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Open or minimally invasive esophagectomy: are the outcomes different?

Bussières, Jean S

Current Opinion in Anesthesiology: February 2009 - Volume 22 - Issue 1 - p 56–60
doi: 10.1097/ACO.0b013e32831cef4b
Thoracic anesthesia: Edited By Javier Campos

Purpose of review Since the beginning of the 1990s, the use of minimally invasive esophagectomy instead of the open technique has increased. Should this type of approach change the way we manage anesthesia for a patient undergoing esophagectomy for cancer?

Recent findings Because valid direct comparisons with open surgery are lacking, one cannot make definitive statements regarding the potential benefits of minimally invasive surgery. Rough comparisons with recent reports on open surgery suggest that reduced mortality, respiratory complications and blood loss, plus a more rapid return to a good quality of life are areas in which minimally invasive surgery might prove superior. Leak rates were similar to those reported with open procedures. Surprisingly, length of hospital stay and overall morbidity are similar with both techniques. Reported operating times appear longer than one might expect for open operations, which mirrors the experience of laparoscopic procedures in other areas.

Summary The implantation of minimally invasive esophagectomy seems inevitable in spite of the absence of randomized, controlled trials. The use of the prone position with one lung ventilation during minimally invasive esophagectomy seems positive. Protective ventilation during one lung ventilation may help to prevent pulmonary complications. Finally, the well accepted use of thoracic epidural anesthesia now has a new positive role following esophagectomy, improving the perfusion at the anastomotic level.

Correspondence to Jean Bussières, MD, Associate Professor, Laval University, Anesthesiologist, University Heart and Lung Institute, Laval Hospital, Quebec City, P.Q., G1V 4G5, Canada Tel: +1 418 656 8711 ext. 2944; fax: +1 418 656 4637; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.