EN-BLOC AND STANDARD ESOPHAGECTOMIES BY THORACOSCOPY

Subtotal esophagectomy was attempted by right thoracoscopy on 13 patie nts, 10 having cancer and 3 long caustic stenosis. Thoracoscopy was co nverted into thoracotomy in 2 patients, owing to loss of selectivity i n one-lung ventilation in 1 and injury to a right intercostal artery f lush to the aorta in the other. One patient with cancer underwent an e sophageal bypass operation only, owing to tumor invasion into the lung at exploratory thoracoscopy. The ten esophagectomies that could be pe rformed in totality by thoracoscopy consisted of seven en bloc resecti ons of the esophagus with extensive lymph node clearance in the poster ior mediastinum, and three standard resections without any lymph node dissection. Postoperative complications included one death due to hepa tic failure, two cases of acute pneumonitis, and one persistent chest wall discomfort at the trocar sites. Up to 51 lymph nodes were found i n the resected specimens of the cancer patients. Six of the 7 cancer p atients who were discharged from the hospital after esophagectomy comp leted by thoracoscopy were alive at 2 to 20 months of follow-up. Five of them were disease free. The study shows that esophageal resections as extensive as those carried out by thoracotomy can be performed by t horacoscopy. It suggests that prompt management of untoward injury to any mediastinal structure adjacent to the esophagus is less easy by th oracoscopy than by thoracotomy, and that classic complications of open thoracic surgery may occur after thoracoscopy as well.