胸腹腔镜联合与常规三切口食管次全切除术治疗食管癌的比较研究

目的探讨胸腹腔镜联合食管次全切除术治疗食管癌的安全性和有效性。方法回顾性分析2009年3月至2011年10月问在郑州大学附属肿瘤医院接受胸腹腔镜联合食管次全切除术的98例食管癌患者的临床资料。选择同期105例行常规三切口食管次全切除术的食管癌患者作为对照。结果与常规三切口组相比,胸腹腔镜联合组患者术中出血量减少[（85．1±32．8）ml比（215．5±60．6）ml],术后住院时间缩短[（12．7±3．5）d比（16．9±4．5）d],术后肺炎[4．1％（4／98）比12．4％（13／105）]、肺不张[3．1％（3／98）比10．5％（11／105）]、需要处理的胸腔积液[3．1％（3／98）比10．5％（11／105）]、急性呼吸窘迫[1．0％（1／98）比7．6％（8／105）]及心律失常[4．1％（4／98）比12.4％（13／105）]等心肺系统并发症发生率下降,差异均有统计学意义（均P〈0．05）。两组手术时间和淋巴结清扫数目的差异无统计学意义,术后吻合口瘘、脓胸、乳糜胸、二次开腹、二次开胸、声带麻痹、肾功能衰竭、胃排空障碍发生率及病死率的差异亦无统计学意义（均P〉0．05）。结论胸腹腔镜食管次全切除术治疗食管癌在技术上是安全可行的．在减少术中出血量、降低术后心肺系统并发症和缩短术后住院时间上具有优势。     

术前放化疗加胸腹腔镜联合手术在局部中晚期食管癌中的应用体会

目的评估术前放化疗加胸腹腔镜联合手术治疗局部中晚期食管癌的可行性及近期疗效。方法2011年6月至2012年2月间浙江省台州医院共对11例局部中晚期（ⅡB-ⅢA期）食管癌患者予以术前放化疗加胸腹腔镜联合手术。术前化疗采取NP方案（长春瑞滨加顺铂）或TP方案（紫杉醇加顺铂）静脉注射;同期采用常规分割放疗,放疗剂量40Gy／20d。放化疗后4～6周施行胸腹腔镜联合经右胸、上腹、左颈三切口食管癌切除术。结果11例患者均完成预定同步放疗方案,期间9例出现不同程度的骨髓抑制。放化疗结束至手术的时间为（49．6±15．4）d。术中除1例患者（放化疗后75d手术）局部纤维化形成外,其余10例患者手术难度并未增加：与同期15例行单纯腔镜食管切除术的患者相比,手术时间明显缩短[（242．3±27．0）min比（280．5±27．2）min,P=0．002],术中出血量明显减少[（168．2±95．6）ml比（244．5±84．8）ml,P=0．042],淋巴结清扫数量相当[（19．5±5．8）枚／例比（20．5±7．1）枚／例,P=0．683],但术后住院时间延长[（18．9±10．3）d比（12．5±4．6）d,P=-0．020]。术后病理示,4例瘤体明显缩小,7例达到病理完全缓解。术后并发症发生率36．4％（4／11）,其中颈部吻合口瘘并肺部感染1例、颈部吻合口瘘并声嘶1例、肺部感染并胸腔积液2例。术后随访1～9个月,未见肿瘤复发。结论术前放化疗加胸腹腔镜联合手术治疗局部中晚期食管癌安全、可行．近期疗效确切。     

无腹部切口的胸、腹腔镜联合IvorLewis食管癌根治术12例报告

目的探讨胸、腹腔镜联合Ivor Lewis食管癌根治术的可行性和近期疗效。方法 2010年9月～2012年3月,胸、腹腔镜联合行Ivor Lewis食管癌根治术12例,腹腔镜下游离胃并清扫腹腔淋巴结,胸腔镜下游离胸段食管,清扫胸部淋巴结,上提胃入胸腔并制作管状胃,于胸腔内行食管胃吻合。结果 12例均顺利完成手术,无中转开胸、开腹,手术时间220～320 min,平均260 min,其中腹腔镜手术时间80～150 min,胸腔镜手术时间70～170 min;术中出血量100～280 ml,平均200 ml。术后4～8 d（平均5.2 d）拔除胸腔闭式引流管,胸腔引流总量480～1040 ml。清扫腹腔及胸腔淋巴结6～12枚,平均8.2枚,其中3例发现阳性淋巴结。术后住院8～11 d,平均9 d。术后无严重并发症,恢复顺利。12例随访3～14个月,平均12个月,无肿瘤复发或转移。结论胸、腹腔镜联合行Ivor Lewis食管癌根治术可行,近期疗效满意。     

