Thoracoscopic Esophagectomy
The Minimally invasive approach for oesophageal resection for cancer (MIO) is increasingly being used in the world. Important advantage is avoidance of thoracotomy while obtaining the same quality of specimen. Thoracoscopic oesophageal resection can be pe
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Thoracoscopic Esophagectomy Miguel A. Cuesta, Donald L. van der Peet, Surya S.A.Y. Biere, Suzanne S. Gisbertz, and Mark van Berge Henegouwen
9.1
Introduction
The global incidence of esophageal cancer has increased by 30 % in the past two decades; in 1990, 316,000 people were diagnosed with esophageal cancer while in 2008, 482,300 new cases of esophageal cancer were recorded [1, 2]. Surgical resection with radical lymphadenectomy – usually after neoadjuvant chemotherapy or chemoradiotherapy – is considered the only curative option for resectable esophageal cancer [3–5]. Open esophagectomy performed through a right thoracotomy and laparotomy puts at least half the patients at risk for developing pulmonary complications. This necessitates prolonged stay in intensive care units and hospital wards and leads to consequences for the postoperative quality of life. Current mortality rates of esophageal resection are less than 5 % [6]. Minimally invasive esophagectomy (MIE), by avoiding thoracotomy and laparotomy, may reduce the rate of pulmonary infections, thereby resulting in a shorter hospital stay [7, 8]. Because M.A. Cuesta () • D.L. van der Peet • S.S.A.Y. Biere • S.S. Gisbertz Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands e-mail: [email protected] M. van Berge Henegouwen Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
of these potential advantages MIE is increasingly implemented in specialized centers.
9.2
Advantages of Minimally Invasive Esophagectomy for Cancer
There is a general consensus in the literature that all esophageal cancers should be operated through the thorax and abdomen, i.e. two-field lymphadenectomy, in order to obtain an adequate radical resection with negative margins (longitudinal and radial), after a well tolerated neoadjuvant therapy (e.g. CROSS scheme). Only in patients with cardiac or respiratory comorbidity or elderly patients with tumors located very distally or at the gastroesophageal (GE) junction may a transhiatal approach be considered the approach of choice [9–18]. Why to perform the esophageal resection by MIE? What are the potential advantages of MIE? We hold these to be less trauma, no necessity for laparotomy and thoracotomy incisions, a better visualization of the operative field, no necessity of total pulmonary block, and less postoperative complications. Moreover, a transhiatal procedure performed laparoscopically allows a better view of the lower mediastinum, less displacement of the heart and a greater hemodynamic stability during operation [13]. The ultimate speculation is that a less traumatic operation will positively affect patient survival.
L. Bonavina (ed.), Innovation in Esophageal Surgery, DOI 10.1007/978-88-470-2469-4_9, © Springer-Verlag Italia 2012
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Fig. 9.1 The patient is positioned in the prone decubitus position
Fig. 9.2 Placement of trocars for the thoracoscopy
Fig. 9.4 The esophagus is dissected from the aorta and contralateral pleura
Fig. 9.3 Dissection of the
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