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Initial Experience with Minimally Invasive Esophagectomy at a Major Cancer Center: First 100 Cases
Rachel Grosser, Inderpal S. Sarkaria, Manjit S. Bains, David J. Finley, Amanda Ghanie, Prasad S. Adusumilli, James Huang, Valerie W. Rusch, David R. Jones, Nabil P. Rizk.
Memorial Sloan-Kettering Cancer Center, New York, NY, USA.

OBJECTIVE: Minimally invasive esophagectomy (MIE) is steadily increasing in utilization, with a growing body of evidence supporting equivalent oncologic outcomes compared with open approaches. In this study, we report on the initial experience with this approach at a major high-volume cancer center over progressive interquartile divisions after inception of an MIE program.
METHODS: All consecutive patients undergoing hybrid MIE, standard total laparoscopic/thoracoscopic MIE, and robotic-assisted laparoscopic/thoracoscopic MIE approaches at Memorial Sloan-Kettering Cancer Center during the study period were retrospectively reviewed from a prospectively maintained database. Outcomes were analyzed by interquartile divisions.
RESULTS: From a total of 310 esophageal resections performed during the study period, 100 patients (32%) underwent MIE from February 18, 2010, to October 14, 2013, with an operative mortality of 2%. The median age was 60.3 years (range, 37-86 years), and 73% of patients underwent induction chemoradiation. Operations included 85 Ivor Lewis resections, 13 McKeown (3-hole) resections, 1 transhiatal resection, and 1 colon interposition. Study results are summarized in Table 1. Hybrid approaches were common in the 1st quartile and absent in the 2nd-4th quartiles. Unplanned conversions from MIE to open procedures decreased from the 1st to 3rd quartiles, and were absent in the fourth quartile. There were predominant in the1st quartile, decreased over the 2nd and 3rd quartiles, and absent in the 4th quartile. There were no emergent conversions and no intraoperative deaths. Operating room time, median length of hospital stay, and mortality decreased over successive quartiles, while the median number of lymph nodes resected increased (Table 1).
CONCLUSIONS: With the inception of an MIE program, initial performance of hybrid approaches combined with a low threshold for conversion early in the experience may be beneficial for the safe, progressive transition to completely laparoscopic/thoracoscopic MIE with oncologic and operative outcomes comparable to those with open esophagectomy.
Table 1
Patient Group (Quartiles)% MIE of total esophageal resectionsHybrid ProceduresConversions to Open ProceduresMedian Operating Room TimeMedian Lymph Nodes
Resected
Median Length of Stay
(Days)
Deaths
1-2527.8%8199:1118121
26-5028.7%0108:4821101
51-7541.7%056:382490
76-10036.2%006:192790


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