微创食管癌切除术150例分析

目的：探讨微创食管癌切除术治疗食管癌的可行性及应用价值。方法回顾性分析我科2009年5月～2014年2月150例微创食管癌切除术（minimally invasive esophagectomy ,MIE）的资料,男87例,女63例,年龄（57．3±9．2）岁。胸上段食管癌35例,胸中段74例,胸下段41例。胸、腹腔镜联合30例,全胸腔镜＋腹部开放115例,胸部开放＋腹腔镜5例,均行食管胃左颈吻合术。结果150例手术均获成功,手术时间（352．2±95．3）min,术中估计失血量（223．2±190．5）ml,术后区域淋巴结清扫数量（30．5±6．2）枚,阳性转移率28．7％（43／150）。术后病理分期ⅠA期18例,ⅠB期35例,ⅡA期39例,ⅡB期24例,ⅢA期19例,ⅢB期15例。术后住院时间（12．8±3．7）d。无围手术期死亡,术后并发症发生率28．7％（43／150）,包括肺部感染11例（7．3％）,呼吸衰竭2例（1．3％）,乳糜胸2例（1．3％）,活动性出血二次手术1例（0．7％）,吻合口漏16例（10．7％）,声音嘶哑7例（4．7％）,气管损伤1例（0．7％）,胸胃排空障碍3例（2．0％）。结论 MIE手术治疗食管癌创伤小,恢复快,技术可行,手术安全合理,值得临床应用推广。     

胸腹腔镜联合食管癌切除二野淋巴结清扫150例报告

目的总结开展胸腔镜联合腹腔镜食管癌切除二野淋巴结清扫的早期经验。方法回顾性分析150例胸腹腔镜食管癌切除二野淋巴结清扫的临床资料。结果150例食管癌患者中．食管上段癌14例,中段癌95例。下段癌41例;其中鳞癌142例。其他类型癌8例。全组无术中死亡者,中转开胸6例,中转开腹2例。手术时间（258±45）min,其中胸腔操作（140±33）min。腹腔和颈部操作（119±28）min。平均术中出血（207±130）ml,切除淋巴结（23．3±8．2）枚／例。肿瘤分期为Ⅰ期39例,Ⅱ期58例,Ⅲ期53例。围手术期并发症发生率为32％（48／150）,其中肺部感染17例．喉返神经麻痹13例,颈部吻合口瘘和心律失常各9例,乳糜胸5例,暂时性胸胃排空障碍5例．肠梗阻2例,肠扭转1例,血小板减少1例。围手术期死亡2例．均死于肺部感染致呼吸衰竭。结论胸腹腔镜联合食管癌切除二野淋巴结清扫是一种技术上可行的微创食管癌术式。     

胸腹腔镜联合食管癌切除350例临床分析

目的：分析胸腹腔镜联合食管切除术（ TLE ）治疗食管癌的临床效果及学习曲线。方法回顾性分析2008年2月至2013年10月四川大学华西医院胸外科连续行TLE的350例患者临床资料,分析患者的术中及术后情况,评价该术式的临床疗效;根据患者接受TLE手术日期的顺序,将TLE开展的早期阶段150例病例平均分为3组,即TLE 1组、TLE 2组及TLE 3组,每组50例,比较3组间的围手术期指标,以分析该术式的学习曲线。结果全组无术中死亡病例,29例（8．3％）患者出现术中并发症,术中中转手术13例（3．7％,开胸9例、开腹4例）。全组手术时间为230～780（平均332．5） min,术中出血量为15～4000（平均160．8） ml。其中,R0切除333例（95．1％）,清扫淋巴结6～42（平均21．6）枚／例。术后住院时间为7～93（平均11．6） d。术后出现并发症75例（21．4％）,术后30 d内死亡3例（0．8％）。与TLE 1组比较,TLE 2组的手术时间、术中失血量、术后住院时间及术后并发症的发生率明显较低,淋巴结清扫数目明显较多（均P＜0．05）。TLE 3组除手术失血量明显少于TLE 2组外,两组间的其他围手术期指标差异均无统计学意义（均P＞0．05）。结论 TLE在技术上安全可行,且能够达到与传统食管癌手术相同的根治效果,是治疗食管癌的可选手术方式。开展TLE约50例后可基本掌握TLE的手术技巧。     

