM, Allred E, Mentzer SJ, Sugerbaker DJ (2001) Transthoracic esophagectomy with radical mediastinal and abdominal lymph node dissection and cervical esophagogastrostomy for esophageal carcinoma. Ann Thorac Surg 72:1918–1924
Yamamoto S, Kawahara K, Maekawa T, Shiraishi T, Shirakusa T (2005) Minimally invasive esophagectomy for stage I and II esophageal cancer. Ann Thorac Surg 80:2070–2075
Rindani R, Martin CJ, Cox MR (1999) Transhiatal versus Ivor-Lewis oesophagectomy: is there a difference? Aust N Z J Surg 69:187–194
Bonavina L, Bona D, Binyom PR, Peracchia A (2004) A laparoscopy-assisted surgical approach to esophageal carcinoma. J Surg Res 117:52–57
Bizekis C, Kent MS, Luketich JD, Buenaventura PO, Landreneau RJ, Schuchert MJ, Alvelo-Rivera M ( 2006) Initial experience with minimally invasive Ivor-Lewis esophagectomy. Ann Thorac Surg 82:402–406
Mariette C, Triboulet JP (2006) Should resectable esophageal cancer be resected? Ann Surg Oncol 13:447–449
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Sanders, G., Borie, F., Husson, E. et al. Minimally invasive transhiatal esophagectomy: lessons learned. Surg Endosc 21, 1190–1193 (2007). https://doi.org/10.1007/s00464-007-9312-y
- Minimally invasive esophagectomy
- Transhiatal esophagectomy
- Esophageal cancer