Minimally invasive esophagectomy for Barrett's esophagus with high-grade dysplasia

Background, Barrett's esophagus with high-grade dysplasia (BE/HGD) is assoc iated with invasive carcinoma in 30% to 70% of cases. Esophagectomy is the treatment of choice for patients with BE/HGD hit esophagectomy can be assoc iated with high morbidity and mortality. The aim of our study was to report our preliminary experience in applying minimally invasive surgical techniq ues to esophagectomy for BE/HGD. Methods. From August 1996 to February 1999, 12 consecutive patients underwe nt minimally invasive esophagectomy for biopsy-proven BE/HGD. Our consort c onsisted of 7 men and 5 women; average age was 64 years (range, 40-78 years ). All patients underwent a complete Ia;laparoscopic ol combined laparoscop ic and thoracoscopic resection of the esophagus with cervical anastomosis. Results, Mean operative time was 7.8 +/- 2.1 hours, mean intensive care uni t 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 pati ents were negative for metastatic disease. There were 6 major complications in 5 patients: I patient had a small bowel perforation requiring operative repair 2 patients needed prolonged ventilatory support for respiratory ins ufficiency, and 3 patients had delayed gastric emptying requiring revision of the pyloromyotomy. The single minor complication in this series was a je junostomy tube-site infection. There were no conversions to laparotomy or t horacotomy. All patients were alive and free of metastatic disease at a mea n follow-up of 12.6 months. Conclusions, Minimally invasive esophagectomy is a feasible and safe altern ative to conventional open esophagectomy for patients with BE/HGD.