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Kyle A. Perry, MD; C. Kristian Enestvedt, MD; Thai Pham, MD; Melissa Welker, BS; Blair A. Jobe, MD; John G. Hunter, MD; Brett C. Sheppard, MD

Arch Surg. 2009;144(7):679-684.

Hypothesis  The perioperative outcomes of laparoscopic inversion esophagectomy (LIE) are comparable to those of open transhiatal esophagectomy (THE), with potential benefits related to the use of minimally invasive techniques.

Design  Case-control study.

Setting  Tertiary care university hospital.

Patients and Interventions  From July 1, 2003, through March 31, 2008, 21 consecutive patients underwent LIE for high-grade dysplasia or clinical stage I esophageal cancer. We compared these patients with 21 stage-matched control patients treated with THE from August 1, 1995, through August 31, 2003.

Main Outcome Measures  Operative time, blood loss, length of hospital stay, perioperative complications, and disease-free survival.

Results  Mean (SD) operative times for LIE (399 [86] minutes) and THE (407 [127] minutes) were not significantly different (P = .80). Patients undergoing LIE had significantly lower intraoperative blood loss (168 mL; P < .001) and overall length of hospital stay (10 days; P = .03) compared with those in the THE group (526 mL and 14 days, respectively). Complication rates were not significantly different between the groups. With a median follow-up of 29 months, there has been 1 systemic recurrence in the LIE group.

Conclusions  Laparoscopic inversion esophagectomy is a safe and effective approach to the treatment of high-grade dysplasia and early esophageal adenocarcinoma. Compared with THE, LIE decreases operative blood loss and length of hospital stay without increasing the operative time, morbidity, or mortality related to esophagectomy.

Author Affiliations: Department of Surgery, Oregon Health & Science University, Portland (Drs Perry, Enestvedt, Pham, Hunter, and Sheppard and Ms Welker); and Division of Thoracic and Foregut Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Jobe).

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