电视胸腔镜食管切除术在食管癌外科治疗中的应用

目的分析电视胸腔镜食管切除术对于食管癌患者的手术安全性和有效性。方法2004年6月至2007年10月。共有36例食管癌患者行胸腔镜食管切除术。食管上段癌5例，食管中段癌25例，食管下段癌6例。其中2例患者既往有胃大部切除手术史，1例患者行术前化疗。手术采用胸腔镜游离胸段食管并清扫纵隔淋巴结，开腹游离胃行食管胃颈部吻合。结果平均手术时间250（190-330）min。其中胸部手术时间平均为70（50-150）min，术中出血量165（100～350）ml，术后胸腔引流管放置时间平均2．9d，平均住院时间8．7d。平均清扫淋巴结14．3枚，其中胸部淋巴结8．2枚。无围手术期死亡，共有11例（30．6％）患者出现术后并发症。结论电视胸腔镜食管切除术治疗食管癌在技术上是安全可行的，有望减少手术创伤，降低肺部并发症的发生。     

胸腹腔镜联合食管癌切除经胸骨后胃-食管颈部器械吻合术后患者生活质量的评价

目的评价胸腔镜和腹腔镜联合行食管癌切除,经胸骨后胃一食管颈部圆形吻合器吻合术与颈胸腹三切口食管癌切除术对患者术后生活质量的影响。方法南方医科大学南方医院胸心外科于2009年1月至2010年10月手术治疗63例胸部中上段食管癌患者,其中行胸腔镜和腹腔镜联合食管癌切除术33例（A组）,颈胸腹三切口食管癌切除术30例（B组）。采用欧洲癌症研究与治疗组织（EORTC）开发的生活质量核心量表QLQ-C30和食管癌补充量表QLQ—OES18评价患者术后的生活质量。结果两组患者一般资料的比较除吻合方式不同外,差异均无统计学意义（P〉0．05）．A组患者术后分别发生颈部吻合口瘘1例（3．0％,1／33）、颈部切口感染1例（3．0％,1／33）和吻合口狭窄1例（3．0％,1／33）：B组发生吻合口瘘8例（26．7％,8／30）,吻合口狭窄2例（6．7％．2／30）．颈部切口感染1例（3．3％,1／30）,肺部感染6例（20．0％,6／30）;均经保守治疗后好转。A组患者术后在吞咽闲难、进食、疼痛、梗阻、呼吸困难、食欲丧失、疲倦、经济困难、躯体功能、角色功能、情绪功能、认知功能、社会功能及总体健康状况维度方面的评分均优于B组,差异有统计学意义（P〈0．05）：其余维度差异无统计学意义。结论胸腔镜和腹腔镜联合食管癌切除术患者颈部器械吻合后并发症发生率低．生活质量明显优于颈胸腹三切口手术的患者。     

胃大部切除术后食管癌的手术治疗

目的 探讨胃大部切除术后食管癌的手术治疗方式和效果。方法 对1972年至1998年间20例胃切除术后食管癌的手术治疗进行分析。结果 左、右后外开胸、上腹正中开腹及左颈3切口,食管癌切除、移植结肠至颈部与食管吻合,腹腔结肠与残胃吻合7例;胸腹联合切口,食管癌切除,将残胃、脾、胰体尾移入左胸内,行食管残胃弓上吻合,空肠Roux-en-Y重建消化道3例;食管残胃弓上吻合,空肠Roux-en-Y重建消化道4例;食管空肠Roux-en-Y重建消化道4例;探查并行小肠造瘘术2例。本组食管癌切除率为90．0％（18／20）。总并发症为30．0％（6／20）。1、3、5年生存率分别为90．0％、64．3％和36．4％。结论 胃大部切除术后食管癌的手术治疗需根据病变部位和病情选择手术方式。胸上段癌采用移植结肠代食管术,胸中、下段癌采用残胃及小肠代食管术,胸下段癌采用选择性小肠代食管术,其方法较为合理。残胃、脾、胰体尾移植入左胸内、食管癌切除、食管残胃吻合、空肠Roux-en-Y重建消化道可供临床作为一种新术式,值得推荐。     

