Title

Minimally invasive oesophagectomy: Current status and future direction

Date of this Version

7-1-2011

Document Type

Journal Article

Publication Details

Citation only

Butler, N., Collins, S., Memon, B., & Memon, M. A. (2011). Minimally invasive oesophagectomy: Current status and future direction. Surgical Endoscopy: Surgical and interventional techniques, 25 (7), 2071-2083.

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2011 HERDC submission. FoR code: 110300

© Copyright Springer Science+Business Media, LLC, 2011

ISSN

0930-2794

Abstract

Background:
Oesophagectomy is one of the most challenging surgeries. Potential for morbidity and mortality is high. Minimally invasive techniques have been introduced in an attempt to reduce postoperative complications and recovery times. Debate continues over whether these techniques are beneficial to morbidity and whether oncological resection is compromised. This review article will analyse the different techniques employed in minimally invasive oesophagectomy (MIO) and critically evaluate commonly reported outcome measures from the available literature.

Methods:
Medline, Embase, Science Citation Index, Current Contents, and PubMed databases were used to search English language articles published on MIO. Thirty-one articles underwent thorough analysis and the data were tabulated where appropriate. To date, only level III evidence exists. Where appropriate, comparisons are made with a meta-analysis on open oesophagectomy.

Results:
Positive aspects of MIO include at least comparable postoperative recovery data and oncological resection measures to open surgery. Intensive care unit requirements are lower, as is duration of inpatient stay. Respiratory morbidity varies. Negative aspects include increased technical skill of the surgeon and increased equipment requirements, increased operative time and limitation with respect to local advancement of cancer. With increasing individual experience, improvements in outcome measures and the amenability of this approach to increasing neoplastic advancement has been shown.

Conclusion:
MIO has outcome measures at least as comparable to open oesophagectomy in the setting of benign and nonlocally advanced cancer. Transthoracic oesophagectomy provides suerior exposure to the thoracic oesophagus compared to the transhiatal approach and is currently preferred. No multicentre randomised controlled trials exist or are likely to come into fruition. As with all surgery, careful patient selection is required for optimal reuslts to MIO.

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This document has been peer reviewed.