Laparoscopic total esophagectomy.

OBJECTIVE

To evaluate early results with laparoscopic total esophagectomy for benign and malignant disease of the esophagus.

DESIGN

Case series involving 9 patients with mean follow-up of 13 months.

SETTING

An advanced endoscopic surgery unit at a tertiary referral teaching hospital.

PATIENTS

Between December 12, 1993, and December 1, 1996, 9 patients with a mean age of 61 years underwent laparoscopic esophagectomy. Indications were adenocarcinoma in 5, squamous cell carcinoma in 1, dysplastic Barrett esophagus in 2, and refractory stricture with severe shortening in 1.

INTERVENTIONS

Gastroduodenal mobilization, transhiatal wide esophageal dissection, gastric tube formation (8 cases), pyloromyotomy (2 cases), cervical anastomosis (8 cases), and laparoscopic jejunal feeding tube placement (8 cases).

OUTCOME MEASURES

Operative time, amount of blood loss, operative complications, length of hospital stay, postoperative complications, dysphagia rates, and survival.

RESULTS

All procedures were completed endoscopically. Operative time was 6.5 hours (range, 4 3/4 to 9 1/4). Average blood loss was 290 mL. One patient required a right thoracoscopy for an intrathoracic anastomosis because of questionable viability of the gastric tube. Mean hospital stay was 6.4 days (range, 4-9 days). Hospital complications included subclavian vein thrombosis (1 patient), dysphonia (6 patients), and atelectasis (5 patients). There were no anastomotic leaks. Three patients subsequently died: 2 of distant metastatic cancer (at 13 months and 33 months) and 1 of cardiac failure at 10 months. The 6 surviving patients were cancer free at a mean follow-up of 13 months. One patient had left vocal cord paralysis. All patients were doing well and had Visick scores of I or II.

CONCLUSIONS

Laparoscopic esophagectomy is a technically feasible but difficult procedure. Despite the long operative times, patients do well and benefit from a shorter hospital stay and more rapid recovery compared with open esophagectomy. Its role as a curative cancer procedure remains unknown, but it may have a place on the basis of its palliative superiority.