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Results of Thoraco- Laparoscopic Esophagectomy for Esophageal Cancer: Experience of 70 Cases at University Medical Center

Vo D Long, Msc, Nguyen H Bac, Prof, Nguyen V Tuan Anh, Nguyen V Hai, Tong P Quang Trung, Ho L Minh Quoc. University Medical Center

Background: Thoracoscopic esophagectomy is rapidly and increasingly being used worldwide because it is a less invasive alternative to open esophagectomy. The aim of this study was to evaluate the feasibility, safety and long-term oncologic results of the thoraco- laparoscopic esophagectomy for esophageal cancer at single center.

Methods: We reviewed the records of 70 consecutive patients who underwent thoraco- laparoscopic esophagectomy due to esophageal cancer at University Medical Center in Hochiminh city Vietnam between January 2008 and June 2016. The gastric tube was introduced via the posterior mediastinum to the cervical level to anastomose with the cervical esophagus on the left neck. Outcome measures included patient demographics and outcomes, operative findings, morbidity, and histopathologic characteristics of the tumor and 1, 3, 5 year overall survival rates.

Results: Of the 70 patients, 3 were women and 67 were men (95.7%), with a mean age of 52 years. All patients were completed by thoracoscopy and laparoscopy with two field lymphadenectomy in 60 patients and three field in the others 10 patients and no conversion. The mean tumor size was 7.1 cm (range, 2–10 cm) with 6 lesions located in the upper third, 28 in the middle third, and 36 in the lower third of the esophagus. The mean operative time was 280 minutes (range, 240–480 minutes) and mean estimated intraoperative blood loss was 63 ml and no transfusion was required. The number of lymph nodes harvested was 20 and the rates of metastatic lymph nodes was 48.8%. There were 32 patients was in the left lateral decubitus position (first period) and others 38 patients was in the prone position (later period). The mean length of hospital stay was 9.8 days (range 7 – 20 days). Postoperative morbidity was encountered in 8 (11.4%) patients including 2 cases with anastomotic leakage at postoperative 7th day, 3 cases with anastomotic stenosis, 2 patients with temporary vocal paralysis and 1 patient with pneumonia but only 1 patient of anastomotic leakge was required to reoperate. The 30-day postoperative mortality rate was 0% All lesions had negative resection margins. The 1, 3 and 5 year overall survival rates were 88,4%, 66% and 38,2%, respectively.

Conclusion: The approach of the esophagectomy through a right thoracoscopy in combination with laparoscopy and cervical incision is feasible, safe and good result of oncologic factor.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 78707

Program Number: S030

Presentation Session: Foregut 1

Presentation Type: Podium

42

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