1
|
Henckens SP, Schuring N, Elliott JA, Johar A, Markar SR, Gantxegi A, Lagergren P, Hanna GB, Pera M, Reynolds JV, van Berge Henegouwen MI, Gisbertz SS. Recurrence and Survival After Minimally Invasive and Open Esophagectomy for Esophageal Cancer: A Post Hoc Analysis of the Ensure Study. Ann Surg 2024; 280:267-273. [PMID: 38577796 PMCID: PMC11224562 DOI: 10.1097/sla.0000000000006280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To determine the impact of operative approach [open (OE), hybrid minimally invasive (HMIE), and total minimally invasive (TMIE) esophagectomy] on operative and oncologic outcomes for patients treated with curative intent for esophageal and junctional cancer. BACKGROUND The optimum oncologic surgical approach to esophageal and junctional cancer is unclear. METHODS This secondary analysis of the European multicenter ENSURE study includes patients undergoing curative-intent esophagectomy for cancer between 2009 and 2015 across 20 high-volume centers. Primary endpoints were disease-free survival (DFS) and the incidence and location of disease recurrence. Secondary endpoints included among others R0 resection rate, lymph node yield, and overall survival (OS). RESULTS In total, 3199 patients were included. Of these, 55% underwent OE, 17% HMIE, and 29% TMIE. DFS was independently increased post-TMIE [hazard ratio (HR): 0.86 (95% CI: 0.76-0.98), P = 0.022] compared with OE. Multivariable regression demonstrated no difference in absolute locoregional recurrence risk according to the operative approach [HMIE vs OE, odds ratio (OR): 0.79, P = 0.257; TMIE vs OE, OR: 0.84, P = 0.243]. The probability of systemic recurrence was independently increased post-HMIE (OR: 2.07, P = 0.031), but not TMIE (OR: 0.86, P = 0.508). R0 resection rates ( P = 0.005) and nodal yield ( P < 0.001) were independently increased after TMIE, but not HMIE ( P = 0.424; P = 0.512) compared with OE. OS was independently improved following both HMIE (HR: 0.79, P = 0.009) and TMIE (HR: 0.82, P = 0.003) as compared with OE. CONCLUSION In this European multicenter study, TMIE was associated with improved surgical quality and DFS, whereas both TMIE and HMIE were associated with improved OS as compared with OE for esophageal cancer.
Collapse
Affiliation(s)
- Sofie P.G. Henckens
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Department of Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef, Amsterdam, the Netherlands
| | - Nannet Schuring
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Department of Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef, Amsterdam, the Netherlands
| | - Jessie A. Elliott
- Department of Surgery, Trinity Centre for Health Sciences, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Asif Johar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Sheraz R. Markar
- Nuffield Department of Surgical Sciences, Surgical Intervention Trials Unit, University of Oxford, Oxford, UK
| | - Amaia Gantxegi
- Department of Surgery, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Surgery, Imperial College London, London, UK
| | | | - Manuel Pera
- Department of Surgery, Section of Gastrointestinal Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - John V. Reynolds
- Department of Surgery, Trinity Centre for Health Sciences, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Mark I. van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Department of Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef, Amsterdam, the Netherlands
| | - Suzanne S. Gisbertz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Department of Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef, Amsterdam, the Netherlands
| | | |
Collapse
|
2
|
Ng CB, Chiu CH, Yeh CJ, Chang YC, Hou MM, Tseng CK, Liu YH, Chao YK. Temporal Trends in Survival Outcomes for Patients with Esophageal Cancer Following Neoadjuvant Chemoradiotherapy: A 14-Year Analysis. Ann Surg Oncol 2024:10.1245/s10434-024-15644-8. [PMID: 38926213 DOI: 10.1245/s10434-024-15644-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The prognosis for patients with esophageal cancer who received neoadjuvant chemoradiotherapy (nCRT) followed by surgery has shown improvement in recent years. We sought to identify the critical factors contributing to enhanced survival outcomes. PATIENTS AND METHODS We retrospectively examined 427 patients with esophageal cancer treated with nCRT and esophagectomy across two periods: P1 (from 1 January 2004 to 31 December 2011) and P2 (from 1 January 2012 to 31 December 2017). The introduction of the CROSS regimen and total meso-esophagectomy in P2 prompted an evaluation of their effects on perioperative outcomes and overall survival (OS). RESULTS During P2, the occurrence of recurrent laryngeal nerve palsy increased significantly from 3.9 to 16.8% (p < 0.001), while pneumonia and in-hospital mortality rates remained unchanged. The median OS improved from 19.2 to 29.2 months (p < 0.001) between P1 and P2. Multivariable analysis identified higher nodal yields and the achievement of major response as favorable prognostic factors. Conversely, an involved circumferential resection margin (CRM), an advanced ypN stage, and pneumonia were independently associated with poor outcomes. Patients treated during P2 had a lower prevalence of involved CRM (10% vs. 25.1%, p < 0.001), a higher rate of major response (52.7% vs. 34.8%, p < 0.01), and a greater nodal yield (27.8 vs. 10.9, p < 0.001). CONCLUSIONS The clinical outcomes following nCRT and surgery have improved significantly over time. This progress can be attributed to multiple factors, with the primary drivers being the refinement of nCRT protocols and the application of radical surgery.