单操作孔胸腔镜联合腹腔镜食管癌根治术六例

目的 探讨单操作孔胸腔镜联合腹腔镜食管癌根治术的可行性及近期疗效。方法2010年3-12月间解放军总医院应用经口置入钉砧头系统（OrVil）．行单操作孔胸腔镜联合腹腔镜食管癌根治术6例。患者先在平卧位下行腹腔镜游离胃并清扫腹腔淋巴结,然后取左侧卧位．在单操作孔胸腔镜下游离食管并清扫胸部淋巴结．最后将胃经膈肌裂孔上提到胸腔后制备管状胃．利用OrVil系统完成胃食管吻合。结果全组手术顺利。无中转开胸病例。手术时间200～320min：腹腔镜手术时间平均75（45～90）min,胸腔镜时间平均160（120～240）min。术中平均出血220（160～300）ml,平均清扫淋巴结12（9-18）枚。术后恢复顺利,未出现吻合口瘘、肺部感染、乳糜胸等严重并发症。结论单操作孔胸腔镜联合腹腔镜食管癌切除后,应用OrVil系统行胃食管胸顶吻合安全、可行。     

腹腔镜辅助食管癌根治术的临床体会

目的:探讨腹腔镜辅助食管癌根治术的安全性及可行性.方法:回顾分析159例食管癌患者行腹腔镜辅助食管癌根治术的临床资料.结果:159例手术均获成功,无中转开腹及围手术期死亡病例.手术时间131～420 min,平均(236.67±47.66) min,术后肛门排气时间及住院时间分别为(3.08±1.02)d和(23.49...     

Thoracoscopic and laparoscopic esophagectomy for benign and malignant disease: lessons learned from 46 consecutive procedures

BACKGROUND: Transhiatal and transthoracic esophagectomy are common approaches for esophageal resection. The literature is limited regarding the combined thoracoscopic and laparoscopic approach to esophagectomy. The aim of this study was to evaluate the outcomes of combined thoracoscopic and laparoscopic esophagectomy for the treatment of benign and malignant esophageal disease. STUDY DESIGN: We performed a retrospective chart review of 46 consecutive minimally invasive esophagectomies performed between August 1998 and September 2002. Indications for esophagectomy were carcinoma (n = 38), Barrett's esophagus with high-grade dysplasia (n = 3), and recalcitrant stricture (n = 5). Of 38 patients with carcinoma 23 (61%) had neoadjuvant therapy. The main outcome measures were operative time, blood loss, length of intensive care unit and hospital stay, conversion rate, morbidity, mortality, pathology, disease recurrence, and survival. RESULTS: Approaches to esophagectomy were thoracoscopic and laparoscopic esophagectomy (n = 41), thoracoscopic and laparoscopic Ivor Lewis resection (n = 3), abdominal only laparoscopic esophagogastrectomy (n = 1), and hand-assisted laparoscopic transhiatal esophagectomy (n = 1). Minimally invasive esophagectomy was successfully completed in 45 (97.8%) of 46 patients. The mean operative time was 350 +/- 75 minutes and the mean blood loss was 279 +/- 184 mL. The median length of intensive care unit stay was 2 days and median length of stay was 8 days. Major complications occurred in 17.4% of patients and minor complications occurred in 10.8%. Late complications were seen in 26.1% of patients. The overall mortality was 4.3%. Among the 38 patients who underwent esophagectomy for cancer the 3-year survival was 57%. In a mean followup of 26 months there was no trocar site or neck wound recurrences. CONCLUSIONS: A thoracoscopic and laparoscopic approach to esophagectomy is technically feasible and safe for the treatment of benign and malignant esophageal disease. With a mean followup of 26 months thoracoscopic and laparoscopic esophagectomy appears to be an oncologically acceptable surgical approach for the treatment of esophageal cancer.     

腔镜食管癌根治术在食管癌治疗中的临床应用

目的探讨腔镜食管癌根治术的安全性及可行性。方法回顾性分析2008年6月至2012年4月福建省肿瘤医院298例行腔镜辅助食管癌根治术患者的临床资料。结果297例在腔镜辅助下成功完成手术,1例中转开腹。手术用时（242．3±58．7）min,术后住院时间（17．4±9．8）d。淋巴结清扫总数（27．5±12．2）枚／例,其中纵隔、腹腔及颈部淋巴结清扫数目分别为（10．7±5．7）、（13．3±7．8）及（7．7±8．1）枚／例。89例（29．9％）出现手术相关并发症,其中肺部感染41例,术后声嘶25例,吻合口瘘9例,切口感染7例,其他7例。术后经2～47个月的随访,3例患者出现吻合口狭窄,其余进食及生活质量良好。结论腔镜辅助胸食管癌根治术是安全、微创、有效的手术方法。     

Minimally invasive surgical enucleation or esophagogastrectomy for benign tumor of the esophagus

