Esofagectomía transhiatal por vía abierta y vía laparoscópica para el cáncer de esófago: análisis de los márgenes de resección y ganglios linfáticos

Abstract

Surgical treatment of cancer of the oesophagus is associated with a high morbidity and mortality. Minimally invasive surgery has been proposed as an alternative to try to reduce these complications; however, at this time there are not many studies that evaluate the oncological validity of this method. The objective of this work is to give a preliminary audit of the results of our experience in both surgical techniques, with special emphasis on the oncopathological aspects (resection margins and lymph nodes). MATERIAL AND METHOD: Between April 2003 and February 2007, 40 patients diagnosed with distal oesophageal cancer were surgically intervened at Charing Cross Hospital, London, 24 open and 16 by laparoscopy in accordance with the surgeon responsible. Of these, 50% received neoadjuvant chemotherapy. Both groups were homogeneous for age, sex, ASA, tumour stage and tumour location. In all cases, the pathological tumour stage (TNM), the tumour distal margin, tumour proximal margin, tumour circumference and number of resected lymph nodes, were collected in a data base. RESULTS: The number of resected lymph nodes was similar in both groups; (19 for open and 18 for laparoscopy). The mean distal tumour margin for the group treated by open surgery was 4.9 cm compared to 4.3 in the group treated by laparoscopy (p = 0.578). The mean proximal tumour margin for the group treated by open surgery was 8.4 cm compared to 4.6 cm in the laparoscopy group (p = 0.004) and tumour circumference margin was positive in 11 patients (45%) belonging to the open group compared to 5 patients (33%) in the laparoscopy group (p = 0.519). CONCLUSIONS: In our experience, laparoscopic surgery for cancer of the oesophagus appears to show similar initial results to those of open surgery as regards the number of resected lymph nodes and resection margins.