Page 10 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Totally Laparoscopic vs Open Transhiatal Esophagectomy:

Our Experience in 93 Patients

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Ali Jangjoo , Sadjad Noorshafiee , Ehsan Alaei , Yasaman Navari , Mahdi Jabbari Nooghabi 5
AbstrAct
Introduction: The incidence of esophageal cancer has been increasing in the last decade. Different types of treatments are available, including
minimally invasive esophagectomy (MIE). The aim of this study was to compare the early outcomes of the open vs totally laparoscopic transhiatal
esophagectomy.
Materials and methods: This case–control study was conducted between May 2012 and January 2014. Patients with esophageal cancer who
presented to Imam Reza Hospital, Mashhad, Iran, were assessed and their eligibility for the surgery type was investigated.
Results: Ninety-three esophagectomies performed. The open group comprised 57 patients and the laparoscopic group consisted of 36 patients.
Mortality occurred in three patients in the open group and seven patients in the laparoscopic group (p < 0.05). Chylothorax happened in four
patients in the open group and only in one patient in the laparoscopic, which showed no significant difference. The mean operating time was
75 ± 16 minutes in the open group and 125 ± 25 minutes in the laparoscopic group (p < 0.05).
Conclusion: Minimally invasive transhiatal esophagectomy is an available option for treatment of esophageal cancer, but our results should
be interpreted with caution due to low sample size and our primary experience in patient selection.
Keywords: Esophageal cancer, Esophagectomy, Laparoscopy, Transhiatal.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1370

IntroductIon 1,3 Surgical Oncology Research Center, Mashhad University of Medical
The incidence of esophageal cancer has been increasing in the last Sciences, Mashhad, Iran
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decades. In the United States, 17,000 new cases are diagnosed 2,4 Endoscopic and Minimally Invasive Surgery Research Center,
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and 15,000 cases die annually. In our region in the north of Iran, Mashhad University of Medical Sciences, Mashhad, Iran
this disease is endemic with a prevalence rate of 180/1,00,000 5 Department of Statistics, Faculty of Mathematical Sciences, Ferdowsi
population. The mean age of the patients is 60 years. Different University of Mashhad, Mashhad, Iran
types of therapy are available for this cancer, but there is a general Corresponding Author: Sadjad Noorshafiee, Endoscopic and
agreement that surgery could be the best option. 1–10 Surgical Minimally Invasive Surgery Research Center, Mashhad University of
treatments consist of different types of methods that are used Medical Sciences, Mashhad, Iran, Phone: +98 513-8402972, e-mail:
today. Most types of current surgical approaches are invasive and emis@mums.ac.ir
harsh and have multiple complications especially respiratory one. How to cite this article: Jangjoo A, Noorshafiee S, Alaei E, et al. Totally
Today, minimally invasive methods, including laparoscopy, have Laparoscopic vs Open Transhiatal Esophagectomy: Our Experience in
progressively improved. 5,10,11 The aim of this study was to compare 93 Patients. World J Lap Surg 2019;12(2):56–58.
the early outcomes of the open vs totally laparoscopic transhiatal Source of support: Research Department of Mashhad University of
esophagectomy. Medical Sciences (ID: 940066)

Conflict of interest: None
MAterIAls And Methods
This pilot case–control study was conducted between May 2012 and esophagectomy. The data concerning the type of operation,
January 2014 after obtaining the approval of the Ethics Committee type of conduit, pylorus drainage procedures, intraoperative
of Mashhad University of Medical Sciences, Mashhad, Iran. Study complications, chest tube insertion and amount and type of drained
population included 93 patients, after excluding patients with fluid, postoperative complications, operative time, and the need
missing data; the study participants consisted of patients who for reoperation were recorded. Then the data were analyzed using
presented with esophageal cancer to Imam Reza Hospital and were SPSS version 16 with Fisher’s exact test and Pearson’s Chi-square
candidates for surgery after preoperative workup and approval of test. p value < 0.05 was set as statistically significant.
their eligibility by a multidisciplinary team. Patients with cervical
esophagus tumor, prior open upper abdominal surgeries, and Surgical Technique
tumor higher than carina level were excluded from the study. Patients were operated on under general anesthesia in supine
All patients underwent neoadjuvant chemoradiotherapy at least position with legs apart. The surgeon stands between the patient’s
4 weeks before surgery. The procedures were described and legs. The peritoneal cavity was explored for metastasis or any
an informed consent was obtained from all patients. They were finding that precludes safe surgery via 10 mm infraumbilical port.
randomly assigned to two groups, namely, open and laparoscopy Another 10 mm port was inserted for ligature device (10 × 35;
groups. Patients underwent either open or laparoscopic transhiatal Covedien, USA) for dissection in left subcostal area in the region

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