Collapse
Affiliation(s)
- Chong Beng Ng
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
- Department of Upper Gastrointestinal Surgery, National Cancer Institute, Putrajaya, Malaysia
| | - Chien-Hung Chiu
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Ju Yeh
- Department of pathology, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chuan Chang
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Mo Hou
- Division of Hematology and Oncology, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Kan Tseng
- Department of Radiation Oncology, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Hen Liu
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
3
|
Deboever N, Jones CM, Yamashita K, Ajani JA, Hofstetter WL. Advances in diagnosis and management of cancer of the esophagus. BMJ 2024; 385:e074962. [PMID: 38830686 DOI: 10.1136/bmj-2023-074962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Esophageal cancer is the seventh most common malignancy worldwide, with over 470 000 new cases diagnosed each year. Two distinct histological subtypes predominate, and should be considered biologically separate disease entities.1 These subtypes are esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC). Outcomes remain poor regardless of subtype, with most patients presenting with late stage disease.2 Novel strategies to improve early detection of the respective precursor lesions, squamous dysplasia, and Barrett's esophagus offer the potential to improve outcomes. The introduction of a limited number of biologic agents, as well as immune checkpoint inhibitors, is resulting in improvements in the systemic treatment of locally advanced and metastatic esophageal cancer. These developments, coupled with improvements in minimally invasive surgical and endoscopic treatment approaches, as well as adaptive and precision radiotherapy technologies, offer the potential to improve outcomes still further. This review summarizes the latest advances in the diagnosis and management of esophageal cancer, and the developments in understanding of the biology of this disease.
Collapse
Affiliation(s)
- Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher M Jones
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kohei Yamashita
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
4
|
Manara M, Bona D, Bonavina L, Aiolfi A. Impact of pulmonary complications following esophagectomy on long-term survival: multivariate meta-analysis and restricted mean survival time assessment. Updates Surg 2024; 76:757-767. [PMID: 38319522 PMCID: PMC11129973 DOI: 10.1007/s13304-024-01761-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Abstract
Pulmonary complications (PC) are common after esophagectomy and their impact on long-term survival is not defined yet. The present study aimed to assess the effect of postoperative PCs on long-term survival after esophagectomy for cancer. Systematic review of the literature through February 1, 2023, was performed. The included studies evaluated the effect of PC on long-term survival. Primary outcome was long-term overall survival (OS). Cancer-specific survival (CSS) and disease-free survival (DFS) were secondary outcomes. Restricted mean survival time difference (RMSTD), hazard ratio (HR), and 95% confidence intervals (CI) were used as pooled effect size measures. Eleven studies were included (3423 patients). Overall, 674 (19.7%) patients developed PC. The RMSTD analysis shows that at 60-month follow-up, patients not experiencing PC live an average of 8.5 (95% CI 6.2-10.8; p < 0.001) months longer compared with those with PC. Similarly, patients not experiencing postoperative PC seem to have significantly longer CSS (8 months; 95% CI 3.7-12.3; p < 0.001) and DFS (5.4 months; 95% CI 1.6-9.1; p = 0.005). The time-dependent HRs analysis shows a reduced mortality hazard in patients without PC at 12 (HR 0.6, 95% CI 0.51-0.69), 24 (HR 0.64, 95% CI 0.55-0.73), 36 (HR 0.67, 95% CI 0.55-0.79), and 60 months (HR 0.69, 95% CI 0.51-0.89). This study suggests a moderate clinical impact of PC on long-term OS, CSS, and DFS after esophagectomy. Patients not experiencing PC seem to have a significantly reduced mortality hazard up to 5 years of follow-up.
