Krebswissenschaft und -therapie

Minimally Invasive Esophagectomy/Gastroesophagectomy for Cancer. Is it Safe in Nepalese Context?

Abstract

Binay Thakur, Li Hui, Mukti Devkota, Chen Xin and Robin Lama

Background: Minimally invasive approach for cancer of esophagus and gastroesophageal junction (GEJ) is gaining more popularity in the developed world mainly because of its better cosmetic results, lesser pain and lesser postoperative stay without compromising the radicality of the cancer surgery and survival. The aim of this study is to review the early outcome of this approach at BP Koirala Memorial Cancer Hospital.

Methods: Resectable tumors of GEJ and esophagus were treated primarily with surgery. Locally advanced tumors were considered for multimodality approach. Three ports were used for Video-assisted thoracoscopic (VATS) esophageal mobilization. Five ports were used for laparoscopic mobilization of stomach. Depending upon the feasibility, either a totally minimally invasive approach or a combination of minimally invasive approach with open technique was used. A 5 cm minilaparotomy was performed to retrieve the specimen.

Results: 34 patients with mean age of 57 years were reviewed. 9%, 38%, 29.5% and 23.5% of patients had malignancies of upper esophagus, middle esophagus, GEJ - I (distal esophagus) and GEJ - II (cardia), respectively. Primary surgery was performed in 91% of cases, whereas 9% underwent preoperative chemoradiation followed by surgery. VATS-laparotomy-neck (3-incision), thoracotomy-laparoscopy-neck (3-incision), laparoscopy-thoracotomy (2-incision), laparoscopic transhiatal-neck (2-incision), VATS-laparoscopy-neck (3-incision) and laparoscopyassisted (1-incision) approaches were used in 15%, 56%, 3%, 12%, 12% and 3%, respectively. Mean number of dissected nodes was 22 and mean number of positive nodes was 6. R0 resection was achieved in 94% of cases. The major postoperative complications were in-hospital mortality (6%), anastomotic leak (12%) and recurrent laryngeal nerve injury (6%). The early (6 months) survival is 97%.

Conclusion: Our results show, minimally invasive surgery is feasible, safe and the early outcome is promising though a longer follow-up is required for its strong recommendation in Nepalese context.