Laparoscopic esophagogastrectomy without thoracic or cervical access for adenocarcinoma of the gastroesophageal junction

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Abstract
The phenomenal progress of minimally invasive surgery has imparted its influence on conventional esophagectomy. Currently, more esophagectomies are being performed by laparoscopic and/or thoracoscopic methods. Esophagogastrectomy for the adenocarcinoma of the gastroesophageal (GE) junction has been a conventional treatment. The literature is limited regarding the laparoscopic approach to esophagogastrectomy. The aim of this study was to evaluate the outcome of laparoscopic esophagogastrectomy in the management of adenocarcinoma of the GE junction. From January 1997 to February 2005, laparoscopic esophagogastrectomy was performed in 32 patients. Indication for operation was adenocarcinoma of the GE junction in all patients. Neo-adjuvant therapy was used in two patients (6.88%) only. Initially, our approach to intrathoracic anastomosis without thoracic and cervical access was to introduce the anvil of circular stapler through minilaparotomy incision (n = 22), but later we switched to trans-oral placement of anvil into the distal end of the esophagus (n = 10). There were 22 men and 10 women. Median age was 61.8 years (range, 39–72). There was no conversion. The laparoscopic esophagogastrectomy was completed in all patients. The pyloromyotomy and feeding jejunostomy were performed in all cases. The median intensive care unit stay was 1 day (range, 1–28); hospital stay was 7 days (range, 5–42). Mean estimated blood loss and mean operative time were 150 ml and 200 min, respectively. At mean follow-up of 14 months (range, 2–40), stage-specific survival was similar to that of other series. In selected cases of adenocarcinoma of the GE junction, laparoscopic esophagogastrectomy offers as good as or better results than open operation in our institution with extensive advance endoscopic and open experience. This study shows that laparoscopic esophagogastrectomy has potential to meet oncologic criteria of clearance and provide the benefits of minimally invasive surgery as well.