Background: Esophagectomy represents the gold standard in the treatment of resectable esophageal cancer. Despite significant improvements in perioperative care, postoperative morbidity and mortality rates remain high. Minimally-invasive surgical techniques introduced to the surgical treatment of esophageal malignancies have been shown to successfully diminish surgical trauma and postoperative morbidity.
Aim: In the present report we present the stepwise implementation of minimally-invasive techniques in the treatment of esophageal cancer at a high-volume center and its influence on overall patient outcome.
Patients and methods: A total of 165 consecutive patients with esophagectomy, in two 4-year periods, namely that before (period A) and that after (period B) the implementation of minimally-invasive esophagectomy (MIE) for cancer, were compared. Patients' characteristics, and perioperative, surgical, oncological and survival outcomes were compared.
Results: In time period A, 73 patients were treated with open esophagectomy (OE), whereas in time period B 37 patients (40.2%) underwent an OE and 55 (59.8%) a minimally-invasive esophagectomy. Surgical and non-surgical complications did not differ significantly between groups (B: 44.6% vs. A: 54.8%; B: 38% vs. A: 35.6%; p>0.05). Duration of ventilation (B: 1.8 days vs. A: 6.7 days), ICU (B: 5.7 days vs. A: 12.2 days) and hospital stay (B: 20.5 days vs. A: 28.4 days) were significantly reduced in patients of time period B. The number of lymph nodes removed and complete resection rates were comparable (mean=18.1 ± 10.1 lymph nodes; B: 87% R0 vs. A: 93.2% R0). No significant differences between the groups were detectable regarding short-term disease-free or overall survival.
Conclusion: The implementation of minimally-invasive esophagectomy is feasible, safe and has the potential to reduce perioperative morbidity without compromising oncological outcome.
Keywords: Minimally-invasive esophagectomy; esophageal cancer; outcome.