Collapse
Affiliation(s)
- Michele Manara
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Via C. Belgioioso N. 173, 20151, Milan, Italy.
| | - Davide Bona
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Via C. Belgioioso N. 173, 20151, Milan, Italy
| | - Luigi Bonavina
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Policlinico San Donato, University of Milan, Milan, Italy
| | - Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Via C. Belgioioso N. 173, 20151, Milan, Italy
| |
Collapse
|
5
|
Hedberg J, Sundbom M, Edholm D, Aahlin EK, Szabo E, Lindberg F, Johnsen G, Førland DT, Johansson J, Kauppila JH, Svendsen LB, Nilsson M, Lindblad M, Lagergren P, Larsen MH, Åkesson O, Löfdahl P, Mala T, Achiam MP. Randomized controlled trial of nasogastric tube use after esophagectomy: study protocol for the kinetic trial. Dis Esophagus 2024; 37:doae010. [PMID: 38366900 PMCID: PMC11144291 DOI: 10.1093/dote/doae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/11/2024] [Accepted: 01/29/2024] [Indexed: 02/18/2024]
Abstract
Esophagectomy is a complex and complication laden procedure. Despite centralization, variations in perioparative strategies reflect a paucity of evidence regarding optimal routines. The use of nasogastric (NG) tubes post esophagectomy is typically associated with significant discomfort for the patients. We hypothesize that immediate postoperative removal of the NG tube is non-inferior to current routines. All Nordic Upper Gastrointestinal Cancer centers were invited to participate in this open-label pragmatic randomized controlled trial (RCT). Inclusion criteria include resection for locally advanced esophageal cancer with gastric tube reconstruction. A pretrial survey was undertaken and was the foundation for a consensus process resulting in the Kinetic trial, an RCT allocating patients to either no use of a NG tube (intervention) or 5 days of postoperative NG tube use (control) with anastomotic leakage as primary endpoint. Secondary endpoints include pulmonary complications, overall complications, length of stay, health related quality of life. A sample size of 450 patients is planned (Kinetic trial: https://www.isrctn.com/ISRCTN39935085). Thirteen Nordic centers with a combined catchment area of 17 million inhabitants have entered the trial and ethical approval was granted in Sweden, Norway, Finland, and Denmark. All centers routinely use NG tube and all but one center use total or hybrid minimally invasive-surgical approach. Inclusion began in January 2022 and the first annual safety board assessment has deemed the trial safe and recommended continuation. We have launched the first adequately powered multi-center pragmatic controlled randomized clinical trial regarding NG tube use after esophagectomy with gastric conduit reconstruction.
