Hypothesis: Laparoscopic-assisted transhiatal esophagectomy (LA-THE) decreases the morbidity and mortality associated with esophagectomy, at the same time enabling a more oncologic operation. Design: Retrospective cohort study. Setting: University tertiary care medical center
Methods: Seventy-two consecutive patients that underwent LA-THE for adenocarcinoma between 9/1995 and 12/2006. Follow-up was complete to July 2007, 6 to 140 (mean 34) months after LA-THE.
Results: Patient characteristics and treatment: Mean patient age: 63.9 +/- 9.6 years; mean body mass index: 27.5 +/- 3.8. Thirty-nine patients (54%) underwent neoadjuvant chemoradiotherapy. LA-THE was used in all patients. The mean operative time: 321 +/- 73 minutes; blood loss 318 +/- 239 ml. All margins were free of cancer and a mean of 11 +/- 7 lymph nodes were retrieved. The median ICU stay was 1 day (1-35) and hospital-stay 9 days (7-58). One patient (1.4%) died within 30-days postoperatively.Complications: Minor: atrial fibrillation 8 (11.1%) patients; pleural effusion 9 (12.5%); wound infection 7 (9.7%); transient recurrent nerve palsy 6 (8.3%); pneumothorax requiring no intervention 12 (16.7%). Major complications: anastomotic leak requiring intervention 7 (9.7%) patients; anastomotic leak requiring no intervention in 7 (9.7%); pneumonia in 7 (9.7%); pneumothorax requiring intervention 6 (8.3%); deep vein thrombosis 4 (5.5%); pulmonary embolism 3 (4.1%); myocardial infarction 2 (2.7%). Late complications included anastomotic stricture in 13 (18.0%) patients. (See Survival Table)
Conclusion: Our study suggests that LA-THE may reduce morbidity and mortality of esophagectomy and with good survival rates, thus should be considered an alternative to open esophagectomy in the treatment of esophageal adenocarcinoma.
Kaplan-Meier Survival by stage

	1-Year	3-Year	5-Year
Stage I (n=22)	100%	100%	80%
Stage IIa (n=21)	86%	57%	57%
Stage IIb (n=5)	100%	80%	80%
Stage III (n=24)	68%	41%	41%
Overall	85%	68%	63%