Video Assisted Thoracoscopic Esophagctomy for Carcinoma Esophagus

Introduction:Thoracoscopic esophagectomy is emerging as an alternative to conventional open esophagectomy. It is perceived to have advantages of reduced surgical trauma and hence lesser postoperative morbidity. This paper presents outcome of patients undergoing thoracoscopic esophagectomy and compares it to patients undergoing open surgery in the same time period in the thoracic surgical service of Tata Memorial Hospital, India.
Methods and Patients:This is a retrospective analysis of a prospective database of 107 patients with carcinoma esophagus and cardia who underwent thoracoscopic esophagectomy between January 2004 and August 2007. Thoracic operative time and blood loss, total blood transfused, ventilatory days, total hospital days, pulmonary complications, major morbidity, anastomotic leak, hospital mortality, cirumferential resection margin, number of lymph nodes harvested, and incidence of relapse were evaluated. These parameters were compared with that of 236 patients undergoing standard open surgery performed during the same time period.
Results:Thoracoscopic esophagectomy was attempted in 132 patients and performed successfully in 107 patients (19% conversion rate). Lung adhesions and advanced disease were the most common reasons for conversion. The two group of patients were similar with respect to pre operative variables. The mean thoracic operative time was two hours for both groups; mean thoracic blood loss was 300 ml for both groups; mean blood transfused was 330 ml, (348 ml for open surgery)mean ventilator days were 1.6 days (1.8 for open surgery), and total hospital stay was 15 days. for both groups The frequency of pulmonary complications was 22% (27% for open surgery), major morbidity from any cause was 23% (25% for open surgery), anastomotic leak rate was 6% (7% for open surgery) and hospital mortality was 5% for both groups. A median number of 30 lymph nodes harvested (31 for open surgey) and the frequency of microscopic positive circumferential resectionl margin was 30% (27% for open surgery). With mean follow up period of 7.5 months the relapse rate was 23% (16% for open surgery). The difference in the outcome measures between the two groups was statistically not significant.
Conclusions: Thoracoscopic esophagectomy compares well with open surgery with respect to safety and short term outcome measures; however it fails to confirm the perceived advantage of thoracoscopic surgery with respect to reduced morbidity and early recovery.

Session: Podium Presentation

Program Number: S004