Uniportal video-assisted thoracoscopic surgery esophagectomy outcomes in 40 consecutive patients

Sezer Aslan; Gamze Gul Tiryaki; Jeyhun Pashayev; Cagatay Cetinkaya; Ali Fuad Durusoy; Nezih Onur Ermerak; Hasan Fevzi Batirel

doi:10.1093/icvts/ivad034

Uniportal video-assisted thoracoscopic surgery esophagectomy outcomes in 40 consecutive patients

Interdiscip Cardiovasc Thorac Surg. 2023 May 4;36(5):ivad034. doi: 10.1093/icvts/ivad034.

Authors

Sezer Aslan¹, Gamze Gul Tiryaki², Jeyhun Pashayev², Cagatay Cetinkaya³, Ali Fuad Durusoy⁴, Nezih Onur Ermerak², Hasan Fevzi Batirel⁵

Affiliations

¹ Department of Thoracic Surgery, Sirnak State Hospital, Sirnak, Turkey.
² Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey.
³ Department of Thoracic Surgery, Uskudar University School of Medicine, Istanbul, Turkey.
⁴ Department of Thoracic Surgery, Beykoz State Hospital, Istanbul, Turkey.
⁵ Department of Thoracic Surgery, Biruni University School of Medicine, Istanbul, Turkey.

Abstract

Objectives: Minimally invasive esophagectomy has improved over time becoming faster and less invasive. We have changed our technical approach from multiportal to uniportal video-assisted thoracoscopic surgery (VATS) esophagectomy over the years. In this study, we analysed our results with uniportal VATS esophagectomy technique.

Methods: This study was a retrospective analysis of 40 consecutive patients with the intent to perform uniportal VATS esophagectomy for esophageal cancer between July 2017 and August 2021. Demographic criteria, comorbidities, neoadjuvant therapy, intraoperative data, complications, length of stay, pathological data, 30- and 90-day mortality and 2-year survival data were recorded.

Results: Forty patients (21 female) were operated (median age 62.9 [53.5-70.25]). Eighteen patients (45%) received neoadjuvant chemoradiation. The chest part of all cases was started with uniportal VATS and 31 (77.5%) was completed uniportally (34 Ivor Lewis, 6 McKeown). The median thoracic operation time in minimally invasive Ivor Lewis esophagectomy was 90 min (77.5-100). The median time for uniportal side-to-side anastomosis was 12 min (11-16). Five (12.5%) patients had leak, and 4 were intrathoracic. Twenty-eight (70%) patients had squamous cell carcinoma, 11 adenocarcinoma and 1 squamous cell carcinoma with sarcomatoid differentiation. Thirty-seven (92.5%) patients had R0 resection. The mean number of lymph nodes dissected was 24 ± 9.5. Thirty- and ninety-day mortality was 2.5% (n = 1). The mean follow-up was 44 ± 2.8 months. Two-year survival was 80%.

Conclusions: Uniportal VATS esophagectomy is a safe, fast and feasible alternative to other minimally invasive and open approaches. Comparable results to contemporary series are observed in perioperative and oncologic outcomes.

Keywords: Esophagectomy; Intrathoracic anastomosis; Ivor Lewis; Minimally invasive; Side-to-side anastomosis; Uniportal VATS.