Minimally invasive radical esophagectomy for esophageal cancer

Background. Thoracoabdominal esophagectomy with three-field lymphadenectomy is considered one of the best treatments for thoracic esophageal carcinoma because the disease is aggressive and lymph node metastasis is common. However, the efficacy of the procedure remains unclear, and it is associated with high postoperative mortality and morbidity. Methods. Seventy patients with esophageal carcinoma underwent thoracoscopic and laparoscopic esophagectomy with three-field lymphadenectomy. We retrospectively reviewed our procedure and the short-term surgical outcome of both thoracoscopic and laparoscopic esophagectomy. Results. In 70 patients, duration of the thoracoscopic and total procedure was 229 ± 50 min and 581 ± 82 min, respectively. For all procedures, estimated blood loss was 447 ± 227 g. Overall mortality was 1%. Postoperative major complications occurred in 18 patients (26%), and respiratory complications occurred in 11 patients (16%). Conclusion. Radical esophagectomy via thoracoscopy and laparoscopy is technically safe and feasible. We consider that the superior visualization and magnified view provided by thoracoscopy and the smaller surgical wounds in thorax and abdomen will prove advantageous to the postoperative clinical course and surgical outcome in spite of the longer operation time. © 2007 Japan Esophageal Society and Springer-Verlag.