Hybrid esophagectomy for esophageal cancer: Combined endoscopy-assisted laparoscopic transhiatal and thoracoscopic esophagectomy with artificial pneumothorax.

Yosuke Izumi, MD, PhD, Tairo Ryotokuji, MD, Michiyo Tokura, MD, Akinori Miura, MD, PhD, Tsuyoshi Kato, MD

Tokyo metropolitan cancer and infectious diseases center, Komagome Hospital

Background: Minimally invasive esophagectomy (MIE) was expected to reduce postoperative mobidity, especially pulmonary complications. One evidence was provided from the group of Europian influential hospitals. But further refinements are needed to realize the ideal MIE and improve survival.

Aim: To assess our outcomes after hybrid esophagectomy and investigate the optimum approach.

Methods: Between August 2000 and April 2011, we performed minimally invasive esophagectomy for 136 cases with esophageal cancer. Our current technique consists of hand-assisted laparoscopic gastric dissection, endoscopy-assisted mediastinoscopic dissection of the middle and lower esophagus under pneumoperitoneum and artificial pneumothorax by transhiatal CO2 insufflation and a right thoracoscopic approach for mobilization of the upper thoracic esophagus and lymph node dissection in the paratracheal region under artificial pneumothorax. This modification (“hybrid esophagectomy”) was done in latest 22 cases to address the obscured view by the lung and shorten the time of thoracoscopic procedure.

Results: Rate of pneumonia was 0% for hybrid esophagectomy and 5.1% for all 136 cases. Motality was 0% in all cases. Operative time of thoracoscopic procedure was 104 min on average for hybrid esophagectomy and 162 min for all cases. Five-year survival rate were 100 % for Stage 0 (n= 19), 96.9% for Stage I (n=46), 84.9 % for Stage II (n=31), 44.7 % for Stage III (n=30) and 30% for Stage IVA (n=10). Three-year disease free survivals were 95.2% in hybrid esophagectomy for 22 cases (Stage 0/ I/ II/ III=5/7/9/1 cases). Cancer stage is according to Japanese Classification of Japan Esophageal Society

Conclusion: MIE has a good short- and long-term outcomes. Hybrid eophagectomy is a good modification to reduce operative time of thoracoscopic procedure and possibly to reduce the risk of pulmonary failure.

Session: Poster Presentation

Program Number: P240

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