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Erschienen in: Indian Journal of Surgical Oncology 2/2021

13.03.2021 | Original Article

Minimally Invasive Esophagectomy the Standard of Care: Experience from a Tertiary Care Cancer Center from India

verfasst von: Rao T. Subramanyeshwar, K. V. V. N. Raju, Sujit Chyau Patnaik, Ajesh Raj Saksena, Reddy R. Pratap, Basanth Kumar Rayani, Vibhavari Milind Naik, Syed Nusrath

Erschienen in: Indian Journal of Surgical Oncology | Ausgabe 2/2021

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Abstract

For localized esophageal cancer, esophageal resection remains the prime form of treatment but is a highly invasive procedure associated with prohibitive morbidity. Minimally invasive esophagectomy (MIE) by laparoscopic or thoracoscopic approach was therefore introduced to reduce surgical trauma and its associated morbidity. We thereby review our minimally invasive esophagectomy results with short- and long-term outcomes. From January 2010 through December 2016, 459 patients with carcinoma esophagus and gastro-esophageal junction undergoing minimally invasive esophagectomy were retrospectively reviewed. The morbidity, mortality data with short- and long-term results of the procedure were studied. Patients were stratified into two arms based on the approach into minimally invasive transhiatal esophagectomy (MI-THE) and minimal invasive transthoracic esophagectomy TTE (MI-THE). Thirty days mortality in the whole cohort was 3.5% (2.5% in MI-THE vs. 5% in MI-TTE arm). Anastomotic leak rates (5 vs. 4.9%), median intensive care unit (ICU) stay (4 days), hospital stay (9 days), were similar between both the approaches. Major pulmonary complications were significantly higher in MI-TTE arm (18.9% vs 12.5%) (p 0.047). Cardiac, renal, conduit-related complication rates, vocal cord palsy, chyle leak, re-exploration, and late stricture rates were similar between the groups. The median number of nodes resected was higher in the MI-TTE arm (14 vs. 12) (p 0.002). R0 resection rate in the entire cohort was 89% (87.4% in MI-THE, 92% in MI-TTE arm p 0.12). The median overall survival and disease-free survival were also not different between MI-THE and MI-TTE arms (34 vs. 38 months, p 0.64) (24 vs. 36 months, p 0.67). Minimally invasive esophagectomy either by transhiatal or transthoracic approach is feasible and can be safely accomplished with a low morbidity and mortality and with satisfactory R0 resection rates, good nodal harvest, and acceptable long-term oncological outcomes.
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Metadaten
Titel
Minimally Invasive Esophagectomy the Standard of Care: Experience from a Tertiary Care Cancer Center from India
verfasst von
Rao T. Subramanyeshwar
K. V. V. N. Raju
Sujit Chyau Patnaik
Ajesh Raj Saksena
Reddy R. Pratap
Basanth Kumar Rayani
Vibhavari Milind Naik
Syed Nusrath
Publikationsdatum
13.03.2021
Verlag
Springer India
Erschienen in
Indian Journal of Surgical Oncology / Ausgabe 2/2021
Print ISSN: 0975-7651
Elektronische ISSN: 0976-6952
DOI
https://doi.org/10.1007/s13193-021-01291-y

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