Uniportal video-assisted thoracoscopic surgery esophagectomy outcomes in 40 consecutive patients

Abstract

Objectives Minimally invasive oesophagectomy has improved over time becoming faster and less invasive. We have changed our technical approach from multiportal to uniportal VATS (video-assisted thoracoscopic surgery) oesophagectomy over the years. In this study we analyzed our results with uniportal VATS oesophagectomy technique. Methods This study was a retrospective analysis of 40 consecutive patients with the intent to perform uniportal VATS oesophagectomy for oesophageal cancer between July 2017 and August 2021. Demographic criteria, comorbidities, neoadjuvant therapy, intraoperative data, complications, length of stay, pathological data, 30 and 90-day mortality and 2-year survival data were recorded. Results Forty patients (21 female) were operated (Median age 62.9 [53.5–70.25]). Eighteen patients (45%) received neoadjuvant chemoradiation. The chest part of all cases was started with uniportal VATS and thirty-one (77.5%) was completed uniportally (34 Ivor Lewis, 6 McKeown). The median thoracic operation time in minimally invasive Ivor Lewis oesophagectomy was 90 min (77.5–100). The median time for uniportal side to side anastomosis was 12 min (11–16). Five (12.5%) patients had leak, four were intrathoracic. Twenty-eight (70%) patients had squamous cell carcinoma, eleven adenocarcinoma and one squamous cell carcinoma with sarcomatoid differentiation. Thirty-seven (92.5%) patients had R0 resection. The mean number of lymph nodes dissected was 24 ± 9.5. 30-and 90-day mortality was 2.5% (n = 1). The mean follow-up was 44 ± 2.8 months. 2-year survival was 80%. Conclusions Uniportal VATS oesophagectomy is a safe, fast and feasible alternative to other minimally invasive and open approaches. Comparable results to contemporary series are observed in perioperative and oncologic outcomes.