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Minimally Invasive Esophagectomy: Outcomes in 222 Patients

Luketich, James D. MD*; Alvelo-Rivera, Miguel MD*; Buenaventura, Percival O. MD*; Christie, Neil A. MD*; McCaughan, James S. MD*; Litle, Virginia R. MD*; Schauer, Philip R. MD*; Close, John M. MA; Fernando, Hiran C. MD*

doi: 10.1097/01.sla.0000089858.40725.68
Original Papers and Discussions

Objective: To assess our outcomes after minimally invasive esophagectomy (MIE).

Summary Background Data: Esophagectomy has traditionally been performed by open methods. Results from most series include mortality rates in excess of 5% and hospital stays frequently greater than 10 days. MIE has the potential to improve these results, but only a few small series have been reported. This report summarizes our experience of 222 cases.

Methods: From 1996 to 2002, MIE was performed in 222 patients. Indications for operation included high-grade dysplasia (n = 47) and cancer (n = 175). Neoadjuvant chemotherapy was used in 78 (35.1%) and radiation in 36 (16.2%). Initially, a laparoscopic transhiatal approach was used (n = 8), but subsequently our approach evolved to include thoracoscopic mobilization (n = 214).

Results: There were 186 men and 36 women. Median age was 66.5 years (range, 39–89). Nonemergent conversion to open procedure was required in 16 patients (7.2%). MIE was successfully completed in 206 (92.8%) patients. The median intensive care unit stay was 1 day (range, 1–30); hospital stay was 7 days (range, 3–75). Operative mortality was 1.4% (n = 3). Anastomotic leak rate was 11.7% (n = 26). At a mean follow-up of 19 months (range, 1–68), quality of life scores were similar to preoperative values and population norms. Stage specific survival was similar to open series

Conclusions: MIE offers results as good as or better than open operation in our center with extensive minimally invasive and open experience. In this single institution experience, we observed a lower mortality rate (1.4%) and shorter hospital stay (7 days) than most open series. Given these results, we are now developing an intergroup trial (ECOG 2202) to assess MIE in a multicenter setting.

This report summarizes outcomes in 222 patients who underwent minimally invasive esophagectomy. The median intensive care unit stay was 1 day; hospital stay was 7 days. The operative mortality rate was 1.4%. At a mean follow-up of 19 months, quality of life scores were similar to population norms.

From the *Division of Thoracic Surgery and Foregut Surgery, University of Pittsburgh Medical Center; and †Department of Dental Public Health and Statistics, University of Pittsburgh, Pittsburgh, PA.

Presented at the American Surgical Association, April 24, 2003, Washington, DC.

Correspondence: Hiran C. Fernando, MD, UPMC Presbyterian, Suite C800 200 Lothrop Street, Pittsburgh, PA 15213. E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.