Postoperative Outcomes Of Minimally Invasive Esophageal Surgery For Esophageal Cancer
Eunjue Yi, Jae Ho Chung, Younggi Jung, JunHee Lee, Kwang Taik Kim, Sungho Lee.
Korea University Anam Hospital, Seoul, Korea, Republic of.
BACKGROUND: The aim of this study is to evaluate the safety and feasibility of minimally invasive esophageal surgery for esophageal cancer in a small volume center. Methods:The medical records of patients who had undergone minimally invasive esophageal surgery (VATS Ivor Lewis operation with laparoscopic gastric mobilization) for their esophageal cancer between June 2017 and September 2019 in our institute were reviewed retrospectively. Perioperative outcomes including postoperative morbidities and mortalities were evaluated. Results: A total of 31 patients (29 men and 2 women, mean age of 65.7±7.30) were included in this study. The mean follow-up periods were 13.3 month (±9.52, ranging from 1.4 to 32.7). The mean operation time for laparoscopic gastric mobilization were 111.3 minutes (±36.83, ranging from 65 to 236) and those for VATS Ivor Lewis operation were 235.5 minutes (±80.53, ranging from 140 to 450). Seven patients underwent Neoadjuvant therapy (neoadjuvant chemoradiation therapy for four, and neoadjuvant chemotherapy for 3 patients). Half of the cases were stage I (16 cases, 12 of IB and 4 of IA), however, operation could be performed in more advanced cases (8 of stage II, 6 of stage III, and one case of stage IV). There were no conversion to open procedure. Two cases of operation were combined with thyroidectomy to remove papillary thyroid cancer. Average stay at intensive care unit were 1.1 days (±0.40, ranging from 1 to 3). Overall complication rates were 49.1%, and complication more than Grade III in Clavien-Dindo classification were 16.1% (One case of empyema requiring surgical intervention, and two cases of endoscopic and radiologic intervention). Overall postoperative morality were 6.4%. No one died before 30 postoperative days. Two patients died at 42 and 47 postoperative days due to acute respiratory failure, and one patients. Conclusion: Minimally invasive esophageal surgery for esophageal cancer could be feasibly performed even in advanced cases. Postoperative pneumonia should be carefully managed to prevent postoperative mortality.
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