Oncologic and short-term outcomes of minimally invasive esophagectomy in esophageal adenocarcinoma: A single-surgeon experience

INTRODUCTION: Esophageal cancer surgery represents one of the major surgical procedures associated with high morbidity and mortality. This study aimed to evaluate the clinical, pathological, and short-term outcomes of esophagectomy cases performed entirely using a minimally invasive approach by a single surgeon.
METHODS: In this retrospective study, 13 patients who underwent surgical resection for esophageal malignancy by a single surgeon at our center were included. Demographic characteristics, surgical techniques, histopathological findings, and neoadjuvant and adjuvant treatment status were analyzed. Perioperative and pathological parameters, including anastomotic leakage, mortality, pT/pN/pM staging, lymph node metastasis, lymphovascular invasion, perineural invasion, surgical margin status, and recurrence, were evaluated.
RESULTS: A total of 13 patients underwent minimally invasive esophagectomy, including minimally invasive abdominal (distal) esophagectomy in 6 patients (46.2%), minimally invasive transhiatal esophagectomy in 4 patients (30.8%), and minimally invasive Ivor Lewis esophagectomy in 3 patients (23.1%). Histopathological evaluation revealed adenocarcinoma in 11 patients (84.6%) and squamous cell carcinoma in 2 patients (15.4%). Neoadjuvant therapy was administered in 5 patients (38.5%), while 7 patients (53.8%) received adjuvant treatment. Anastomotic leakage occurred in 2 patients (15.4%), and the overall mortality rate was 15.4% (n=2). Lymph node metastasis was detected in 7 patients (53.8%), with pT3 being the most common tumor stage. The median number of retrieved lymph nodes was 19. Based on the available follow-up data, radiologically detected recurrence was observed in 1 patient (7.7%).
DISCUSSION AND CONCLUSION: In selected patients with esophageal cancer, minimally invasive esophagectomy performed by a single surgeon may provide acceptable short-term clinical and oncological outcomes when oncological principles are carefully followed. Despite the inherent morbidity and mortality associated with esophagectomy, our findings suggest that minimally invasive approaches can be safely implemented in appropriately selected patients. Larger multicenter studies with longer follow-up are needed to further validate these findings.

Keywords: Esophageal neoplasms, esophagectomy, minimally invasive surgical procedures, adenocarcinoma, surgical outcomes, lymph node excision