Updated experiences with minimally invasive Mc Keown esophagectomy for esophageal cancer

• Published in: 世界胃肠病学杂志：英文版 no. 45; pp. 12873 - 12881
• Main Author: Ju-wei Mu Shu-geng gao Qi Xue You-Sheng Mao Da-li wang Jun Zhao Yu-Shun gao Jin-feng Huang Jie He
• Format: Journal Article
• Language: English
• Published: 2015
• Subjects: invasive;Esophagecto; procedures;Minimally; Surgical
• ISSN: 1007-9327; 2219-2840

AIM: To update our experiences with minimally invasive Mc Keown esophagectomy for esophageal cancer.METHODS: we retrospectively reviewed the medical records of 445 consecutive patients who underwent minimally invasive Mc Keown esophagectomy between January 2009 and July 2015 at the Cancer Hospital of Chinese Academy of Medical Sciences and used 103 patients who underwent open Mc Keown esophagectomy in the same period as controls. Among 375 patients who underwent total minimally invasive Mc Keown esophagectomy, 180 in the early period were chosen for the study of learning curve of total minimally invasive Mc Keown esophagectomy. These 180 minimally invasive Mc Keown esophagectomies performed by five surgeons were divided into three groups according to time sequence as group 1(n = 60), group 2(n = 60) and group 3(n = 60).RESULTS: Patients who underwent total minimally invasive Mc Keown esophagectomy had significantly less intraoperative blood loss than patients who underwent hybrid minimally invasive Mc Keown esophagectomy or open Mc Keown esophagectomy(100 ml vs 300 ml vs 200 ml, P = 0.001). However, there were no significant differences in operation time, number of harvested lymph nodes, or postoperative morbidity includingincidence of pulmonary complication and anastomotic leak between total minimally invasive Mc Keown esophagectomy, hybrid minimally invasive Mc Keown esophagectomy and open Mc Keown esophagectomy groups. There were no significant differences in 5-year survival between these three groups(60.5% vs 47.9% vs 35.6%, P = 0.735). Patients in group 1 had significantly longer duration of operation than those in groups 2 and 3. There were no significant differences in intraoperative blood loss, number of harvested lymph nodes, or postoperative morbidity including incidence of pulmonary complication and anastomotic leak between groups 1, 2 and 3.CONCLUSION: Total minimally invasive Mc Keown esophagectomy was associated with reduced intraoperative blood loss and comparable short term and long term survival compared with hybrid minimally invasive Mc Keown esophagectomy or open Mckeown esophagectomy. At least 12 cases are needed to master total minimally invasive Mc Keown esophagectomy in a high volume center.