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Laparoscopic Total Esophagectomy

Laparoscopic Total Esophagectomy Abstract Objective: To evaluate early results with laparoscopic total esophagectomy for benign and malignant disease of the esophagus. Design: Case series involving 9 patients with mean follow-up of 13 months. Setting: An advanced endoscopic surgery unit at a tertiary referral teaching hospital. Patients: Between December 12, 1993, and December 1, 1996, 9 patients with a mean age of 61 years underwent laparoscopic esophagectomy. Indications were adenocarcinoma in 5, squamous cell carcinoma in 1, dysplastic Barrett esophagus in 2, and refractory stricture with severe shortening in 1. Interventions: Gastroduodenal mobilization, transhiatal wide esophageal dissection, gastric tube formation (8 cases), pyloromyotomy (2 cases), cervical anastomosis (8 cases), and laparoscopic jejunal feeding tube placement (8 cases). Outcome Measures: Operative time, amount of blood loss, operative complications, length of hospital stay, postoperative complications, dysphagia rates, and survival. Results: All procedures were completed endoscopically. Operative time was 6.5 hours (range, 4¾ to 9½). Average blood loss was 290 mL. One patient required a right thoracoscopy for an intrathoracic anastomosis because of questionable viability of the gastric tube. Mean hospital stay was 6.4 days (range, 4-9 days). Hospital complications included subclavian vein thrombosis (1 patient), dysphonia (6 patients), and atelectasis (5 patients). There were no anastomotic leaks. Three patients subsequently died: 2 of distant metastatic cancer (at 13 months and 33 months) and 1 of cardiac failure at 10 months. The 6 surviving patients were cancer free at a mean follow-up of 13 months. One patient had left vocal cord paralysis. All patients were doing well and had Visick scores of I or II. Conclusions: Laparoscopic esophagectomy is a technically feasible but difficult procedure. Despite the long operative times, patients do well and benefit from a shorter hospital stay and more rapid recovery compared with open esophagectomy. Its role as a curative cancer procedure remains unknown, but it may have a place on the basis of its palliative superiority.Arch Surg. 1997;132:943-949 References 1. Begos BG, Modlin IM. Laparoscopic cholecystectomy: from gimmick to gold standard . Clin Gastroenterol . 1994;19:325-330.Crossref 2. Hinder RA, Filipi CJ, Wetscher G, et al. Laparoscopic Nissen fundoplication is an effective treatment for gastro-esophageal reflux disease . Ann Surg . 1994;116: 758-767. 3. Sangster W, Swanstrom LL. Laparoscopic-guided feeding jejunostomy . SurgEndosc . 1993;7:308-310. 4. Orringer MB, Marshall B, Stirling MC. Transhiatal esophagectomy for benign and malignant disease . J Thorac Cardiovasc Surg . 1993;105:256-277. 5. Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review . Am J Surg . 1995;169:634-640.Crossref 6. Finley RJ, Lamy A, Clifton J, et al. Gastrointestinal function following esophagectomy for malignancy . Am J Surg . 1995;169:471-475.Crossref 7. DePaula AL, Hashiba K, Ferreira EAB, et al. Laparoscopic transhiatal esophagectomy with esophagogastroplasty . Surg Laparosc Endosc . 1995;5:1-5.Crossref 8. Dallemagne B, Weerts JM, Jehaes C, et al. Case report: subtotal oesophagectomy by thoracoscopy and laparoscopy . Minim Invasive Ther . 1992;1:183-185.Crossref 9. McAnena OJ, Rogers J, Williams NS. Right thoracoscopically assisted oesophagectomy for cancer . Br J Surg . 1994;81:236-238.Crossref 10. Cuschieri A, Shimi S, Banting S. Endoscopic oesophagectomy through a right thoracoscopic approach . J R Coll Surg Edinb . 1992;37:7-11. 11. Sadanaga N, Kuwano H, Watanabe M, et al. Laparoscopy-assisted surgery: a new technique for transhiatal esophageal dissection . Am J Surg . 1994;168:355-357.Crossref 12. Jagot P, Sauvanet A, Berthoux L, et al. Laparoscopic mobilization of the stomach for oesophageal replacement . Br J Surg . 1996;83:540-542.Crossref 13. Bemelman WA, Taat CW, Slors FM, et al. Delayed postoperative emptying after esophageal resection is dependent on the size of the gastric substitute . J Am Coll Surg . 1995;180:461-464. 14. Millikan KW, Silverstein J, Hart V, et al. A15-year review of esophagectomy for carcinoma of the esophagus and cardia . Arch Surg . 1995;130:617-624.Crossref 15. Stark SP, Romberg MS, Pierce GE, et al. Transhiatal versus transthoracic esophagectomy for adenocarcinoma of the distal esophagus and cardia . Am J Surg . 1996;172:478-482.Crossref 16. Moon MR, Schulte WJ, Haasler GB, et al. Transhiatal and transthoracic esophagectomy for adenocarcinoma of the esophagus . Arch Surg . 1992;127:951-955.Crossref 17. Vogel SB, Mendenhall WM, Sombeck MD, et al. Downstaging of esophageal cancer after preoperative radiation and chemotherapy . Ann Surg . 1995;221:685-695.Crossref 18. Hagen JA, Peters J, DeMeester TR. Superiority of extended en bloc esophagogastrectomy for cancer of the lower esophagus and cardia . J Thorac Cardiovasc Surg . 1993;106:850-859. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Laparoscopic Total Esophagectomy

