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Members and Subscribers Article
Contemporary outcomes of left thoraco-abdominal esophagectomy due to cancer in the esophagus or gastroesophageal junction, a multicenter cohort study
With the increasing implementation of minimally invasive approaches in esophageal and gastric surgery, familiarity with open techniques such as the left thoracoabdominal (LTA) approach to esophagectomy is declining. In this article from the groups in Seattle, Stockholm, Oxford, Montreal, Amsterdam, Rome, Belgium and London, the authors provide a contemporary multi-institutional experience describing the LTA approach for esophageal and junctional cancers. Over a ten-year period, the six participating centers undertook some 793 cases using the LTA approach, with data collected from prospectively maintained databases. Operative technique and case selection are described, and outcomes are reported according to standardized ECCG definitions. Indications for LTA included junctional tumors (Siewert type II or III) where an extended gastrectomy or Ivor Lewis esophagectomy was assessed to be less suitable, for example large bulky tumors or tumors infiltrating both the stomach and the esophagus, making it difficult to preoperatively determine the optimal reconstructive technique. In this series, over 80% of patients had cT3-4 tumors, with over 65% cN+, and 35% ypN2-3. Key outcomes include an anastomotic leak rate of 4.8%, 30-day mortality of 1.9% and 3-year overall survival of 46.4%, highlighting that favourable outcomes can be achieved with this technique, even within a cohort characterized by a comparatively advanced disease status. This study represents the largest experience of the left thoracoabdominal approach to esophagectomy in the literature to date. This article challenges us to ask ourselves as a community – as we strive to advance the utilization of minimally invasive and robotic techniques, how can we best safeguard, cherish, and pass forward our shared experience in complex open surgical techniques, so that these techniques remain part of the armamentarium of upper gastrointestinal surgeons in the future?
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