Minimally invasive esophagectomy: evaluation of mediastinal lymphadenectomy for T1b thoracic esophageal cancer

Background Patients undergoing minimally invasive esophagectomy (MIE) may benefit from lower respiratory complications and total morbidity compared with those undergoing open transthoracic esophagectomy (OTE) according to a recent meta-analysis. Local recurrence rates after MIE need to be determined for an assessment of complete resection. The aim of this study was to investigate whether MIE is effective for submucosal (T1b) esophageal cancer in terms of survival and morbidity. Methods Clinical results were compared between 25 patients with pathologically comfirmed submucosal (pT1b) carcinoma of the thoracic esophagus who underwent MIE from July 2000 to August 2008 (MIE group) and 37 patients with pT1b esophageal cancer treated by OTE from January 1992 to January 1998 (OTE group) to evaluate the extent of mediastinal lymph node dissection and the invasiveness of both procedures. The total number of retrieved lymph nodes, the rate of mediastinal recurrence, perioperative outcomes and survival rates were retrospectively compared. Results The total number of retrieved lymph nodes and the rate of mediastinal lymph node recurrence were not significantly different between MIE and OTE groups. Major complications following MIE included pneumonia ( n = 1, 4.0%), recurrent laryngeal nerve palsy ( n = 3, 12.0%) and anastomotic leakage ( n = 1, 4.0%). Incidence of pneumonia was significantly lower compared with the OTE group ( p = 0.03). Thirty-day or in-hospital mortality was 0% in both groups. Five-year overall survival for MIE was 100% and for OTE 92%. Conclusions Minimally invasive esophagectomy may be a comparable or superior option to OTE in surgery for T1b esophageal cancer.