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Outcomes After Minimally Invasive Esophagectomy: Review of Over 1000 Patients

Luketich, James D. MD; Pennathur, Arjun MD; Awais, Omar DO; Levy, Ryan M. MD; Keeley, Samuel MD; Shende, Manisha MD; Christie, Neil A. MD; Weksler, Benny MD; Landreneau, Rodney J. MD; Abbas, Ghulam MD; Schuchert, Matthew J. MD; Nason, Katie S. MD, MPH

doi: 10.1097/SLA.0b013e3182590603
Original Articles

Background: Esophagectomy is a complex operation and is associated with significant morbidity and mortality. In an attempt to lower morbidity, we have adopted a minimally invasive approach to esophagectomy.

Objectives: Our primary objective was to evaluate the outcomes of minimally invasive esophagectomy (MIE) in a large group of patients. Our secondary objective was to compare the modified McKeown minimally invasive approach (videothoracoscopic surgery, laparoscopy, neck anastomosis [MIE-neck]) with our current approach, a modified Ivor Lewis approach (laparoscopy, videothoracoscopic surgery, chest anastomosis [MIE-chest]).

Methods: We reviewed 1033 consecutive patients undergoing MIE. Elective operation was performed on 1011 patients; 22 patients with nonelective operations were excluded. Patients were stratified by surgical approach and perioperative outcomes analyzed. The primary endpoint studied was 30-day mortality.

Results: The MIE-neck was performed in 481 (48%) and MIE-Ivor Lewis in 530 (52%). Patients undergoing MIE-Ivor Lewis were operated in the current era. The median number of lymph nodes resected was 21. The operative mortality was 1.68%. Median length of stay (8 days) and ICU stay (2 days) were similar between the 2 approaches. Mortality rate was 0.9%, and recurrent nerve injury was less frequent in the Ivor Lewis MIE group (P < 0.001).

Conclusions: MIE in our center resulted in acceptable lymph node resection, postoperative outcomes, and low mortality using either an MIE-neck or an MIE-chest approach. The MIE Ivor Lewis approach was associated with reduced recurrent laryngeal nerve injury and mortality of 0.9% and is now our preferred approach. Minimally invasive esophagectomy can be performed safely, with good results in an experienced center.

We evaluated the outcomes in 1011 patients who underwent minimally invasive esophagectomy. The operative mortality was 1.68%, and median length of stay of 8 days. Minimally invasive esophagectomy can be performed safely, with good results in an experienced center.

From the Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA.

Reprints: James D. Luketich, MD, Department of Cardiothoracic Surgery, University of Pittsburgh, 200 Lothrop St, C800 PUH, Pittsburgh, PA 15213. E-mail: luketichjd@upmc.edu

Disclosure: The authors declare no conflicts of interest.

Presented at American Surgical Association, 131st Annual Meeting, April 14–16, 2011, at Boca Raton, Florida.

© 2012 Lippincott Williams & Wilkins, Inc.