Esophagectomy in a low volume single center favoring a total minimally invasive approach – 55 Patients in 7 years

Background:

In Austria, esophageal cancer is not very common. The Incidence is 2.8/100,000 per year, thus esophageal cancer is on rank 18 of the most common carcinomas (less than 1% of the annually emerging malignant tumors). Multimodal treatment including surgery is standard for locally advanced esophageal cancer with a 5-year survival rate of around 40 – 50% in patients treated with curative intent.

Methods:

Retrospective single institution study in a tertiary care center using prospectively collected data with patient survival as primary endpoint and morbidity as secondary endpoint.

Results:

From 2010 – 1017, 55 Patients received an esophageal resection. The mean age was 61,5 years, five patients (9%) were female. Squamous cell carcinoma appeared in 37%, adenocarcinoma in 59% and a verrucous carcinoma in 4% of our patients. 98% of patients received an esophagectomy with gastric tube pull up, in 2% the colon was used for reconstruction. In patients with carcinoma located in the lower and middle thoracic esophagus a thoracic anastomosis was targeted (78%), in carcinomas of the upper thoracic esophagus a left cervical anastomosis (22%) was performed. Depending on location and comorbidities patients received either a conventional operation (11%), a hybrid operation with laparotomy and thoracoscopic esophageal resection (59%) or a totally minimal invasive approach (30%). The 60-day mortality was < 2%, the need for reoperation < 10%. Major complications (Clavien-Dindo III-V) were observed in 30%.

Conclusion:

Esophagectomy is a high-risk operation with serious mortality and morbidity. However, patients may profit of a tailored approach with intent for the minimal invasive approach even in a low volume center when expertise in high-end endocopic surgery is available.