Background: Minimally invasive esophagectomy (MIE) can be expected to reduce postoperative mobidity, especially pulmonary complications, and motality. But further refinements are needed to realize the theoretical advantadges and improve survival.
Aim: To assess our outcomes after minimally invasive esophagectomy and investigate the opitimum approach.
Method: Between August 2000 and December 2007, we performed minimally invasive esophagectomy for 80 cases with esophageal squamous cell cancer. Our current technique consists of hand-assisted laparoscopic gastric dissection, mediastinoscopic dissection of the middle and lower esophagus under pneumoperitoneum and a right thoracoscopic approach for mobilization of the intrathoracic esophagus and lymph node dissection in the paratracheal region under artificial pneumothorax with CO2. This modification (“Hybrid esophagectomy”) was done in latest 37 cases to address the obscured view by the lung.
Results: Postoperative vital capacity is well recovered in MIE. Rate of pulmonary complications is lower in Hybrid esophagectomy (2.7%). Motality was 0% in MIE. Operative time of thoracoscopic procedure was 1h46m on average in Hybrid esophagectomy. Three-year disease free survivals were 100% for Stage 0, 89% for Stage I, 67% for Stage II, 53% for StageIII (Cancer stage is according to Japan Esophageal Society).
Conclusion: MIE is suitable for cancer sugery. Mediastinoscopic dissection under pneumoperitneum using transhiatal approach and artificial pneumothrax with CO2 are good modification to reduce operative time of thoracoscopic procedure and possibly to reduce the risk of pulmonary failure.
Program Number: P315