A preliminary experience with minimally invasive Ivor Lewis esophagectomy

SUMMARY With several small series examining minimally invasive Ivor Lewis esophagectomies, we look to contribute to a growing experience. In reporting our initial results, safety, initial oncologic completeness, and preliminary outcomes with a minimally invasive Ivor Lewis esophagectomy were demonstrated. From 2007 to 2010, 40 minimally invasive Ivor Lewis esophagectomies were carried out. The approach was a laparoscopic mobilization of the stomach and a thoracoscopic esophageal mobilization and creation of a high intrathoracic anastomosis. Indications included esophageal cancer in 39 patients and esophageal gastrointestinal stromal tumor in one patient. Median age was 62 (range 39–77) with 31 (78%) male patients. Non‐emergent conversion was required in two (5%) patients. Twenty‐five (63%) patients underwent neoadjuvant therapy. Mean operative time was 364 minutes (range 285–455), and mean blood loss was 205 cc (range 100–400). All patients underwent an R0 resection including the removal of all Barrett's esophagus, and mean number of nodes harvested was 21 (range 11–41). Median intensive care unit stay was 1 day (range 1–3), and hospital stay was 7 days (range 6–19). There were no anastomotic leaks and no 30‐day mortality. Postoperative complications included eight (21%) patients with atrial fibrillation and two (5%) chylothorax, one requiring ligation. At a mean follow‐up of 16.5 months (range 1–39 months), five (13%) patients have had a distant recurrence; there have been no local recurrences. Minimally invasive Ivor Lewis esophagectomy, although technically challenging, can be carried out with reasonable operative times, a short length of stay, and minimal complication. Final oncologic validity is pending longer follow‐up and a larger series.