Swanstrom, Lee L.; Hansen, Paul
Archives of Surgery , Volume 132 (9) – Sep 1, 1997
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References (20)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1997.01430330009001
Publisher site
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Abstract

Abstract Objective: To evaluate early results with laparoscopic total esophagectomy for benign and malignant disease of the esophagus. Design: Case series involving 9 patients with mean follow-up of 13 months. Setting: An advanced endoscopic surgery unit at a tertiary referral teaching hospital. Patients: Between December 12, 1993, and December 1, 1996, 9 patients with a mean age of 61 years underwent laparoscopic esophagectomy. Indications were adenocarcinoma in 5, squamous cell carcinoma in 1, dysplastic Barrett esophagus in 2, and refractory stricture with severe shortening in 1. Interventions: Gastroduodenal mobilization, transhiatal wide esophageal dissection, gastric tube formation (8 cases), pyloromyotomy (2 cases), cervical anastomosis (8 cases), and laparoscopic jejunal feeding tube placement (8 cases). Outcome Measures: Operative time, amount of blood loss, operative complications, length of hospital stay, postoperative complications, dysphagia rates, and survival. Results: All procedures were completed endoscopically. Operative time was 6.5 hours (range, 4¾ to 9½). Average blood loss was 290 mL. One patient required a right thoracoscopy for an intrathoracic anastomosis because of questionable viability of the gastric tube. Mean hospital stay was 6.4 days (range, 4-9 days). Hospital complications included subclavian vein thrombosis (1 patient), dysphonia (6 patients), and atelectasis (5 patients). There were no anastomotic leaks. Three patients subsequently died: 2 of distant metastatic cancer (at 13 months and 33 months) and 1 of cardiac failure at 10 months. The 6 surviving patients were cancer free at a mean follow-up of 13 months. One patient had left vocal cord paralysis. All patients were doing well and had Visick scores of I or II. Conclusions: Laparoscopic esophagectomy is a technically feasible but difficult procedure. Despite the long operative times, patients do well and benefit from a shorter hospital stay and more rapid recovery compared with open esophagectomy. Its role as a curative cancer procedure remains unknown, but it may have a place on the basis of its palliative superiority.Arch Surg. 1997;132:943-949 References 1. Begos BG, Modlin IM. Laparoscopic cholecystectomy: from gimmick to gold standard . Clin Gastroenterol . 1994;19:325-330.Crossref 2. Hinder RA, Filipi CJ, Wetscher G, et al. Laparoscopic Nissen fundoplication is an effective treatment for gastro-esophageal reflux disease . Ann Surg . 1994;116: 758-767. 3. Sangster W, Swanstrom LL. Laparoscopic-guided feeding jejunostomy . SurgEndosc . 1993;7:308-310. 4. Orringer MB, Marshall B, Stirling MC. Transhiatal esophagectomy for benign and malignant disease . J Thorac Cardiovasc Surg . 1993;105:256-277. 5. Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review . Am J Surg . 1995;169:634-640.Crossref 6. Finley RJ, Lamy A, Clifton J, et al. Gastrointestinal function following esophagectomy for malignancy . Am J Surg . 1995;169:471-475.Crossref 7. DePaula AL, Hashiba K, Ferreira EAB, et al. Laparoscopic transhiatal esophagectomy with esophagogastroplasty . Surg Laparosc Endosc . 1995;5:1-5.Crossref 8. Dallemagne B, Weerts JM, Jehaes C, et al. Case report: subtotal oesophagectomy by thoracoscopy and laparoscopy . Minim Invasive Ther . 1992;1:183-185.Crossref 9. McAnena OJ, Rogers J, Williams NS. Right thoracoscopically assisted oesophagectomy for cancer . Br J Surg . 1994;81:236-238.Crossref 10. Cuschieri A, Shimi S, Banting S. Endoscopic oesophagectomy through a right thoracoscopic approach . J R Coll Surg Edinb . 1992;37:7-11. 11. Sadanaga N, Kuwano H, Watanabe M, et al. Laparoscopy-assisted surgery: a new technique for transhiatal esophageal dissection . Am J Surg . 1994;168:355-357.Crossref 12. Jagot P, Sauvanet A, Berthoux L, et al. Laparoscopic mobilization of the stomach for oesophageal replacement . Br J Surg . 1996;83:540-542.Crossref 13. Bemelman WA, Taat CW, Slors FM, et al. Delayed postoperative emptying after esophageal resection is dependent on the size of the gastric substitute . J Am Coll Surg . 1995;180:461-464. 14. Millikan KW, Silverstein J, Hart V, et al. A15-year review of esophagectomy for carcinoma of the esophagus and cardia . Arch Surg . 1995;130:617-624.Crossref 15. Stark SP, Romberg MS, Pierce GE, et al. Transhiatal versus transthoracic esophagectomy for adenocarcinoma of the distal esophagus and cardia . Am J Surg . 1996;172:478-482.Crossref 16. Moon MR, Schulte WJ, Haasler GB, et al. Transhiatal and transthoracic esophagectomy for adenocarcinoma of the esophagus . Arch Surg . 1992;127:951-955.Crossref 17. Vogel SB, Mendenhall WM, Sombeck MD, et al. Downstaging of esophageal cancer after preoperative radiation and chemotherapy . Ann Surg . 1995;221:685-695.Crossref 18. Hagen JA, Peters J, DeMeester TR. Superiority of extended en bloc esophagogastrectomy for cancer of the lower esophagus and cardia . J Thorac Cardiovasc Surg . 1993;106:850-859.

Journal

Archives of Surgery – American Medical Association

Published: Sep 1, 1997

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