Comparison of perioperative outcomes after combined thoracoscopic-laparoscopic esophagectomy and open Ivor–Lewis esophagectomy

Abstract Background Thoracoscopic-laparoscopic esophagectomy (TLE) has gained popularity in specialized centers. This study compares the perioperative outcomes of TLE and Ivor-Lewis esophagectomy (ILE). Methods Forty-four consecutive TLEs were compared with 46 historical ILEs. Outcomes included surg...

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Bibliographic Details
Published in:The American journal of surgery 2010-05, Vol.199 (5), p.594-598
Main Authors: Pham, Thai H., M.D, Perry, Kyle A., M.D, Dolan, James P., M.D, Schipper, Paul, M.D, Sukumar, Mithran, M.D, Sheppard, Brett C., M.D, Hunter, John G., M.D
Format: Article
Language:English
Subjects:
Abdomen
Aged
Blood
Body mass index
Cancer therapies
Chi-Square Distribution
Classification
Cohort Studies
Combined Modality Therapy
Complications
Endoscopy
Esophageal cancer
Esophageal Neoplasms - mortality
Esophageal Neoplasms - pathology
Esophageal Neoplasms - surgery
Esophagectomy
Esophagectomy - methods
Esophagectomy - mortality
Esophagoscopy - methods
Esophagus
Female
Follow-Up Studies
Gastrointestinal surgery
Hospital Mortality - trends
Humans
Ivor-lewis esophagectomy
Laparoscopy
Length of Stay
Lymphatic system
Male
Medical personnel
Medical prognosis
Middle Aged
Minimally invasive
Minimally Invasive Surgical Procedures - methods
Minimally Invasive Surgical Procedures - mortality
Morbidity
Mortality
Neoplasm Staging
Ostomy
Patients
Perioperative Care - methods
Perioperative morbidity
Postoperative Complications - mortality
Postoperative Complications - physiopathology
Probability
Retrospective Studies
Society
Statistical analysis
Statistics, Nonparametric
Surgery
Survival Rate
Thoracoscopy - methods
Thoracotomy - methods
Thrombosis
Tomography
Treatment Outcome
Veins & arteries
Wounds
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Summary:Abstract Background Thoracoscopic-laparoscopic esophagectomy (TLE) has gained popularity in specialized centers. This study compares the perioperative outcomes of TLE and Ivor-Lewis esophagectomy (ILE). Methods Forty-four consecutive TLEs were compared with 46 historical ILEs. Outcomes included surgical time and blood loss, hospital length of stay, 30-day mortality rate, and complications. Results TLE took longer to perform (543 vs 437 min; P < .01) than ILE, but produced less blood loss (407 vs 780 mL; P < .01). The median length of stay and 30-day mortality did not differ between groups. Cardiovascular (41% for TLE vs 30% for ILE; P = .19) and pulmonary complications (31% TLE vs 30% ILE; P = 1.0) occurred frequently in both groups, but TLE patients had fewer wound complications (4% TLE vs 17% ILE; P = .05). Conclusions Despite longer surgical times, TLE produced decreased intraoperative blood loss and wound complications. These findings suggest that with further technical refinement TLE may ameliorate the morbidity seen with ILE.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2010.01.005