Collapse
Affiliation(s)
- Jakob Hedberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - David Edholm
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Eirik Kjus Aahlin
- Department of GI and HPB Surgery, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
- Department of GI and HPB Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Eva Szabo
- Department of Surgery, Örebro University, Örebro, Sweden
| | - Fredrik Lindberg
- Department of Surgical and Perioperative Sciences Surgery, Umeå University, Umeå, Sweden
| | - Gjermund Johnsen
- Department of Gastrointestinal Surgery, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dag Tidemann Førland
- Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Jan Johansson
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Joonas H Kauppila
- Department of Surgery, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Lars Bo Svendsen
- Department of Surgery and Transplantation, Copenhagen University Hospital, Copenhagen, Denmark
| | - Magnus Nilsson
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Stockholm, Sweden
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Mats Lindblad
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholn, Sweden
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Oscar Åkesson
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Per Löfdahl
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tom Mala
- Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Michael Patrick Achiam
- Department of Surgery and Transplantation, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
6
|
Yang Y, Jiang C, Liu Z, Zhu K, Yu B, Yuan C, Qi C, Li Z. Impact of operative time on textbook outcome after minimally invasive esophagectomy, a risk-adjusted analysis from a high-volume center. Surg Endosc 2024; 38:3195-3203. [PMID: 38632118 DOI: 10.1007/s00464-024-10834-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND We aimed to study the impact of operative time on textbook outcome (TO), especially postoperative complications and length of postoperative stay in minimally invasive esophagectomy. METHODS Patients undergoing esophagectomy for curative intent within a prospectively maintained database from 2016 to 2022 were retrieved. Relationships between operative time and outcomes were quantified using multivariable mixed-effects models with medical teams random effects. A restricted cubic spline (RCS) plotting was used to characterize correlation between operative time and the odds for achieving TO. RESULTS Data of 2210 patients were examined. Median operative time was 270 mins (interquartile range, 233-313) for all cases. Overall, 902 patients (40.8%) achieved TO. Among non-TO patients, 226 patients (10.2%) had a major complication (grade ≥ III), 433 patients (19.6%) stayed postoperatively longer than 14 days. Multivariable analysis revealed operative time was associated with higher odds of major complications (odds ratio 1.005, P < 0.001) and prolonged postoperative stay (≥ 14 days) (odds ratio 1.003, P = 0.006). The relationship between operative time and TO exhibited an inverse-U shape, with 298 mins identified as the tipping point for the highest odds of achieving TO. CONCLUSIONS Longer operative time displayed an adverse influence on postoperative morbidity and increased lengths of postoperative stay. In the present study, the TO displayed an inverse U-shaped correlation with operative time, with a significant peak at 298 mins. Potential factors contributing to prolonged operative time may potentiate targets for quality metrics and risk-adjustment process.
Collapse
Affiliation(s)
- Yuxin Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Chao Jiang
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Zhichao Liu
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Kaiyuan Zhu
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Boyao Yu
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Chang Yuan
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Cong Qi
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Zhigang Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China.
| |
Collapse
|
7
|
Drake JA, Sinnamon AJ, Saeed S, Mehta R, Palm RF, Baldonado JJ, Fontaine JP, Pimiento JM. Totally minimally invasive laparoscopic robot-assisted Ivor Lewis esophagectomy: improved technique and outcomes over 200 cases. J Gastrointest Oncol 2024; 15:544-554. [PMID: 38756649 PMCID: PMC11094488 DOI: 10.21037/jgo-23-923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/23/2024] [Indexed: 05/18/2024] Open
Abstract
Background Surgical resection of esophageal and gastroesophageal junction cancers is a very complex procedure with step learning curve. New technologies have made minimally invasive surgery possible, but challenges still remain for wide spread adoption of these techniques. This article aims to describe the outcomes and salient technical points of a totally minimally invasive, laparoscopic, robot-assisted Ivor Lewis esophagectomy (LRAMIE). Methods Retrospective observational cohort study performed at a specialty cancer center using a prospectively maintained institutional database. Patients undergoing LRAMIE (laparoscopic abdomen, robotic chest) from 2014-2023 were included. Patients undergoing transhiatal and three-field esophagectomy were excluded. Operative and postoperative outcomes were compared over the study period to identify potential associations between outcomes over time. Results Two-hundred patients were identified who underwent LRAMIE. Median age was 65 years and most were male (87.5%). The open conversion rate was 1% (n=2), which occurred within the first 30 cases. Operative time and blood loss were improved at the 60-case mark (P<0.001). Anastomotic stricture rate improved after 50 cases, and leak rate improved after 80 cases. Postoperative length of stay improved at both 50 and 100 cases with a median LOS of 6 days after 100 cases. Rate of postoperative pneumonia, 30- and 90-day mortality were reduced after 100 cases, although not statistically significant for mortality due to too few events. Conclusions Totally minimally invasive Ivor Lewis esophagectomy at a high-volume center is a safe procedure. Operative outcomes improved significantly after 50-80 cases, followed by improvement in anastomotic results and postoperative outcomes, with corresponding excellent oncologic outcomes.
