Thoracoscopic esophageal mobilization for pharyngolaryngoesophagectomy

Background. Pharyngolaryngoesophagectomy (PLE) for hypopharyngeal cancers a nd tumors of the cervical esophagus is a procedure of significant morbidity and mortality. Conventional esophageal mobilization is performed with the transhiatal dissection technique. Thoracoscopic esophageal mobilization is tested as an alternative to determine whether surgical outcome can be impro ved. Methods. From 1994 to 1998, thoracoscopic mobilization was carried out in 3 0 consecutive patients who underwent PLE (PLE-TS). This was compared to a h istorical cohort of 30 patients who had PLE with transhiatal mobilization ( PLE-TH). Results. in PLE-TS, thoracoscopic esophageal mobilization was successful in 28 patients (939'0). Median blood loss was 700 mL (range, 164 to 3,000 mL) compared to 1,000 mt (range, 400 to 2,200 mt) in group PLE-TH, p = 0.21. T horacoscopy time was 90 minutes (range, 60 to 180 minutes). Total operating time were 392 minutes (range, 180 to 570 minutes) and 300 minutes (range, 150 to 550 minutes) in PLE-TS and PLE-TH, respectively (p = 0.03). Major pu lmonary complications occurred in 7 (23%) and 8 (27%) patients in PLE-TS an d PLE-TH, respectively (p = 0.77). Cardiac complications occurred in 7 (23% ) and 5 (17%) patients in PLE-TS and PLE-TH, respectively (p = 0.52). Thirt y-day mortality rates were 3.3% and 10% (p = 0.6) and hospital mortality ra tes were 13% and 17%, (p = 1.0). Conclusions. Thoracoscopy was safe and feasible. Morbidity and mortality af ter PLE was not significantly reduced. The theoretical advantage offered by thoracoscopy may be offset by the lengthened time of one-lung anesthesia. (C) 2000 by The Society of Thoracic Surgeons.