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Parthasarathi et al. Mini-invasive Surg 2019;3:20 I http://dx.doi.org/10.20517/2574-1225.2019.10 Page 11 of 14

Table 1. Demographic, intraoperative, postoperative parameters
Sr. No. Parameter Value (Mean ± Standard Deviation)
(1) Age (in years) 64.4 ± 10.86
(2) Sex (M:F) 3:1
(3) Etiology Total-143
(a) Malignant 139 (97.20%)
(b) Non-malignant 4 (2.79%)
(4) (a) Thoraco-laparoscopy 138 (96.50%)
(b) Robotic 5 (3.49%)
(5) Duration (in mins) 457.97 ± 79.35
(6) Blood loss (in ml) 138.08 ± 29.3
(7) Lymph nodes retrieved 22.68 ± 9.49
(8) Anastomosis
(a) Circular 46 (32.16%)
(b) Linear stapler 25 (17.48%)
(c) Hand sewn 72 (50.34%)
(9) ICU stay (in days) 4.68 ± 3.95
(10) Duration of hospital stay (in days) 13.48 ± 7.43
(11) Histology (n-139)
(a) Adeno carcinoma 121 (87.05%)
(b) Squamous cell carcinoma 18 (12.94%)
(12) T Staging (n-139)
(a) T2 56 (40.28%)
(b) T3 77 (55.39%)
(c) T4 6 (4.31%)
(13) Complications 25.17%
(a) Pneumonia 12 (8.39%)
(b) RLN injury 2 (1.39%) - 1 required tracheostomy
(c) Chyle leak 1 (0.69%)
(d) Anastomotic Leak 3 (2.09%)
(e) Anastomotic stricture 18 (12.58%)
(14) Re-intervention 3 (2.09%) (combined endoscopic and
(a) Endoscopic thoracoscopic procedure done)
(b) Thoracoscopy 3 (2.09%)
3 (2.09%)
(15) 30-day mortality 1 (0.69%)

anastomosis in 25 (17.48%) of cases. The mean lymph node retrieval rate was 22.68 ± 9.49 nodes. The
average ICU stay in the postoperative period was 4.68 ± 3.95 days, and overall hospital stay was 13.48 ±
7.43 days. Among malignant cases (139), adenocarcinoma in 121 (87.05%), SCC 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 25.17% (pneumonia - 8.39%, RLN (recurrent laryngeal nerve) injury in 1.39%, anastomotic leak
in 2.09%, chyle leak in 0.69%). Overall anastomotic stricture rate is 12.58%. The stricture rate was more in
linear stapler technique compared to the other two. Six cases had re-intervention in the form of endoscopic
procedures in 3 (2.09%) and re-thoracoscopy in 3 (2.09%). Laparoscopic feeding jejunostomy was done in
2% of patients who had re-intervention because of anastomotic leak. Overall 30-day mortality noted in 1
case (0.69%).

DISCUSSION
We have been performing minimally invasive esophagectomies since 1997 . Since then all esophagectomies
[7]
were conducted in the prone position during the thoracic phase. For cases of GE junction tumors, we
[8]
performed trans hiatal esophagectomies with excellent results . But later on, to achieve better proximal
clearance we have opted performing thoracolaparoscopic esophagectomies. In cases of SCC of lower
esophagus close to GE junction, we have performed intrathoracic anastomosis using circular stapler close
to the level of the thoracic inlet. Throughout 11 years, the rate of performing intrathoracic anastomosis
improved year by year because of change in the incidence of adenocarcinoma and experience in the
technique of intrathoracic anastomosis. For lesions requiring division above the level of the azygous arch,