PURPOSE: Minimally invasive esophagectomy (MIE) is gaining increasing popularity as a modality for esophagegeal resection in patients with both elective and emergent indications. We report the experience of a single thoracic group converting from open to a minimally invasive approach, and hypothesize that the results and efficacy would be similar for both procedures.
METHODS: A retrospective chart review was carried out comparing 17 consecutive patients who underwent a minimally invasive esophagectomy with 38 patients who underwent an open procedure during the prior 4 years. Primary outcome measures were hospital length of stay, 30-day mortality, complications and nutritional status on discharge.
RESULTS: Both groups had similar age distribution (means of 67, MIE vs. 63, open) and pathology (adenocarcinoma in 70% MIE vs. 61% open). MIE was performed in one patient for perforation during a diagnostic procedure. Average length of stay was significantly shorter in MIE patients (12 days vs. 21 days). 30-day mortality rate was lower in MIE patients (6% vs. 11%). Postoperative atrial fibrillation was more common in MIE (24%) when compared with open (8%) however postoperative respiratory complications was far less likely in MIE (pneumonia 6%, respiratory failure 18%) when compared with open (pneumonia 16%, respiratory failure 27%). No significant difference in leak rate was noted. A more rapid recovery was noted in MIE patients with tube feedings required in 6% of discharges, compared with 18% of patients undergoing an open procedure.
CONCLUSION: Minimally invasive esophagectomy has distinct advantages over open procedures in terms of patient recovery. As evidenced by our experience, MIE can safely be adopted by surgeons experienced in open esophagectomy and applied with comparable outcomes.
CLINICAL IMPLICATIONS: MIE is likely to become standard of care for patients who can undergo the procedure. Our results demonstrate that surgeons currently practicing open esophagectomy can confidently consider adopting this novel and evolving procedure.
DISCLOSURE: Jeremiah Martin, None.