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Revista chilena de cirugía

On-line version ISSN 0718-4026

Abstract

NORERO, Enrique et al. Initial experience with minimally invasive transtoraxic esophagectomy in semiprone position for esophageal cancer. Rev Chil Cir [online]. 2018, vol.70, n.1, pp.27-34. ISSN 0718-4026.  http://dx.doi.org/10.4067/S0718-40262018000100027.

Introduction

Surgical treatment of esophageal cancer is associated with high morbidity and mortality. The minimally invasive approach has been introduced with the aim of reducing postoperative morbidity.

Aim

To describe the surgical technique and the results of transthoracic minimally invasive esophagectomy (MIE) in semiprone position.

Material and Methods

Descriptive cohort study. Patients with an elective MIE for cancer were included between April 2013 and May 2017. Demographic, perioperative, pathology and survival variables were recorded.

Results

We included 33 patients (24 men, age 69 years, 91% with comorbidities). The predominant location of the tumor was in the middle and lower thirds of the esophagus (90%). Fifteen (45%) patients received neoadjuvant treatment. There were no cases of conversion to thoracotomy. The reconstruction was performed with stomach in 93%. Cervical anastomosis was performed in 66% and thoracic anastomosis in 30%. The operative time was 420 (330-570) minutes and bleeding 200 (20-700) cc. The 90-day mortality rate was 0%. Overall morbidity was 78%, there was a 15% occurrence of pneumonia and 9% required a reoperation. The hospital stay was 23 (11-81) days. The histology was squamous carcinoma in 51% and adenocarcinoma in 45%. Margins were RO at 87%. The lymph node count reached 30 (9-45) lymph nodes. Overall 2-year survival is 68%.

Conclusion

The preliminary results of this technique are favorable, without any case of postoperative mortality. The oncological results demonstrate a high percentage of RO surgery and adequate lymph node count.

Keywords : Esophageal neoplasms; Esophagectomy; Prone position; Minimally invasive surgical procedures.

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