Video-assisted thoracoscopic esophagectomy for esophageal cancer

Background: The Ivor-Lewis procedure is a radical, invasive, and effective procedure for the resection of most esophageal cancers. To minimize invasiv eness, we performed thoracoscopic and video-assisted esophagectomy and medi astinal dissection for esophageal cancer. Methods: From November 1995 to June 1997, 23 patients with intrathoracic es ophageal cancer, excluding T4 cancers, underwent thoracoscopic and video-as sisted esophagectomy. Bilateral cervical dissections were performed as well as preparation of the gastric tube and transhiatal dissection of the lower esophagus. The cervical esophagus was cut using a stapler knife, and esoph ageal reconstruction was performed through the retrosternal route or anteri or chest wall. Next, thoracoscopic mediastinal dissection and esophagectomy were performed. Results: The mean volume of blood loss was 163 +/- 122 ml; mean thoracoscop ic surgery duration, 111 +/- 24 min; mean postoperative day for patients to start eating, 8 +/- 3 days; and mean hospital stay, 26 +/- 8 days. No pati ent developed systemic inflammatory response syndrome postoperatively. Trac heal injury occurred and was repaired during the thoracoscopic approach in one patient. No patients died within 30 days after surgery. Postoperative c omplications included transient recurrent nerve palsy in five patients, pul monary secretion retention requiring tracheotomy in two, and chylothorax in one. Five patients died of cancer recurrence within 1 year of surgery. Conclusions: Our surgical experience with thoracoscopic and video-assisted esophagectomy indicate that it is a feasible and useful procedure.