Early experience in minimally invasive esophagectomy for treatment of thoracic esophageal cancer

Abstract

Abstract Introduction: Minimally invasive esophagectomy (MIE) has gained popularity in the surgical treatment of esophageal cancer over the past three decades. By introducing minimally invasive techniques, esophageal oncological surgery has advanced in terms of safety, radicality, functional preservation and quality of life post-esophagectomy of the patients. Material and Method: We present the experience of the Center of Excellence in Esophageal Surgery at Sf. Maria Clinical Hospital regarding total (MIE) through total 3D HD thoraco-laparoscopic modified McKeown triple approach. In between January 2015 - December 2021, 24 patients (M) were treated for thoracic esophageal cancer. The average age of patients was 57 years. Most of the esophageal tumors were midthoracic (62.5%), 83.3% were squamous carcinomas and half were moderately differentiated. Most of the esophageal tumors were locally advanced tumors (cT3N1 – 58.3%), 18 patients were staged III. 70.8% of patients received neoadjuvant chemo radiotherapy. Results: Thoracoscopic esophageal mobilizations were successful in all 24 patients, no conversion to thoracotomy. Laparoscopic gastric mobilizations were successful in all 24 patients, conversion to open technique was performed in 7 patients for creation extracoporeally of the gastric conduit through an epigastric minilaparotomy. The esophageal substitute was represented by the gastric conduit. The intraoperative blood loss was minimal. The average duration of surgical interventions was 360 minutes. All the surgical interventions were considered with curative intention (R0). The rate of intraoperative complications was 20.8%. The rate of early postoperative complications was 66%. Distribution of postoperative complications according to the Clavien-Dindo Classification (0-33.3%, 1-16.6%, 2-4.1%, 3a-12.5%, 3b-8.3%, 4a-0%, 4b-8.3%, 5-16.6%) highlighted a rate of 33.3% of major complications. The advantages of MIE observed in the studied group in the postoperative period were: reduced postoperative pain, improved comfort and early mobilization of the patients. Conclusions: The early outcomes of using the minimally invasive approach in the treatment of esophageal cancer in our clinic include the reduction of perioperative morbidity, the duration of hospitalization and a faster recovery.