Experience in surgical resection of benign tumor of the esophagus is limited. Authors performed a chart review of 5 patients who underwent minimally invasive surgical resection of benign esophageal tumor. Main outcome measures included operative approaches, tumor's location and size, and outcomes. Tumor location were middle esophagus (n = 1), distal esophagus (n = 2), and gastroesophageal junction (n = 2). There were 4 females with a mean age of 55 years. Surgical approaches included thoracoscopic enucleation (n = 1), laparoscopic enucleation (n = 1), and laparoscopic and thoracoscopic Ivor Lewis esophagogastrectomy (n = 3). There were no open conversions. Mean operative time for enucleation was 127 minutes and 240 minutes for Ivor Lewis esophagectomy. Mean hospital stay was 5.8 days. There were no major or minor complications. Three patients developed stomal stenosis. The 30-day mortality was zero. Surgical pathology showed leiomyoma in 3 patients and gastrointestinal stromal tumor in 2 patients. Tumor size ranged from 1.1 to 10.5 cm. There has been no tumor recurrence at a mean follow-up of 14 months. Minimally invasive surgical enucleation or esophagogastrectomy for benign esophageal tumor is feasible and safe. The optimal approaches should be tailored based on the location and size of the tumor.     

Minimally invasive Ivor Lewis esophagectomy

Ivor Lewis esophagectomy consists of a laparotomy and right thoracotomy for resection of the intrathoracic esophagus. Recent advances in minimally invasive surgical technology have allowed surgeons to apply laparoscopy and thoracoscopy to perform esophagectomy. However, there have been few reports that describe a totally minimally invasive Ivor Lewis esophagectomy. We present a case of combined laparoscopic and thoracoscopic resection of the distal third esophagus with an intrathoracic esophagogastric reconstruction for esophageal carcinoma.     

侧俯卧位全腔镜食管癌手术淋巴结清扫的临床分析

目的总结侧俯卧位全腔镜食管癌切除术清扫胸腹二野淋巴结的临床经验。方法回顾性分析2009年9月-2011年2月82例全腔镜食管癌切除术与78例常规颈、胸、腹三切口食管癌切除术的临床资料。比较2组手术的胸腹部各区域淋巴结清扫数目、淋巴结转移度、生存率及术后并发症发生率。结果2组均顺利完成手术,2组清扫左右喉返神经旁淋巴结数目分别为（4．1±3．4）枚及（1．1±1．7）枚,上纵隔淋巴结数目分别为（6．8±5．O）枚及（4．9±4．0）枚,腔镜组均多于开放组（P〈0．05）。腔镜组3年生存率（65．4％）与开放组（62．3％）相似（10g—rank检验,X2=0．022,P=0．886）。结论侧俯卧位全腔镜食管癌切除淋巴结清扫疗效肯定,尤其是清扫上纵隔及左右喉返神经旁淋巴结方面,更为有效及彻底。     

腹腔镜“隧道式”全胃游离在腔镜食管癌根治术中的应用

目的：探索适合完全腔镜操作的全胃游离及更加简单易行的手术方法。方法：回顾分析为715例患者行腔镜辅助食管癌根治术的临床资料,术中采用“腹腔镜‘隧道式’全胃游离”法。结果：713例手术获得成功,2例中转开腹;其中行腹腔镜辅助食管癌根治术（Ivor Lewis）273例,腹腔镜联合胸腔镜食管癌三野根治术212例,腹腔镜辅助食管癌三野根治术230例。腹腔手术时间21～42min,平均（28．46±8．12）min;术中腹腔出血量10～45ml,平均（17±6）ml;平均住院（14．43±5．82）d;腔镜清扫淋巴结总数平均（30．46±10．81）枚,纵隔、腹腔及颈部平均清扫淋巴结数量分别为（15．36±4．22）枚、（15．74±5．63）枚及（12．35±7．19）枚。术后189例出现手术相关并发症,经治疗后均痊愈。术后随访2～47个月,随访率100％,发生吻合口狭窄14例,经胃镜下扩张后进食明显改善,余者进食及生活质量良好。结论：腹腔镜“隧道式”全胃游离优化了手术流程．简化了手术难度．易于学习掌握．具有一定的临床推广价值。     