Collapse
Affiliation(s)
- Justin A. Drake
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Andrew J. Sinnamon
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | | | - Rutika Mehta
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Russell F. Palm
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | | | - Jacques P. Fontaine
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Jose M. Pimiento
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| |
Collapse
|
8
|
Rucker AJ, D'Amico TA, Pappas TN. Ivor Lewis Esophagectomy and the Care of Humphrey Bogart's Midesophageal Cancer. Ann Thorac Surg 2024:S0003-4975(24)00278-9. [PMID: 38615977 DOI: 10.1016/j.athoracsur.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/18/2024] [Accepted: 03/30/2024] [Indexed: 04/16/2024]
Abstract
In 1945, the Welsh surgeon Ivor Lewis first reported performing the resection of a midesophageal tumor through a combined approach involving the abdomen and right chest. Although his technique was initially rebuffed by the preeminent esophageal surgeons of the time, it quickly became the standard approach for cancers of the midesophagus. Here we review the development and early dissemination of Lewis' operation using the case of the American actor Humphrey Bogart, who underwent an Ivor Lewis esophagectomy for esophageal cancer in 1956.
Collapse
Affiliation(s)
- A Justin Rucker
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.
| | - Thomas A D'Amico
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Theodore N Pappas
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
9
|
Bona D, Manara M, Bonitta G, Guerrazzi G, Guraj J, Lombardo F, Biondi A, Cavalli M, Bruni PG, Campanelli G, Bonavina L, Aiolfi A. Long-Term Impact of Severe Postoperative Complications after Esophagectomy for Cancer: Individual Patient Data Meta-Analysis. Cancers (Basel) 2024; 16:1468. [PMID: 38672550 PMCID: PMC11048031 DOI: 10.3390/cancers16081468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Severe postoperative complications (SPCs) may occur after curative esophagectomy for cancer and are associated with prolonged hospital stay, augmented costs, and increased in-hospital mortality. However, the effect of SPCs on survival after esophagectomy is uncertain. AIM To assess the impact of severe postoperative complications (SPCs) on long-term survival following curative esophagectomy for cancer, we conducted a systematic search of PubMed, MEDLINE, Scopus, and Web of Science databases up to December 2023. The included studies examined the relationship between SPCs and survival outcomes, defining SPCs as Clavien-Dindo grade > 3. The primary outcome measure was long-term overall survival (OS). We used restricted mean survival time difference (RMSTD) and 95% confidence intervals (CIs) to calculate pooled effect sizes. Additionally, we applied the GRADE methodology to evaluate the certainty of the evidence. RESULTS Ten studies (2181 patients) were included. SPCs were reported in 651 (29.8%) patients. The RMSTD overall survival analysis shows that at 60-month follow-up, patients experiencing SPCs lived for 8.6 months (95% Cis -12.5, -4.7; p < 0.001) less, on average, compared with no-SPC patients. No differences were found for 60-month follow-up disease-free survival (-4.6 months, 95% CIs -11.9, 1.9; p = 0.17) and cancer-specific survival (-6.8 months, 95% CIs -11.9, 1.7; p = 0.21). The GRADE certainty of this evidence ranged from low to very low. CONCLUSIONS This study suggests a statistically significant detrimental effect of SPCs on OS in patients undergoing curative esophagectomy for cancer. Also, a clinical trend toward reduced CSS and DFS was perceived.
