CAN THE MORBIDITY OF ESOPHAGECTOMY BE REDUCED BY THE THORACOSCOPIC APPROACH

Esophagectomies have a high morbidity rate, mainly related to pulmonar y complications. The aim of this work was to assess whether the thorac oscopic approach could reduce this morbidity. We have made a prospecti ve study of the results of 29 attempts of esophagectomy using a right thoracoscopic approach. There were 20 males and 9 females having an av erage age of 47. The indication was a squamous cell carcinoma in 22 pa tients, an adenocarcinoma in I patient, a melanoma in I patient, and a caustic stenosis in 5. The whole esophagus was mobilized thoracoscopi cally and the esophagectomy was completed through the abdomen, The rec onstruction was achieved using a gastric pull-through and a cervical a nastomosis. There were five failures for the following reasons: unrese ctable carcinoma (one case), large tumor making a thoracoscopic dissec tion unsafe (two cases), and incomplete lung collapse making the expos ure of the posterior mediastinum difficult (two cases). The average ti me of the thoracoscopic procedure was 135 min. The postoperative cours e was uneventful in ail but five patients who had a pulmonary complica tion: atelectasis (three cases), right purulent pleural effusion (one case), acute respiratory disease syndrome (one case). The latter compl ication was lethal. Four out of five respiratory complications occurre d in patients for whom the dissection was considered difficult, Among the other complications, there were five anastomotic leakages and thre e cases of laryngeal nerve palsy. The mortality rate was 3.8%. These i nitial results do not show a real benefit of the thoracoscopic approac h for esophageal dissection, especially with respect to difficult esop hagectomies. Further evaluation of the technique is needed.