Modified Mckeown Minimally Invasive Esophagectomy For Esophageal Cancer: A 5-Year Retrospective Study Of 142 Patients In A Single Institution

Background: To achieve decreased invasiveness and lower morbidity, minimally invasive esophagectomy (ME) was introduced in 1997 for localized esophageal cancer. The combined thoracoscopic-laparoscopic esophagectomy (left neck anastomosis, defined as the McKeown ME procedure) has been performed since 2007 at our institution. From 2007 to 2011, our institution subsequently evolved as a high-volume MIE center in China. We aim to share our experience with MIE, and have evaluated the outcomes of 142 patients.Methods: We retrospectively reviewed 142 consecutive patients who had presented with esophageal cancer undergoing McKeown ME from July 2007 to December 2011. The procedure, surgical outcomes, disease-free and overall survival of these cases were assessed.Results: The average total procedure time was 270.5 +/- 28.1 min. The median operation time for thoracoscopy was 81.5 +/- 14.6 min and for laparoscopy was 63.81 +/- 9.1 min. The average blood loss associated with thoracoscopy was 123.8 +/- 39.2 ml, and for laparoscopic procedures was 49.9 +/- 14.3 ml. The median number of lymph nodes retrieved was 22.8. The 30 day mortality rate was 0.7%. Major surgical complications occurred in 24.6% and major non-surgical complications occurred in 18.3% of these patients. The median DFS and OS were 36.0 +/- 2.6 months and 43.0 +/- 3.4 months respectively.Conclusions: Surgical and oncological outcomes following McKeown MIE for esophageal cancer were acceptable and comparable with those of open-McKeown esophagectomy. The procedure was both feasible and safe properties that can be consolidated by experience.