HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fernando, H.C. Articles by Christie, N.A. Search for Related Content PubMed PubMed Citation Articles by Fernando, H.C. Articles by Christie, N.A. Related Collections Esophagus - other

Eur J Cardiothorac Surg 2002;22:1-6
© 2002 Elsevier Science NL

Outcomes of minimally invasive esophagectomy (MIE) for high-grade dysplasia of the esophagus

Division of Thoracic Surgery and the Minimally Invasive Surgery Center, University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA

Received 17 September 2001; received in revised form 22 February 2002; accepted 15 March 2002.

* Corresponding author. UPMC Presbyterian, Suite C800 200 Lothrop Street, Pittsburgh, PA 15213, USA. Tel.: +1-412-647-7555; fax: +1-412-647-7550
e-mail: fernandohc{at}msx.upmc.edu

Objective: The management of high-grade dysplasia (HGD) of the esophagus is controversial with some clinicians advocating non-operative ablation or surveillance. Minimally invasive esophagectomy (MIE) allows re-section of the esophagus and may minimize morbidity. This report summarizes our experience with MIE for HGD. Methods: A retrospective review of 28 patients who underwent MIE for a pre-operative diagnosis of HGD. MIE initially involved a laparoscopic transhiatal approach (n=1), but subsequently evolved to laparoscopy with VATS mobilization (n=27) of the esophagus. Results: From August 1996 to March 2001, 28 patients underwent MIE. There were 23 males and five females; median age was 61 (40–78) years. Median hospital stay was 5 (3–20) days and ICU stay was 1 (1–20) day. One patient required conversion to laparotomy because of dense adhesions. There were ten other patients who had successful MIE despite prior laparotomy. Median operating time was 8 (5.8–13) h. One death occurred from sepsis, pneumonia and multi-system organ failure. Complications occurred in 15 patients. In addition to the patient who died, five re-operations were required for: small bowel perforation (n=1), jejunostomy leak (n=1), pyloric dilation for gastric outlet obstruction (n=1), cholecystectomy (n=1), incision and drainage of an abdominal abscess (n=1). Final pathologies were HGD (n=17), in situ cancer (n=6) and invasive cancer (n=5). At a median follow-up of 13 (2–41) months all hospital survivors are alive and free of disease. Conclusions: This report confirms the risk of occult cancer in patients with HGD (39% in this series) supporting the recommendation for esophagectomy. MIE can be performed with acceptable results and may minimize morbidity compared to previous reports of open esophagectomy for HGD.

Key Words: High grade dysplasia • Minimally invasive esophagectomy

This article has been cited by other articles:

				E. Crema, L. B.P. Ribeiro, J. A. Terra Jr, and A. A. Silva Laparoscopic Transhiatal Subtotal Esophagectomy for the Treatment of Advanced Megaesophagus Ann. Thorac. Surg., October 1, 2005; 80(4): 1196 - 1201. [Abstract] [Full Text] [PDF]

				A. Altorjay, J. Kiss, B. Paal, Z. Tihanyi, F. Luka, Z. Farsang, I. Asztalos, and I. Altorjay The place of gastro-jejuno-duodenal interposition following limited esophageal resection Eur. J. Cardiothorac. Surg., August 1, 2005; 28(2): 296 - 300. [Abstract] [Full Text] [PDF]