Minimally Invasive Esophagectomy for End-Stage Achalasia: A Single Institution Experience and Literature Review

Background: Surgical outcomes after minimally invasive esophagectomy (MIE) for patients with end-stage achalasia are limited. This study presents a case series of end-stage achalasia patients who underwent MIE at a high-volume institution and review of the literature. Methods: We conducted a retrospective review of a single academic institution from 2010 to 2019. Patients with end-stage achalasia who underwent a MIE were included. Descriptive statistics for demographics as well as 90-day surgical outcomes (length of stay, readmission, reoperation, overall complications, and mortality) were included. Results: A total of 16 patients underwent MIE for achalasia during the study period, 14 (87.5%) 3-field and 2 (12.5%) trans-hiatal esophagectomies. The mean age was 52.5 (SD ± 10.5) years and 56.3% (9/16) were women. Mean operative time was 456.6 (SD ± 83.96) minutes. Within 90-days, the overall complication rate was 50% (8 patients). Of these complications, 4 had minor complications (Clavian-Dindo Grade I and II) and 4 had complications that required further interventions (Clavian-Dindo Grade ≥ III). Four (26.7%) patients were readmitted, 3 (18.8%) patients required reoperation, and 1 (6.3%) had an anastomotic leak. The reasons for reoperation included: 1 anastomotic leak, 1 chyle leak, and 1 incarcerated paraconduit hernia. No mortalities occurred. Conclusion: MIE should be considered for end-stage achalasia only as a last resort for patients with debilitating symptoms. While mortality was low, overall complications were high, even at a high-volume institution.