Division of Thoracic Surgery, Ohio State University Wexner Medical Center, USAFulltext PDF
Background: The morbidity and mortality remain relatively high for transthoracic esophagectomy with open thoracotomy. I compared a total laparoscopic and thoracoscopic Ivor Lewis esophagectomy (MIE) cohort with a well matched cohort of open Ivor Lewis esophagectomy (OIE) cases.Methods: This is a retrospective review 50 patients diagnosed with esophageal carcinoma or high grade dysplasia who underwent minimally invasive or open Ivor Lewis esophagectomy from August 2009 to June 2013. A total of 25 patients underwent MIE and 25 patients underwent OIE. The postoperative morbidity and 60-day mortality were reported for the two groups.Results: The MIE and OIE groups were well matched for age, gender, FEV-1 % predicted, ejection fraction, coronary artery disease, COPD, and neoadjuvant chemoradiation. The 60 day mortality rate was 0% in the MIE group compared 4% in the OIE group (p=0.98). The mean hospital length of stay was 11 days + 4.3 for the MIE group compared to 13.4 days + 6.9 for the OIE group [p=0.149]. The rate of all pulmonary complications were significantly higher in the OIE group compared to the MIE group (44% compared to 4% [p=0.002].Conclusion: Total thoracoscopic and laparoscopic Ivor Lewis (MIE) esophagectomy produced clinical outcomes that are similar to the outcomes for OIE at our institution. The advantage for MIE appears to be fewer pulmonary complications which may be a function of the deleterious effects of thoracotomy.
Esophagectomy; Minimally invasive surgery; Esophageal surgery
Merritt RE. Minimally Invasive Ivor Lewis Esophagectomy Improves Pulmonary Complications Compared to Open Ivor Lewis Esophagectomy. Clin Surg. 2016; 1: 1133.