Minimally Invasive Esophagectomy for Esophageal Cancer: Comparative Analysis of Open and Hand-Assisted Laparoscopic Abdominal Lymphadenectomy with Gastric Conduit Reconstruction

Background and Objectives: Esophagectomy for esophageal cancer is an invasive procedure. Minimally invasive approaches such as hand-assisted laparoscopic surgery (HALS) might reduce surgical stress and improve postoperative course. Methods: We retrospectively analyzed 216 consecutive patients who underwent esophagectomy for esophageal cancer through either HALS (109 patients) or open laparotomy (107 patients), through an abdominal approach. The peri-and postoperative outcomes were compared between the two groups. Results: No significant difference was observed in physical and tumor status between the two groups. The mean operating time (HALS: 452 +/- 65, Open: 456 +/- 69 min) and mean number of resected lymph nodes (HALS: 19.3 +/- 7.1, Open: 20.8 +/- 8.3) were similar, while total blood loss was lower in HALS (HALS: 695 +/- 369, Open: 1,101 +/- 540 ml; P = 0.0001). The postoperative course showed marginally lower incidences of pulmonary (HALS: 6.4%, Open: 14.0%; P = 0.062) and overall complications (HALS: 23.9%, Open: 35.5%; P = 0.11), lower C-reactive protein level at postoperative days 1, 3, and 7, and shorter duration of systemic inflammatory response syndrome (HALS: 2.3 days, Open: 3.5 days; P = 0.0002) in HALS than in OPEN. The disease-free survival rates at 2 years were 65% in HALS and 53% in Open. Conclusions: The findings suggest that HALS is feasible and useful for patients with esophageal cancer. J. Surg. Oncol. 2011; 104: 623-628. (C) 2011 Wiley Periodicals, Inc.