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Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons
57th Annual Meeting Abstracts


Poster 24

Abstract Title

A Preliminary Experience with Minimally Invasive Ivor Lewis Esophagectomy

 

Author Block

Luis F. Tapias-Vargas, MD, Christopher R. Morse, MD

Division of Thoracic Surgery, Massachusetts GeneralHospital, Boston, MA

 

Abstract Body

Background: With several small series examining minimally invasive Ivor Lewis esophagectomies, we look to contribute to this growing experience. In reporting our initial results, we demonstrate the safety, initial oncologic completeness, and preliminary outcomes with a minimally invasive Ivor Lewis esophagectomy.

Methods: From 2007 to 2010, 33 MIE were performed. The approach was a laparoscopic mobilization of the stomach and a thoracoscopic esophageal mobilization and creation of a high intrathoracic anastomosis. Indications included esophageal cancer in 32 patients and an esophageal GIST in 1 patient.

Results: The median age was 61 (range, 39-77) with 25 (76%) male patients. Nonemergent conversion was required in 2 patients (6%). MIE was completed in 31 patients (94%). Nineteen patients (58%) underwent neoadjuvant therapy. Mean operative time was 370 min (range, 285-455) and mean blood loss was 214cc (range, 100-400). All patients underwent an R0 resection and mean number of nodes harvested was 22 (range, 11-41). Median ICU stay was 1 day (range, 1-3) and hospital stay was 7 days (range, 6-19). There were no anastomotic leaks and no 30-day mortality. Postoperative complications included atrial fibrillation (7) and two chylothorax, one requiring ligation.. At a mean follow up of 16.5 months (1-34), 5 patients have had a distant recurrence; there have been no local recurrences. Conclusion: Minimally invasive Ivor Lewis esophagectomy, although technically challenging, can be performed with reasonable operative times, a short length of stay and minimal complication. Final oncologic validity is pending longer followup and a larger series.

 

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