Open Versus Laparoscopically-assisted Esophagectomy for Cancer

Open Versus Laparoscopically-assisted Esophagectomy for Cancer

Inclusion criteria

• Squamous cell or adenocarcinoma of the thoracic esophagus T1, T2, T3, N0-N1, M0, before any treatment
• Middle or lower third esophageal carcinoma, junctional tumor Siewert type I
• Patients who underwent or not neoadjuvant chemotherapy or chemoradiation
• Tumor deemed to be resectable in a curative intent at the preoperative setting
• Age less than 75 years old, OMS status 0, 1 or 2
• Patient who can undergo one or the other surgical modality
• Written informed consent form
• Possible follow-up

Exclusion criteria

• General criteria: PO2 ≤ 60 mmHg; PCO2 > 45 mmHg; FEV ≤ 1000 ml/sec

• Hepatic cirrhosis
• Recent myocardial infarction (in the previous 6 months) or progressive coronary disease
• Distal arteritis (Leriche-Fontaine stage II upwards)
• Concomitant cancer, other than subcarinal esophageal cancer
• Disease-related factors

• Invasion of subclavicular lymph nodes in a clinical examination or on biospy
• Lymph nodes near the origin of the celiac artery with a diameter ≥ 1 cm on CT or that appear to be suspect on endoscopic ultrasound (to differentiate them from the paracardial or left gastric lymph nodes, which does not constitute an exclusion criterion)
• Recurrent nerve palsy
• Evidence of extension to the tracheobronchial tree
• Signs of mediastinal invasion (vertebral contact, aortic contact ≥ 90°, or invasion of nonresectable neighboring organs such as the aorta, trachea, main bronchi, etc.)
• Distant metastasis
• Laparoscopy-related factors

• Patient presenting a general contraindication to laparoscopy
• A history of median or subcostal laparotomy