A Hybrid, Minimally Invasive Surgical Treatment of Lower Third Oesophageal and Cardiac Tumours: Analysis of the Learning Period

Background Using minimally invasive techniques in the surgical management of malignant oesophageal tumours has emerged as a global trend. However, implementing this novel approach necessitates a protracted learning period and is associated with elevated perioperative morbidity and mortality. In this retrospective analysis, we evaluated the perioperative outcomes and complications that accompany the learning phase of hybrid, minimally invasive surgical therapy for lower third oesophageal and cardiac tumours. Methods The present study set out the methodology behind the treatment of 28 patients (mean age 61 (19–65) with lower third oesophageal and cardiac tumours (squamous cell carcinoma (n = 8), adenocarcinoma (n = 19) and leiomyosarcoma (n = 1)). The majority of the patients (89%, 25/28) received neoadjuvant oncological therapy (the FLOT or CROSS regimen based on histology). Surgical intervention involved a hybrid, minimally invasive technique, comprising laparoscopic transhiatal oesophageal mobilization, Akiyama gastric tube formation and thoracoscopic oesophageal mobilization, intrathoracic anastomosis formation via mini-thoracotomy (26 cases) or cervical anastomosis creation (2 cases). Results There were no intraoperative complications. However, five major complications were identified in the postoperative period (17.8%, 5/28), including anastomotic failure in three cases (10.7%, 3/28), as well as one septic and one pulmonary complication (ARDS). The in-hospital mortality rate was 7% (2/28). Subgroup analysis showed that the majority of serious complications, including three anastomosis failures, occurred among the initial 14 patients. In the subsequent 14 patients, no anastomosis failure occurred, and there was a notable reduction in the proportion of Clavien–Dindo Grade IIIA and II complications (26.7% to 15.4% and 20.0% to 7.7%, respectively). Conclusion The hybrid, minimally invasive approach can safely be used in surgically treating malignant tumours of the lower third of the oesophagus and the heart, thus shortening the learning period and reducing the incidence of perioperative complications, including anastomotic failure.