Overcoming challenges in implementing a minimally invasive esophagectomy program at a Veterans Administration medical center

BackgroundMinimally invasive esophagectomy (MIE) is a technically demanding procedure that requires expertise in laparoscopy and esophageal surgery. The authors hypothesized that the safe and effective development of such a program could be performed at a Veterans Administration health care system using existing faculty members.MethodsLength of stay, operative factors, and morbidity and mortality of patients undergoing MIE from December 2007 to August 2009 were reviewed.ResultsEighteen consecutive patients underwent planned MIE. They were all men, with a median age of 60 years (range, 43–69 years) and a median American Society of Anesthesiologists score of 3. Eighty-three percent were able to undergo MIE resection. Eighty-nine percent of patients received neoadjuvant therapy. The median operative duration was 420 minutes (range, 300–480 minutes). There was 1 death within 30 days because of a pulmonary embolus and 1 anastomotic leak. Three patients had postoperative pneumonias. The median and mean length of stay were 10 and 13 days, respectively (range, 6–50 days). Negative margins were achieved in all patients. The mean number of lymph nodes resected was 15 (range, 6–30).ConclusionsThe development of an MIE program is feasible at a Veterans Administration hospital when combining the expertise of minimally invasive and esophageal surgeons.