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Page 2 of 14 Parthasarathi et al. Mini-invasive Surg 2019;3:20 I http://dx.doi.org/10.20517/2574-1225.2019.10

(87.05%), squamous cell carcinoma in 18 (12.94%). Among these cases T2, lesions in 56 (40.28%), T3 lesions in
77 (55.39%), T4 lesions in 6 (4.31%) The overall complication rate was 12.58% (pneumonia- 8.39%, RLN injury
in 1.39%, anastomotic leak in 2.09%, chyle leak in 0.69%, anastomotic stricture in 12.58%). 3 (2.09%) cases had
re-intervention in the form of combined endoscopic procedures (stenting) and re-thoracoscopic lavage in 3. Overall
30-day mortality in 1 case (0.69%).

Conclusion: Thoracolaparoscopic esophagectomy with intrathoracic Ivor Lewis anastomosis is an excellent option
for selected patients, in experienced hands.

Keywords: Ivor Lewis esophagectomy, thoracolaparoscopic, carcinoma esophagus, adenocarcinoma esophagus,
intrathoracic anastomosis, minimally invasive surgery

INTRODUCTION
Worldwide, an estimated 572,034 new esophageal cancer cases and 508,585 deaths are expected annually,
[1]
according to data from the GLOBOCAN database . Over the last decade, the incidence of squamous cell
carcinoma (SCC) has declined, and the rate of adenocarcinoma of the esophagus, esophagogastric junction
[2,3]
(EGJ) and gastric cardia is on raise .

Various minimally invasive approaches that include trans-hiatal, McKeown’s, and Ivor Lewis are
increasingly being used given a significant reduction in the pulmonary morbidity involved with their
open counterparts. For adenocarcinoma of the distal esophagus and EGJ lesions, proximal gastrectomy
with subtotal esophagectomy and intrathoracic anastomosis or total gastrectomy with lower mediastinal
[4]
lymph node dissection is the surgical treatment . Ivor Lewis esophagectomy (ILE) including thoracotomy
[5]
and laparotomy was the commonly performed surgery and now minimally invasive ILE including
[6]
thoracoscopy and laparoscopy, has gained popularity . The main obstacles for widespread use of minimally
invasive surgery are the adequacy of esophageal resection margin and complete radical lymphadenectomy
with minimal morbidity. These challenges can be addressed by improvement in techniques throughout the
learning curve.

Till now very few centers are regularly performing minimally invasive ILE worldwide and to our
knowledge, this is possibly most extensive series from India.

METHODS
This is a retrospective study of a prospectively maintained database of all consecutive patients who have
undergone minimally invasive thoracolaparoscopic esophagectomy at a quaternary care teaching hospital
from 2009 to 2018.

The primary objective of this study is to access the outcomes of the said procedure, mainly in terms of
postoperative recovery, complications, and pathological completeness. There are no exclusions during this
period.

The records of demographic details, investigations, perioperative data, and complications, if any were
retrieved into a proforma. The pathological reports along with followup details too, were added.

All patients with suspected esophageal malignant lesion underwent routine pre-operative blood
investigations, ultrasonography of the abdomen, along with esophagogastroduodenoscopy. Contrast-
enhanced computerized tomography scan of the abdomen and chest were done unless there was a high