TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY 3D HD FOR THORACIC ESOPHAGEAL CANCER AFTER NEOADJUVANT  CHEMORADIOTHERAPY

F. Achim; M. Gheorghe; A. Constantin; P. Hoara; C. Popa; A. Alkadour; Iuliana Vergu; Adelina Birceanu; S. Constantinoiu

doi:10.33695/jss.v5i3.226

F. Achim General and Esophageal Surgery Clinic, Center of Excellence in Esophageal Surgery, Sf. Maria Clinical Hospital, Bucharest, Romania
M. Gheorghe General and Esophageal Surgery Clinic, Center of Excellence in Esophageal Surgery, Sf. Maria Clinical Hospital, Bucharest, Romania
A. Constantin General and Esophageal Surgery Clinic, Center of Excellence in Esophageal Surgery, Sf. Maria Clinical Hospital, Bucharest, Romania
P. Hoara General and Esophageal Surgery Clinic, Center of Excellence in Esophageal Surgery, Sf. Maria Clinical Hospital, Bucharest, Romania
C. Popa General and Esophageal Surgery Clinic, Center of Excellence in Esophageal Surgery, Sf. Maria Clinical Hospital, Bucharest, Romania
A. Alkadour General and Esophageal Surgery Clinic, Center of Excellence in Esophageal Surgery, Sf. Maria Clinical Hospital, Bucharest, Romania
Iuliana Vergu Intensive Care Department, Sf. Maria Clinical Hospital, Bucharest, Romania
Adelina Birceanu Pathology Department, Sf. Maria Clinical Hospital, Bucharest, Romania
S. Constantinoiu General and Esophageal Surgery Clinic, Center of Excellence in Esophageal Surgery, Sf. Maria Clinical Hospital, Bucharest, Romania

DOI: https://doi.org/10.33695/jss.v5i3.226

Keywords: totally minimally invasive esophagectomy, three-dimensional esophagectomy, chemoradiotherapy, the modified McKeown triple approach

Abstract

Esophagectomy is a major surgical procedure with morbidity, and mortality related to the patient's
condition, stage of the disease at the moment of diagnosis, complementary treatments and surgical
experience of the surgeon. Minimally invasive esophagectomy (MIE) may lead to a reduction in
perioperative morbidity and mortality with an acceptable quality of life and similar oncologic results
to an open approach. We present an experience of the Center of Excellence in Esophageal Surgery
regarding totally MIE through thoracolaparoscopic modified McKeown triple approach, followed
by esophageal reconstruction by gastric intrathoracic pull-up and cervical esophagogastric
anastomosis and feeding jejunostomy in a patient with thoracic esophageal cancer who underwent
preoperative neoadjuvant chemoradiotherapy. The short-term outcomes of the totally minimally
invasive esophagectomy procedure were very encouraging. The overall operative times were:
thoracoscopic - 120 minutes, laparoscopic - 130 minutes and cervical - 50 minutes with a total of
360 minutes. The intraoperative blood loss was 200 ml. The postoperative outcome was favorable
with early feeding on the jejunostomy. The control of cervical anastomosis was performed in the 6th
day postoperative and the patient was discharged in the 10th day postoperative without any
symptomatology. At the first and third-month follow-up was not reported any postoperative
complications. The totally minimally invasive approach using advanced technology of endoscopic
surgery allowed for this patient a simple postoperative evolution, no major complications and a
good recovery after extensive surgery. The solid experience in open esophageal surgery of
Upper Gastro-Intestinal surgeons provides a fast learning curve of complex minimally invasive
surgical procedures with reduced perioperative morbidity. Long-term follow-up can confirm the
results from the literature regarding the survival, which is expected to be for these patients at
least equivalent with outcomes after open esophagectomy.