Minimally Invasive Esophagectomy: Outcomes in 222 Patients

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

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)486-495
Number of pages10
JournalAnnals of Surgery
Volume238
Issue number4
StatePublished - Oct 2003
Externally publishedYes

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Esophagectomy
Length of Stay
Mortality
Conversion to Open Surgery
Anastomotic Leak
Intensive Care Units
Quality of Life
Radiation
Drug Therapy
Survival
Population
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

Luketich, J. D., Alvelo-Rivera, M., Buenaventura, P. O., Christie, N. A., McCaughan, J. S., Litle, V. R., ... Zinner, M. J. (2003). Minimally Invasive Esophagectomy: Outcomes in 222 Patients. Annals of Surgery, 238(4), 486-495.

Minimally Invasive Esophagectomy : Outcomes in 222 Patients. / Luketich, James D.; Alvelo-Rivera, Miguel; Buenaventura, Percival O.; Christie, Neil A.; McCaughan, James S.; Litle, Virginia R.; Schauer, Philip R.; Close, John M.; Fernando, Hiran C.; Zinner, Michael J.

In: Annals of Surgery, Vol. 238, No. 4, 10.2003, p. 486-495.

Research output: Contribution to journalArticle

Luketich, JD, Alvelo-Rivera, M, Buenaventura, PO, Christie, NA, McCaughan, JS, Litle, VR, Schauer, PR, Close, JM, Fernando, HC & Zinner, MJ 2003, 'Minimally Invasive Esophagectomy: Outcomes in 222 Patients', Annals of Surgery, vol. 238, no. 4, pp. 486-495.
Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR et al. Minimally Invasive Esophagectomy: Outcomes in 222 Patients. Annals of Surgery. 2003 Oct;238(4):486-495.
Luketich, James D. ; Alvelo-Rivera, Miguel ; Buenaventura, Percival O. ; Christie, Neil A. ; McCaughan, James S. ; Litle, Virginia R. ; Schauer, Philip R. ; Close, John M. ; Fernando, Hiran C. ; Zinner, Michael J. / Minimally Invasive Esophagectomy : Outcomes in 222 Patients. In: Annals of Surgery. 2003 ; Vol. 238, No. 4. pp. 486-495.
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abstract = "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.",
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