Zero leaks with minimally invasive esophagectomy: a team-based approach.

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http://highwire.stanford.edu/cgi/medline/pmid;20202395

Medline Abstract

Zero leaks with minimally invasive esophagectomy: a

team-based approach.

A Khithani, J Jay, C Galanopoulos, D Curtis, A Vo, and DR Jeyarajah

JSLS,

October 1, 2009;

13(4):

542-9.

Abstract

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Cancer Center,

Methodist Dallas Medical Center, Dallas, Texas, USA.

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INTRODUCTION: Minimally invasive surgery has been applied in several

ways to esophagectomy. Newer techniques have improved patient outcomes

while maintaining oncological principles; however, mortality still

exists. Most series have reported mortality rates ranging from 2% to

25%. The aim of this study was to determine the efficacy of minimally

invasive esophagectomies (MIE) in a non-university tertiary care center.

METHODS: MIE in the form of a combined thoracoscopic and laparoscopic

technique was performed cooperatively by 2 surgeons. Records of patients

who underwent MIE between September 2005 and August 2008 were

retrospectively reviewed. RESULTS: Thirty-four patients underwent MIE

over a 3-year period. There was a male predominance. Mean age at

presentation was 62.6 years. Comorbidities were documented in 79% of the

patients. Most patients (68%) presented with dysphagia. Two patients

had end-stage achalasia, 1 had corrosive esophageal stricture, and 31

had esophageal malignancies. No mortalities were reported. No

anastomotic leaks were observed. Eighteen (58%) patients with malignancy

received preoperative chemoradiotherapy. Six (33%) patients had a

pathological response (CR) on final histopathology. The mean operating

time was 294 minutes. The mean blood loss was 302 mL. CONCLUSIONS:

Minimally invasive esophagectomy can be performed with results that meet

and exceed reported benchmarks. A team-based approach greatly impacts

the outcome of the surgery. This surgical technique must be standardized

to achieve this outcome.

Publication Type: Journal article

PMID: 20202395

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