Outcome Following Laparoscopic Trans-Hiatal Esophagectomy for Esophageal Cancer

J C Cash, MD, J Zehetner, MD, MMM, Babek Heyadati, Peter F Crookes, MD, Namir Katkhouda, MD, Rodney J Mason, MD, John C Lipham, MD

University of Southern California Department of Surgery, Keck Medical Center of USC

Background: Minimally invasive techniques for esophagectomy have been published and most involve a multiple field approach including combined laparoscopic and thoracoscopic mobilization of the esophagus. A laparoscopic transhiatal esophagectomy with cervical anastomosis should potentially reduce the complications caused by thoracotomy. The aim of this study is to compare outcomes of laparoscopic transhiatal esophagectomy (LTE) as a single therapy compared to open transhiatal esophagectomy (OTE) and en-bloc esophagectomy (EBE).

Methods: A retrospective chart review was performed on all patients that had a LTE for cancer between July 2008 and July 2012, performed by a single surgeon (JL). Data was compared to a historic cohort of patients who underwent OTE and EBE at the same institution from July 2002 to July 2008.

Results: There were 33 patients with LTE, compared to 60 patients with OTE and 139 patients with EBE. Median age was 72 years, 75.5 years and 61 years, respectively (p<0.0001). Prevalence of co-morbidities was 76%, 83% and 63% (p=0.01). The presence of minor operative complications was similar among the groups (p=0.36), but major complications (defined as those requiring intervention other than conservative management, prolonging hospital stay, or any anastomotic complication) were significantly less common in the LTE group (12%, 23%, 33% respectively, p=0.04). The median number of blood transfusions during hospitalization was significantly lower in the LTE group (0, 2.5, 3, p=0.005). Median tumor size was significantly smaller (1.5cm, 2.2cm, 3cm, p=0.03) but the LTE group had a significantly higher % of patients with neo-adjuvant treatment (39%, 14%, 29%, p=0.008). Median Lymph-node yield for LTE was lower compared to OTE and EBE (22, 33, 49.5, p<0.0001), but the % of patients with positive nodes was similar (33%, 33%, 39%, p=0.69). The LTE group had a conversion rate of 6.1%. Mortality was not significantly different among the groups (0, 2%, 4%, p=0.38). The median length of stay for the LTE group was significantly lower (10 days, 13 days, 15 days, p<0.0001). Overall survival was not different between the 3 groups (p=0.80) with a median survival at 36 months of 70%, 65% and 65% respectively.

Conclusion: Laparoscopic transhiatal esophagectomy can be performed safely with significantly less major complications and shorter hospital stay than open esophagectomy. The reduced lymph-node harvest did not impact overall survival.

Session: Podium Presentation

Program Number: S059