Comparison of laparoscopic inversion esophagectomy and open transhiatal esophagectomy for high-grade dysplasia and stage I esophageal adenocarcinoma

Hypothesis: The perioperative outcomes of laparoscopic inversion esophagectomy (LIE) are comparable to those of open transhiatal esophagectomy (THE), with potential benefits related to the use of minimally invasive techniques. Design: Case-control study. Setting: Tertiary care university hospital. Patients and Interventions: From July 1, 2003, through March 31, 2008, 21 consecutive patients underwent LIE for high-grade dysplasia or clinical stage I esophageal cancer. We compared these patients with 21 stage-matched control patients treated with THE from August 1, 1995, through August 31, 2003. Main Outcome Measures: Operative time, blood loss, length of hospital stay, perioperative complications, and disease-free survival. Results: Mean (SD) operative times for LIE (399 [86] minutes) and THE (407 [127] minutes) were not significantly different (P=.80). Patients undergoing LIE had significantly lower intraoperative blood loss (168 mL; P<.001) and overall length of hospital stay (10 days; P=.03) compared with those in the THE group (526 mL and 14 days, respectively). Complication rates were not significantly different between the groups. With a median follow-up of 29 months, there has been 1 systemic recurrence in the LIE group. Conclusions: Laparoscopic inversion esophagectomy is a safe and effective approach to the treatment of high-grade dysplasia and early esophageal adenocarcinoma. Compared with THE, LIE decreases operative blood loss and length of hospital stay without increasing the operative time, morbidity, or mortality related to esophagectomy.