经口置入钉砧头技术用于全腔镜食管癌切除胸腔内胃食管吻合

目的 介绍一种通过经口置入钉砧头进行全腔镜食管切除胸腔内胃食管吻合的新技术.方法 2010年4月至6月,6例食管癌患者经口置入钉砧头进行全腔镜食管切除胸腔内胃食管吻合术.患者男性5例,女性1例;年龄38～69岁,平均55岁.病变位于贲门1例,食管下段4例,食管中段1例.病变平均长度4 cm.6例患者均采用腹腔镜胸腔镜联合食管癌切除胃食管胸腔内吻合术.手术分为两大步骤,首先采用腹腔镜游离胃和腹段食管,而后采用胸腔镜游离胸段食管并切除病变食管,应用经口置入钉砧头的方法进行胸腔内胃食管吻合术.结果 本组6例患者手术顺利,未发生术中并发症、中转开腹或开胸等情况.平均手术时间380 min,平均术中出血量300 ml,平均恢复进食时间为术后9 d.术后病理学检查示:食管鳞状细胞癌5例,食管小细胞癌1例,切缘和吻合口圈均阴性.pTNM分期:T2N0M0期3例,T2N1M0期1例,T3N0M0期2例.术后无吻合口和其他重大并发症.结论 本方法创伤小、恢复快,是一种较为安全可靠、操作简便的腔镜下胸腔内胃食管吻合方法.     

Minimally Invasive Approach to Esophagectomy

Background:

Recent advances in laparoscopic and thoracoscopic surgery have made it possible to perform esophagectomy using minimally invasive techniques. The aim of this report was to present our preliminary experience with minimally invasive esophagectomy.

Methods:

We reviewed our experience on eight patients who underwent minimally invasive esophagectomy using either laparoscopic and/or thoracoscopic techniques from June 1996 to May 1997. Indications for esophagectomy included stage I carcinoma (5), palliative resection (1), Barrett''s with high grade dysplasia (1) and end stage achalasia (1).

Results:

The average age was 68 years (54-82). The surgical approach to esophagectomy included laparoscopic transhiatal esophagectomy with cervical anastomosis (n=4), thoracoscopic and laparoscopic esophagectomy with cervical anastomosis (n=1), and laparoscopic mobilization with right mini-thoracotomy and intra-thoracic anastomosis (n=3). Conversion to mini-laparotomy was required in two patients (25%) to complete esophageal dissection and facilitate gastric pull-up. The mean operative time was 460 minutes. The mean intensive care stay was 1.9 days (range of 0-7 days) with a mean hospital stay of 13-8 days. Minor complications included atrial fibrillation (n=1), pleural effusion (n=2) and persistent air leak (n=1). Major complications included cervical anastomotic leak (n=1), and delayed gastric emptying requiring pyloroplasty (n=1). There was no perioperative mortality.

Conclusions:

This preliminary experience suggests that minimally invasive esophagectomy is safe and feasible in centers with experience in advanced minimally invasive surgical procedures. Further studies are necessary to determine advantages over open esophagectomy.     

Minimally invasive esophagectomy: outcomes in 222 patients

OBJECTIVE: To assess our outcomes after minimally invasive esophagectomy (MIE). SUMMARY BACKGROUND DATA: Esophagectomy has traditionally been performed by open methods. Results from most series include mortality rates in excess of 5% and hospital stays frequently greater than 10 days. MIE has the potential to improve these results, but only a few small series have been reported. This report summarizes our experience of 222 cases. METHODS: From 1996 to 2002, MIE was performed in 222 patients. Indications for operation included high-grade dysplasia (n = 47) and cancer (n = 175). Neoadjuvant chemotherapy was used in 78 (35.1%) and radiation in 36 (16.2%). Initially, a laparoscopic transhiatal approach was used (n = 8), but subsequently our approach evolved to include thoracoscopic mobilization (n = 214). RESULTS: There were 186 men and 36 women. Median age was 66.5 years (range, 39-89). Nonemergent conversion to open procedure was required in 16 patients (7.2%). MIE was successfully completed in 206 (92.8%) patients. The median intensive care unit stay was 1 day (range, 1-30); hospital stay was 7 days (range, 3-75). Operative mortality was 1.4% (n = 3). Anastomotic leak rate was 11.7% (n = 26). At a mean follow-up of 19 months (range, 1-68), quality of life scores were similar to preoperative values and population norms. Stage specific survival was similar to open series. CONCLUSIONS: MIE offers results as good as or better than open operation in our center with extensive minimally invasive and open experience. In this single institution experience, we observed a lower mortality rate (1.4%) and shorter hospital stay (7 days) than most open series. Given these results, we are now developing an intergroup trial (ECOG 2202) to assess MIE in a multicenter setting.