Esophagectomy: the Comparison of Conventional and Minimally Invasive Approach

Evgeny V. Levchenko ¹, Nikolay V. Khandogin ¹, Sergey Y. Dvoretskiy ², Igor V. Komarov ², Roman I. Yurin ¹, Oleg Y. Mamontov ¹, Nikita E. Levchenko ¹

¹ Federal State Budgetary Institution N. N. Petrov National Medical Research Centre of Oncology, Saint Petersburg, Russia; ² Federal State Budgetary Educational Institution of Higher Education Academician I. P. Pavlov The First Saint Petersburg Medical University, Saint Petersburg, Russia;

Date, time and location: 2018.05.25 13:30, Congress Hall, 2F–C

Abstract

Objective. The advantages and disadvantages of conventional and minimally invasive technique in esophagectomy are debatable. The aim was to estimate the results after complex treatment of esophageal carcinoma by the means of comparison of oncological principles abidance, complications, recurrence free (RFS) and overall survival (OS) in groups of conventional (CE), minimally invasive (MIE) and hybrid minimally invasive esophagectomy (HMIE).

Methods. Our experience of 274 cases in 1995-2017 was reviewed (120 - CE, 103 - MIE, 51 - HMIE). The indication for surgery was esophageal carcinoma, surgery was performed either the final step of complex treatment or independent surgery. The average age was 59,3 years.

Results. The median and the mode for blood loss were 200 ml and 200 ml in MIE, 600 ml and 500 ml in CE; for operative time they were 370 min and 340 min in MIE, 300 min and 300 min in CE respectively; for intensive care unit stay they were equal to 1 day both in MIE and HMIE, that is 5 times less than in CE (p<0,01, CI 95 %). The mean hospital stay was 14,0 days (p>0,05, CI 95 %). Conversion to CE was required in 5,8 % patients. The overall complications rate was similar among groups (p>0,05, CI 95 %). Anastomotic leakage, pulmonary and cardio‑vascular complications remain the significant complications after esophagectomy and frequently lead to postoperative mortality regardless the type of surgery (p<0,01, CI 95 %). Anastomotic leak registered less frequently in HMIE with thoracotomy and hand‑sewn esophagogastroanastomosis (p<0,05, CI 95 %). OS was depended on metastatic lymph nodes quantity, postoperative pulmonary complications, tumor length, age; RFS was depended on metastatic lymph nodes quantity, completeness of lymph nodes harvesting (p<0,01, CI 95 %).

Conclusions. The surgery type does not matter in complications rate. HMIE with thoracotomy and hand‑sewn esophagogastroanastomosis reveals the safest profile among groups.