Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2015; 21(45): 12873-12881
Published online Dec 7, 2015. doi: 10.3748/wjg.v21.i45.12873
Updated experiences with minimally invasive McKeown esophagectomy for esophageal cancer
Ju-Wei Mu, Shu-Geng Gao, Qi Xue, You-Sheng Mao, Da-Li Wang, Jun Zhao, Yu-Shun Gao, Jin-Feng Huang, Jie He
Ju-Wei Mu, Shu-Geng Gao, Qi Xue, You-Sheng Mao, Da-Li Wang, Jun Zhao, Yu-Shun Gao, Jin-Feng Huang, Jie He, Department of Thoracic Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Mu JW and He J designed and performed the research, analyzed the data and wrote the manuscript; Gao SG, Xue Q, Mao YS, Wang DL, Zhao J, Gao YS and Huang JF performed the research.
Supported by The Fund of Capital Health Technology Development Priorities Research Project, No. 2014-1-4021.
Institutional review board statement: Institutional Review Board of Cancer Hospital, Chinese Academy of Medical Science reviewed and approved this study.
Informed consent statement: Informed consent was given by patients preoperatively. All included patients accepted the possibility to collect their patient data.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jie He, MD, PhD, Professor, Department of Thoracic Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China. hejie@cicams.ac.cn
Telephone: +86-10-87788207 Fax: +86-10-67787079
Received: September 12, 2015
Peer-review started: September 15, 2015
First decision: October 22, 2015
Revised: October 27, 2015
Accepted: November 9, 2015
Article in press: November 9, 2015
Published online: December 7, 2015
Processing time: 84 Days and 13.8 Hours
Abstract

AIM: To update our experiences with minimally invasive McKeown esophagectomy for esophageal cancer.

METHODS: We retrospectively reviewed the medical records of 445 consecutive patients who underwent minimally invasive McKeown esophagectomy between January 2009 and July 2015 at the Cancer Hospital of Chinese Academy of Medical Sciences and used 103 patients who underwent open McKeown esophagectomy in the same period as controls. Among 375 patients who underwent total minimally invasive McKeown esophagectomy, 180 in the early period were chosen for the study of learning curve of total minimally invasive McKeown esophagectomy. These 180 minimally invasive McKeown esophagectomies performed by five surgeons were divided into three groups according to time sequence as group 1 (n = 60), group 2 (n = 60) and group 3 (n = 60).

RESULTS: Patients who underwent total minimally invasive McKeown esophagectomy had significantly less intraoperative blood loss than patients who underwent hybrid minimally invasive McKeown esophagectomy or open McKeown esophagectomy (100 mL vs 300 mL vs 200 mL, P = 0.001). However, there were no significant differences in operation time, number of harvested lymph nodes, or postoperative morbidity including incidence of pulmonary complication and anastomotic leak between total minimally invasive McKeown esophagectomy, hybrid minimally invasive McKeown esophagectomy and open McKeown esophagectomy groups. There were no significant differences in 5-year survival between these three groups (60.5% vs 47.9% vs 35.6%, P = 0.735). Patients in group 1 had significantly longer duration of operation than those in groups 2 and 3. There were no significant differences in intraoperative blood loss, number of harvested lymph nodes, or postoperative morbidity including incidence of pulmonary complication and anastomotic leak between groups 1, 2 and 3.

CONCLUSION: Total minimally invasive McKeown esophagectomy was associated with reduced intraoperative blood loss and comparable short term and long term survival compared with hybrid minimally invasive McKeown esophagectomy or open Mckeown esophagectomy. At least 12 cases are needed to master total minimally invasive McKeown esophagectomy in a high volume center.

Keywords: Surgical procedures; Minimally invasive; Esophagectomy; Outcome; Learning curve

Core tip: Total minimally invasive McKeown esophagectomy had reduced intraoperative blood loss and comparable short term and long term survival compared with hybrid minimally invasive McKeown esophagectomy or open Mckeown esophagectomy. At least 12 cases are needed to master total minimally invasive McKeown esophagectomy in a high volume cancer center.