Overcoming challenges in implementing a minimally invasive esophagectomy program at a Veterans Administration medical center

BACKGROUND: Minimally invasive esophagectomy (MIE) is a technically demanding procedure that requires expertise in laparoscopy and esophageal surgery. The authors hypothesized that the safe and effective development of such a program could be performed at a Veterans Administration health care system using existing faculty members. METHODS: Length of stay, operative factors, and morbidity and mortality of patients undergoing MIE from December 2007 to August 2009 were reviewed. RESULTS: Eighteen consecutive patients underwent planned MIE. They were all men, with a median age of 60 years (range, 43-69 years) and a median American Society of Anesthesiologists score of 3. Eighty-three percent were able to undergo MIE resection. Eighty-nine percent of patients received neoadjuvant therapy. The median operative duration was 420 minutes (range, 300-480 minutes). There was 1 death within 30 days because of a pulmonary embolus and 1 anastomotic leak. Three patients had postoperative pneumonias. The median and mean length of stay were 10 and 13 days, respectively (range, 6-50 days). Negative margins were achieved in all patients. The mean number of lymph nodes resected was 15 (range, 6-30). CONCLUSIONS: The development of an MIE program is feasible at a Veterans Administration hospital when combining the expertise of minimally invasive and esophageal surgeons. (C) 2011 Elsevier Inc. All rights reserved.