Revista de SIDA e investigación clínica

Minimally Invasive Esophagectomy in People Living with HIV

Abstract

Rajkumar JS, Akbar S, Anirudh JR, Prabhakaran R, N Kumaraswamy, Selvamuthu Poongulali, Jayakrishna Reddy and Nabeel Nazeer

Background: People living with HIV infection have a longer survival rate after the introduction of Highly active antiretroviral therapy (HAART). Hence major resections in these patients can be performed safely.

Materials and methods: 5 retro positive patients underwent minimally invasive esophagostomy (MIE) in our institution between 2010 and 2015. Patient demographics, HIV status (CD4 count and viral load), Post-operative mortality, technical feasibility and outcomes were analyzed.

Results: Out of the 5 thoraco-lap esophagectomies, none required conversion. One patient died in the postoperative period due to overwhelming chest infection and sepsis (mortality - 20%). Two patients (40%) required prolonged ventilatory support in the postoperative setting. We had anastomotic leak in one patient (20%), which settled spontaneously. The expired patient carried maximum viral load (1,57,454) and lowest CD4 count (120).

Conclusion: Minimally invasive esophagectomy is a safe and viable option in retro positive patients, wherein the morbidity of laparotomy and thoracotomy are avoided. We report, what we believe is the first pilot case series of 5 minimally invasive esophagectomies in HIV positive patients and we believe that this study will be the shoulders for the next generation of investigators to stand on.