Assisted laparoscopic transhiatal esophagectomy for the treatment of esophageal cancer.

BACKGROUND: Esophageal resection for the treatment of esophageal cancer is usually associated with high morbido-mortality risks, that can be reduced using laparoscopy. Laparoscopic transhiatal esophagectomy (LTE) has the potential to improve these results but, to-date, only a few limited series of cases have been reported. This report summarizes our experience in 24 cases. OBJECTIVE: To assess the outcomes following LTE. METHODS AND MATERIALS: Between 1998 and 2005, LTE was performed in 24 patients; 18 men and 6 women with an overall mean age of 63 years (range: 36-85). Indication for surgery was lower third esophageal cancer; 11 squamous cell carcinoma and 13 adenocarcinoma. Neoadjuvant chemotherapy and radiotherapy were used in 18 patients (75%). A laparoscopic transhiatal approach was used to perform an esophagectomy with curative intent. A cervical esophagogastric anastomosis was created. RESULTS: No reversion to conventional open surgery was required. Mean anesthesia time was 293.8 min (range: 255-360). Major complications occurred in 7 patients (29.2%). Two patients (8.3%) had leakage from the cervical anastomosis. Surgical mortality was 8.3%. The median stay in Intensive Care Unit was 5 days (range: 1-29). Median hospital stay was 11.5 days (range: 7-54). At a mean follow-up of 24.9 months, 8 patients (36.4%) had disease recurrence (36.4%), global survival rate was 62.5%, and diseasefree survival rate was 50%. CONCLUSIONS: Assisted laparoscopic transhiatal esophagectomy for lower third esophageal cancer is a potentially safe and effective method when performed by surgeons with expertise in the field. Benefits from this approach need to be confirmed by further randomized studies.

Assisted laparoscopic transhiatal esophagectomy for the treatment of esophageal cancer

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Background. Esophageal resection for the treatmentof esophageal cancer is usually associatedwith high morbido-mortality risks, that can be reducedusing laparoscopy. Laparoscopic transhiatalesophagectomy (LTE) has the potential to improvethese results but, to-date, only a few limited seriesof cases have been reported. This report summarizesour experience in 24 cases.Objective. To assess the outcomes following LTE.Methods and materials. Between 1998 and 2005,LTE was performed in 24 patients; 18 men and 6women with an overall mean age of 63 years(range: 36-85). Indication for surgery was lowerthird esophageal cancer; 11 squamous cell carcinomaand 13 adenocarcinoma. Neoadjuvant chemotherapyand radiotherapy were used in 18 patients(75%). A laparoscopic transhiatal approach wasused to perform an esophagectomy with curativeintent. A cervical esophagogastric anastomosis wascreated.Results. No reversion to conventional open surgerywas required. Mean anesthesia time was 293.8 min(range: 255-360). Major complications occurred in 7patients (29.2%). Two patients (8.3%) had leakagefrom the cervical anastomosis. Surgical mortalitywas 8.3%. The median stay in Intensive Care Unitwas 5 days (range: 1-29). Median hospital stay was11.5 days (range: 7-54). At a mean follow-up of 24.9months, 8 patients (36.4%) had disease recurrence(36.4%), global survival rate was 62.5%, and diseasefreesurvival rate was 50%.Conclusions. Assisted laparoscopic transhiatal esophagectomyfor lower third esophageal cancer is apotentially safe and effective method when performedby surgeons with expertise in the field.Benefits from this approach need to be confirmedby further randomized studies