Erik A Green, MD, MPH, Kais Rona, MD, Christopher Ducoin, MD, MPH. Tulane University
Background: Esophagectomy remains a mainstay of treatment for esophageal malignancies as well as for refractory benign disease. Advances in laparoscopic and thoracosopic surgery have helped promote a variety of minimally invasive esophageal resection procedures. All of these, however, require a thoracic and/or neck incision. Here we describe a case series of patients treated with a totally laparoscopic esophagectomy technique.
Methods: A retrospective review of patients who underwent totally laparoscopic esophagectomy from April 2016 to April 2018 was conducted. Inclusion criteria comprised of benign stricture less than 5cm from the GE junction, adenocarcinoma Siewart classification II-III, and those with T1-T3 disease no evidence of nodal or metastatic disease.
Our standard approach consisted of four surgical ports placed in the upper abdomen. Intra-abdominal and mediastinal dissection was performed laparoscopically. Anastamosis in all 5 cases was achieved with an EEA stapler with the anvil passed trans-orally. Esophagoscopy was used as an adjunct, and a jejunal feeding tube was placed in all cases.
Results: Five patients underwent a totally laparoscopic distal esophagectomy procedure. Median age was 65 years (44-77 years) and the male to female ratio was 2:3. The indication for resection in 3 patients was benign distal stricture, refractory to more conservative treatments. Adenocarcinoma of the distal esophagus was the indication in the other 2 patients. In the 2 adenocarcinoma cases neoadjuvant chemoradiation was given, the initial staging was T2/3N0M0, and both were Siewert type II.
No cases required conversion to an open procedure. The mean operative time was 289 minutes (234-322 min). There was no 30-day mortality. Mean ICU stay was 12.8 days (2-32 days) and mean hospital stay 15.6 days (7-32 days). 3 of 5 patients had an uneventful post-operative course. 2 of 5 patients, including one case of benign stricture and one case of adenocarcinoma, experienced post-operative complications. One patient had respiratory failure with reintubation, and the other a contained leak, both necessitated a prolonged ICU stay. Neither of the two patients required reoperation or revision. R0 resection was achieved in both cases of adenocarcinoma.
Conclusion: We present a case series of 5 patients who underwent a totally laparoscopic transhiatal distal esophagectomy. Our preliminary results suggest it may be a safe alternative for distal benign strictures as well as for select patients with adenocarcinoma of the distal esophagus. Continued refinement of this technique may help decrease the morbidity and mortality of esophagectomy by avoiding a thoracic or neck incision.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95553
Program Number: P465
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster