%0 Journal Article
%T Minimally Invasive Esophagectomy for Esophageal Cancer: The First Experience from Pakistan
%A Farrukh Hassan Rizvi
%A Syed Shahrukh Hassan Rizvi
%A Aamir Ali Syed
%A Shahid Khattak
%A Ali Raza Khan
%J International Journal of Surgical Oncology
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/864705
%X Background. Two common procedures for esophageal resection are Ivor Lewis esophagectomy and transhiatal esophagectomy. Both procedures have high morbidity rates of 20¨C46%. Minimally invasive esophagectomy has been introduced to decrease morbidity. We report initial experience of MIE to determine the morbidity and mortality associated with this procedure during learning phase. Material and Methods. Patients undergoing MIE at our institute from January 2011 to May 2013 were reviewed. Record was kept for any morbidity and mortality. Descriptive statistics were presented as frequencies and continuous variables were presented as median. Survival analysis was performed using Kaplan Meier curves. Results. We performed 51 minimally invasive esophagectomies. Perioperative morbidity was in 16 (31.37%) patients. There were 3 (5.88%) anastomotic leaks. We encountered 1 respiratory complication. Reexploration was required in 3 (5.88%) patients. Median operative time was 375 minutes. Median hospital stay was 10 days. The most frequent long-term morbidity was anastomotic narrowing observed in 5 (9.88%) patients. There were no perioperative mortalities. Our mean overall survival was 37.66 months (95% confidence interval 33.75 to 41.56 months). Mean disease-free survival was 24.43 months (95% CI 21.26 to 27.60 months). Conclusion. Minimally invasive esophagectomy, when performed in the learning phase, has acceptable morbidity and mortality. 1. Introduction Neoadjuvant treatment for locally advanced esophageal cancer is the standard of care [1, 2]. Esophagectomy has historically remained a very morbid procedure [3]. There are various modes of intervention among both open and minimally invasive groups. Previously, it was considered that transthoracic esophagectomy is the standard of care for oncological resection, but Orringer challenged this claim in the 1970s and redescribed the transhiatal procedure as equally effective but less morbid than transthoracic procedure owing to less postoperative pulmonary complications [4]. With the advent of laparoscopes, there has been a gradually increasing interest in minimally invasive procedures. Minimally invasive esophagectomy is a well-established intervention for esophageal resection. It is a complex procedure requiring greater operative time, but it is associated with shorter hospital stay and lesser blood transfusion requirements [5¨C8]. At our institution open esophagectomy remains the standard mode of intervention since 1998. Since 2011, we have started performing minimally invasive esophagectomy, with thoracic part of the
%U http://www.hindawi.com/journals/ijso/2014/864705/