Collapse
Affiliation(s)
- Davide Bona
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy; (D.B.); (M.M.); (G.B.); (G.G.)
| | - Michele Manara
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy; (D.B.); (M.M.); (G.B.); (G.G.)
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy; (D.B.); (M.M.); (G.B.); (G.G.)
| | - Guglielmo Guerrazzi
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy; (D.B.); (M.M.); (G.B.); (G.G.)
| | - Juxhin Guraj
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy; (D.B.); (M.M.); (G.B.); (G.G.)
| | - Francesca Lombardo
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy; (D.B.); (M.M.); (G.B.); (G.G.)
| | - Antonio Biondi
- Department of General Surgery and Medical Surgical Specialties, G. Rodolico Hospital, Surgical Division, University of Catania, 95131 Catania, Italy;
| | - Marta Cavalli
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Surgery, University of Insubria, 20157 Milan, Italy
| | - Piero Giovanni Bruni
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Surgery, University of Insubria, 20157 Milan, Italy
| | - Giampiero Campanelli
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Surgery, University of Insubria, 20157 Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, 20097 Milan, Italy
| | - Alberto Aiolfi
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy; (D.B.); (M.M.); (G.B.); (G.G.)
| |
Collapse
|
10
|
Schuring N, van Berge Henegouwen MI, Gisbertz SS. History and evidence for state of the art of lymphadenectomy in esophageal cancer surgery. Dis Esophagus 2024; 37:doad065. [PMID: 38048446 PMCID: PMC10987971 DOI: 10.1093/dote/doad065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/29/2023] [Accepted: 11/07/2023] [Indexed: 12/06/2023]
Abstract
The current curative multimodal treatment of advanced esophageal cancers consists of neoadjuvant or perioperative chemo(radio)therapy followed by a radical surgical resection of the primary tumor and a 2- or 3-field lymphadenectomy. One of the most important predictors of long-term survival of esophageal cancer patients is lymph node involvement. The distribution pattern of lymph node metastases in esophageal cancer is unpredictable and depends on the primary tumor location, histology, T-stage and application of neoadjuvant or perioperative treatment. The optimal extent of the lymphadenectomy remains controversial; there is no global consensus on this topic yet. Some surgeons advocate an aggressive and extended lymph node dissection to remove occult metastatic disease, to optimize oncological outcomes. Others promote a more restricted lymphadenectomy, since the benefit of an extended lymphadenectomy, especially after neoadjuvant chemoradiotherapy, has not been clearly demonstrated, and morbidity may be reduced. In this review, we describe the development of lymphadenectomy, followed by a summary of current evidence for lymphadenectomy in esophageal cancer treatment.
Collapse
Affiliation(s)
- Nannet Schuring
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Gastroenterology and Hepatology, Amsterdam UMC Location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Challine A, Kirouani M, Markar SR, Tzedakis S, Jaquet R, Piessen G, Dabakoyo-Yonli TS, Lefèvre JH, Lazzati A, Voron T. MIRO study: Do the results of a randomized controlled trial apply in a real population? Surgery 2024; 175:1055-1062. [PMID: 38490752 DOI: 10.1016/j.surg.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/04/2023] [Accepted: 11/26/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND The aim of our study was to evaluate the external validity of the MIRO randomized controlled trial findings in a similar nationwide setting "real life" population, especially the benefit of a hybrid approach in esophageal resection for pulmonary complication. The external validity of randomized controlled trial findings to the general population with the same condition remains problematic because of the inherent selection bias and rigid inclusion criteria. METHODS This study was a cohort study from a National Health Database (Programme de Medicalisation des Systemes d'Informations) between 2010 and 2022. All adult patients operated on using Ivor Lewis resection for esophageal cancer were included. We first validated the detection algorithm of postoperative complications in the health database. Then, we assessed the primary outcome, which was the comparison of postoperative severe pulmonary complications, leak rate, and 30-day mortality between the 2 surgical approaches (hybrid versus open) over a decade. RESULTS Between 2010 and 2012, 162 of 205 patients in the MIRO trial were anonymously identified in the health care database. No difference between randomized controlled trials and healthcare database measurements was found within severe respiratory complications (24% vs 22%, respectively) nor within leak rate (10% vs 9%, respectively). After application of selection criteria according to the MIRO trial, 3,852 patients were included between 2013 and 2022. The hybrid approach was a protective factor against respiratory complications after adjustment for confounding variables (odds ratio = 0.83; 95% confidence interval = 0.71-0.98, P = .025). No significant difference in the 30-day mortality rate or 30-day leakage rate between the types of approach was reported. CONCLUSION This national cohort study demonstrates the external validity of the MIRO randomized controlled trial findings in a real-life population within France.
