Laparoscopic Versus Open Gastroplasty in Esophagectomy for Esophageal Cancer: A Comparative Study

Abstract

How best to approach esophagectomy is a controversial issue. In the last decade, the opportunity to use minimally invasive surgical methods for esophagectomy has been documented, but their real advantages over conventional surgery have yet to be clearly established. The aim of this study was to compare a series of patients who underwent laparoscopic esophagectomy with those who underwent open surgery to ascertain the feasibility, safety, and clinical advantages of the former surgical techniques. Between January 2002 and May 2004, 14 patients with cancer of the esophagus underwent laparoscopic esophagectomy and another 14 had conventional open esophagectomy. Their demographic features, and intraoperative and postoperative data were compared. The 2 groups were comparable in terms of age, American Society of Anesthesiologists score, and site of the neoplasm. The operating times were the same for transhiatal laparoscopic esophagectomy and conventional surgery, although using the thoraco-laparoscopic access took longer than the thoraco-laparotomic procedure (P<0.05). The hospital stay was shorter after laparoscopy (P<0.05). No differences emerged in terms of morbidity, mortality, number of transfusions, and time in the intensive care. The numbers of lymph nodes removed were comparable. In conclusion, it is feasible and safe to use a laparoscopic approach instead of open surgery for esophagectomy, but the former does not offer very significant clinical advantages in the postoperative stage. A shorter hospital stay seems to be the most significant finding. The minimally invasive procedure would seem to assure oncological radicality because it enables lymphadenectomy to be as thorough as in the conventional surgical approach.

Minimally Invasive Versus Open Esophagectomy: Meta-Analysis of Outcomes

“…The main criteria for trial exclusion included reviews, double publications, different primary outcomes, and non-comparative studies [15][16][17][18]26].…”

“…Using the electronic databases Medline, Embase, Pubmed and the Cochrane Library, we identified all English language comparative studies from 1997 to 2009 that involved minimally invasive versus open esophagectomy [7][8][9][10][11][12][13][14][15][16][17][18]. A combination of the following search terms were used: randomized controlled trials, comparative study, esophagectomy, minimally invasive surgery, open transhiatal, VATS, thoracoscopy, laparoscopic transhiatal, gastric conduit, thoracotomy and esophageal cancer.…”

Minimally invasive oesophagectomy: current status and future direction

“…Seven series [25][26][27][28][29][30][31] directly compared open oesophagectomy versus MIO; two of these [27,28] were performed prospectively. Review of 30 of the identified papers revealed three main groups of common outcome measures: operative data, morbidity and mortality data, and oncological resection data.…”

Treatment of perforation in the healthy esophagus: analysis of 12 cases

“…In the last two cases treated, the reconstruction was done using a laparoscopic technique for the mobilization and transposition of the stomach. This approach was borrowed from our experience with cancer patients with a view to reducing the surgical trauma [33]. The choice of the route for gastric tubule transposition cannot be standardized in delayed reconstruction.…”