Is Thoracoscopic Esophagectomy Feassible for a Minimally Invasive Surgery?

Iwao Kaneda, Norio Higuchi, Takashi Akaishi*, Kenji Kaino, Jiro Kikuchi, Akihiko Huruta

Ishinomaki Red Cross Hospital
*Second Department of Surgery, Tohoku University School of Medicine

To investigate the feasibility of thoracoscopic esophagectomy for thoracic esophageal cancer, we evaluated the number of mediastinal lymph nodes harvested, a picture of the mediastinum after en bloc lymphadenectomy by means of thoracoscopy, postoperative pain, postoperative pulmonary function, requirement of ventilatory support and postoperative complications. From September 1994 to February 1997, 37 patients with thoracic esophageal cancer underwent total esophagectomy with en block mediastinal lymphadenectomy by means of thoracoscopy. We compared this series with patients receiving esophagectomy for thoracic esophageal cancer by conventional thoracotomy. All patients tolerated the procedure well, and the thoracoscopic esophagectomy was successfully completed in all of them. The operating time for thoracoscopy was 199±43 min and the estimated blood loss was 359±250 ml. The number of mediastinal lymph nodes harvested was 8∼48 (mean 23.6). Postoperative pain in the thoracoscopic group was significantly less than in the thoracotomy group (p<0.05 by t test). Postoperative pulmonary function of the thoracoscopic group was better preserved than in the thoracotomy group. Requirement of ventilatory support and postoperative complications of the thoracoscopic group were, however, similar to those of thoracotomy group. Conclusions: The completeness of mediastinal lymph node dissection is equivalent to that of the conventional open technique. Though thoracoscopic esophagectomy is much less invasive than the open technique, we find it difficult to say that thoracoscopic esophagectomy is truly a minimally invasive operation.

Key words
thoracoscopic esophagectomy, en bloc mediastinal lymphadenectomy, minimally invasive surgery

Reprint requests
Iwao Kaneda Department of Surgery, Ishinomaki Red Cross Hospital
1-7-10 Yoshino-cho, Ishinomaki, 986-0015 JAPAN

Accepted
December 3, 1997

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