Elsevier

Surgery

Volume 127, Issue 3, March 2000, Pages 284-290
Surgery

Original Communications
Minimally invasive esophagectomy for Barrett’s esophagus with high-grade dysplasia

Presented at the annual meeting of The Society of Surgical Oncology, Orlando, Fla, March 4-7, 1999.
https://doi.org/10.1067/msy.2000.103489Get rights and content

Abstract

Background: Barrett’s esophagus with high-grade dysplasia (BE/HGD) is associated with invasive carcinoma in 30% to 70% of cases. Esophagectomy is the treatment of choice for patients with BE/HGD but esophagectomy can be associated with high morbidity and mortality. The aim of our study was to report our preliminary experience in applying minimally invasive surgical techniques to esophagectomy for BE/HGD. Methods: From August 1996 to February 1999, 12 consecutive patients underwent minimally invasive esophagectomy for biopsy-proven BE/HGD. Our consort consisted of 7 men and 5 women; average age was 64 years (range, 40-78 years). All patients underwent a complete laparoscopic or combined laparoscopic and thoracoscopic resection of the esophagus with cervical anastomosis. Results: Mean operative time was 7.8 ± 2.1 hours, mean intensive care unit stay was 2.6 ± 2.2 days, and mean length of hospital stay was 8.3 ± 4.7 days. Five patients (42%) had carcinoma in situ or carcinoma identified on pathologic specimen. Analyses of all resected lymph nodes in the 12 patients were negative for metastatic disease. There were 6 major complications in 5 patients: 1 patient had a small bowel perforation requiring operative repair, 2 patients needed prolonged ventilatory support for respiratory insufficiency, and 3 patients had delayed gastric emptying requiring revision of the pyloromyotomy. The single minor complication in this series was a jejunostomy tube-site infection. There were no conversions to laparotomy or thoracotomy. All patients were alive and free of metastatic disease at a mean follow-up of 12.6 months. Conclusions: Minimally invasive esophagectomy is a feasible and safe alternative to conventional open esophagectomy for patients with BE/HGD. (Surgery 2000;127:284-90.)

Section snippets

Methods

From August 1996 to February 1999, 12 consecutive patients underwent minimally invasive esophagectomy for biopsy-proven BE/HGD at the University of Pittsburgh Medical Center. Our consort consisted of 7 men and 5 women; average age was 64 years (range, 40-78 years). During this time period, one patient with BE/HGD was treated nonsurgically because of her advanced age and poor performance status. Biopsy specimens in all 12 patients were reviewed and confirmed to be accurate by 2 experienced

Results

All 12 patients underwent successful minimally invasive esophagectomy without conversion to laparotomy or thoracotomy (Table I).

. Demographics and operative outcomes of patients who underwent minimally invasive esophagectomy for BE/HGD

Patient no.Age (y)/GenderProcedureDiagnosisPathologyICU stay (d)LOS (d)
 155/FLTEBE/HGDBE/HGD14
 277/MLM/TEBE/HGDBE/HGD213
 355/MLM/TEBE/HGDAdenocarcinoma in situ16
 458/MLM/TEBE/HGDBE/HGD612
 570/FLM/TEBE/HGDAdenocarcinoma in situ27
 673/MLM/TEBE/HGDBE/HGD15
 766/MLM/TEBE/HGD

Discussion

What constitutes the optimal management for patients with BE/HGD remains controversial. Surgical resection is the most definitive curative treatment, but concern about high morbidity and mortality associated with esophagectomy has influenced some clinicians to consider other options such as endoscopic biopsy surveillance, PDT, or endoscopic mucosectomy.3, 4, 5 The rationale for endoscopic surveillance is that some patients with BE/HGD will not progress to develop invasive cancer. The Hines VA

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Reprint requests: Ninh T. Nguyen, MD, Department of Surgery, 4301 X St, Sacramento, CA 95817-2214.

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