Modified McKeown Minimally Invasive Esophagectomy for Esophageal Cancer: a 5-year Retrospective Study of 142 Patients in a Single Institution

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2013 Dec 31

PMID 24376537

Citations 12

Authors

Baofu Chen

Bo Zhang

Chengchu Zhu

Zhongrui Ye

Chunguo Wang

Dehua Ma

Minhua Ye

Min Kong

Jiang Jin

Jiang Lin

Chunlei Wu

Zheng Wang

Jiahong Ye

Jian Zhang

Quanteng Hu

Affiliations

Soon will be listed here.

Abstract

Background: To achieve decreased invasiveness and lower morbidity, minimally invasive esophagectomy (MIE) was introduced in 1997 for localized esophageal cancer. The combined thoracoscopic-laparoscopic esophagectomy (left neck anastomosis, defined as the McKeown MIE procedure) has been performed since 2007 at our institution. From 2007 to 2011, our institution subsequently evolved as a high-volume MIE center in China. We aim to share our experience with MIE, and have evaluated the outcomes of 142 patients.

Methods: We retrospectively reviewed 142 consecutive patients who had presented with esophageal cancer undergoing McKeown MIE from July 2007 to December 2011. The procedure, surgical outcomes, disease-free and overall survival of these cases were assessed.

Results: The average total procedure time was 270.5 ± 28.1 min. The median operation time for thoracoscopy was 81.5 ± 14.6 min and for laparoscopy was 63.8 ± 9.1 min. The average blood loss associated with thoracoscopy was 123.8 ± 39.2 ml, and for laparoscopic procedures was 49.9 ± 14.3 ml. The median number of lymph nodes retrieved was 22.8. The 30 day mortality rate was 0.7%. Major surgical complications occurred in 24.6% and major non-surgical complications occurred in 18.3% of these patients. The median DFS and OS were 36.0 ± 2.6 months and 43.0 ± 3.4 months respectively.

Conclusions: Surgical and oncological outcomes following McKeown MIE for esophageal cancer were acceptable and comparable with those of open-McKeown esophagectomy. The procedure was both feasible and safe - properties that can be consolidated by experience.

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References

KARL R, Schreiber R, Boulware D, Baker S, Coppola D . Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy. Ann Surg. 2000; 231(5):635-43. PMC: 1421050. DOI: 10.1097/00000658-200005000-00003. View

Hayden J, Sue-Ling H, Sarela A, Dexter S . Minimally invasive management of chylous fistula after esophagectomy. Dis Esophagus. 2007; 20(3):251-5. DOI: 10.1111/j.1442-2050.2007.00644.x. View

Chen B, Zhu C, Wang C, Ma D, Lin J, Zhang B . [Clinical comparative study of minimally invasive esophagectomy versus open esophagectomy for esophageal carcinoma]. Zhonghua Wai Ke Za Zhi. 2010; 48(16):1206-9. View

Pennathur A, Awais O, Luketich J . Technique of minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg. 2010; 89(6):S2159-62. DOI: 10.1016/j.athoracsur.2010.03.069. View

Lazzarino A, Nagpal K, Bottle A, Faiz O, Moorthy K, Aylin P . Open versus minimally invasive esophagectomy: trends of utilization and associated outcomes in England. Ann Surg. 2010; 252(2):292-8. DOI: 10.1097/SLA.0b013e3181dd4e8c. View

Ninomiya I, Osugi H, Tomizawa N, Fujimura T, Kayahara M, Takamura H . Learning of thoracoscopic radical esophagectomy: how can the learning curve be made short and flat?. Dis Esophagus. 2010; 23(8):618-26. DOI: 10.1111/j.1442-2050.2010.01075.x. View

Nakamura M, Iwahashi M, Nakamori M, Ishida K, Naka T, Iida T . An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer. Langenbecks Arch Surg. 2007; 393(2):127-33. DOI: 10.1007/s00423-007-0253-7. View

Biere S, Cuesta M, van der Peet D . Minimally invasive versus open esophagectomy for cancer: a systematic review and meta-analysis. Minerva Chir. 2009; 64(2):121-33. View

Osugi H, Takemura M, Higashino M, Takada N, Lee S, Ueno M . Video-assisted thoracoscopic esophagectomy and radical lymph node dissection for esophageal cancer. A series of 75 cases. Surg Endosc. 2002; 16(11):1588-93. DOI: 10.1007/s00464-002-9019-z. View

10.

Luketich J, Alvelo-Rivera M, Buenaventura P, Christie N, McCaughan J, Litle V . Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg. 2003; 238(4):486-94. PMC: 1360107. DOI: 10.1097/01.sla.0000089858.40725.68. View

11.

Luketich J, Pennathur A, Awais O, Levy R, Keeley S, Shende M . Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg. 2012; 256(1):95-103. PMC: 4103614. DOI: 10.1097/SLA.0b013e3182590603. View

12.

Birkmeyer J, Siewers A, Finlayson E, Stukel T, Lucas F, Batista I . Hospital volume and surgical mortality in the United States. N Engl J Med. 2002; 346(15):1128-37. DOI: 10.1056/NEJMsa012337. View

13.

Avital S, Zundel N, Szomstein S, Rosenthal R . Laparoscopic transhiatal esophagectomy for esophageal cancer. Am J Surg. 2005; 190(1):69-74. DOI: 10.1016/j.amjsurg.2004.12.004. View

14.

Noshiro H, Iwasaki H, Kobayashi K, Uchiyama A, Miyasaka Y, Masatsugu T . Lymphadenectomy along the left recurrent laryngeal nerve by a minimally invasive esophagectomy in the prone position for thoracic esophageal cancer. Surg Endosc. 2010; 24(12):2965-73. DOI: 10.1007/s00464-010-1072-4. View

15.

Zhu C, Chen S, Ye M . [Esophagectomy combined with radical lymphadenectomy by video-thoracoscopy]. Zhonghua Wai Ke Za Zhi. 2005; 43(10):628-30. View

16.

Smithers B, Gotley D, McEwan D, Martin I, Bessell J, Doyle L . Thoracoscopic mobilization of the esophagus. A 6 year experience. Surg Endosc. 2001; 15(2):176-82. DOI: 10.1007/s004640000307. View

17.

Kinjo Y, Kurita N, Nakamura F, Okabe H, Tanaka E, Kataoka Y . Effectiveness of combined thoracoscopic-laparoscopic esophagectomy: comparison of postoperative complications and midterm oncological outcomes in patients with esophageal cancer. Surg Endosc. 2011; 26(2):381-90. DOI: 10.1007/s00464-011-1883-y. View

18.

Puntambekar S, Agarwal G, Joshi S, Rayate N, Sathe R, Patil A . Thoracolaparoscopy in the lateral position for esophageal cancer: the experience of a single institution with 112 consecutive patients. Surg Endosc. 2010; 24(10):2407-14. DOI: 10.1007/s00464-010-0963-8. View

19.

Law S, Fok M, Chu K, Wong J . Thoracoscopic esophagectomy for esophageal cancer. Surgery. 1997; 122(1):8-14. DOI: 10.1016/s0039-6060(97)90257-9. View

20.

Bailey S, Bull D, Harpole D, Rentz J, Neumayer L, Pappas T . Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg. 2003; 75(1):217-22; discussion 222. DOI: 10.1016/s0003-4975(02)04368-0. View