Collapse
Affiliation(s)
- Alexandre Challine
- Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France; HeKA, Inria, Paris, France; Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France.
| | - Mehdi Kirouani
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Sheraz R Markar
- Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom
| | | | | | - Guillaume Piessen
- CHU Lille, Department of Digestive and Oncological Surgery, F-59000 Lille, France; Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000 Lille, France
| | | | - Jérémie H Lefèvre
- Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Andrea Lazzati
- HeKA, Inria, Paris, France; Service de chirurgie digestive et bariatrique, Centre intercommunal de Créteil, Créteil, France
| | - Thibault Voron
- Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
| |
Collapse
|
12
|
Masuda Y, Leong EKF, So JBY, Shabbir A, Lam Jia Wei T, Chia DKA, Kim G. A systematic review and meta-analysis of mediastinoscopy-assisted transhiatal esophagectomy (MATHE). Surg Oncol 2024; 53:102042. [PMID: 38330804 DOI: 10.1016/j.suronc.2024.102042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Transhiatal esophagectomy (THE) avoids thoracotomy but sacrifices mediastinal lymphadenectomy. Mediastinoscopy-assisted transhiatal esophagectomy (MATHE) allows for visualisation and en-bloc dissection of mediastinal lymph nodes while retaining the benefits of THE. However, given its novel inception, there is a paucity of literature. This study aimed to conduct the first meta-analysis to explore the efficacy of MATHE and clarify its role in the future of esophagectomy. METHODS Four databases (PubMed, EMBASE, Scopus, and Cochrane Library) were searched from inception to May 1, 2023. Studies were included if they reported outcomes for patients with esophageal cancer who underwent MATHE. Meta-analyses of proportions and pooled means were performed for the outcomes of intraoperative blood loss, lymph node (LN) harvest, mean hospital length of stay (LOS), mean operative time, R0 resection, conversion rates, 30-day mortality rate, 5-year OS, and surgical complications (anastomotic leak, cardiovascular [CVS] and pulmonary complications, chyle leak and recurrent laryngeal nerve palsy [RLN]). Sensitivity analyses were performed for outcomes with substantial statistical heterogeneity. RESULTS The search yielded 223 articles; 28 studies and 1128 patients were included in our analysis. Meta-analyses of proportions yielded proportion rates: 30-day mortality (0 %, 95 %CI 0-0), 5-year OS (60.5 %, 95 %CI 47.6-72.7), R0 resection (100 %, 95 %CI 99.3-100), conversion rate (0.1 %, 95 %CI 0-1.2). Among surgical complications, RLN palsy (14.6 %, 95 %CI 9.5-20.4) were most observed, followed by pulmonary complications (11.3 %, 95 %CI 7-16.2), anastomotic leak (9.7 %, 95 %CI 6.8-12.8), CVS complications (2.3 %, 95 %CI 0.9-4.1) and chyle leak (0.02 %, 95 %CI 0-0.8). Meta-analysis of pooled means yielded means: LN harvest (18.6, 95 %CI 14.3-22.9), intraoperative blood loss (247.1 ml, 95 %CI 173.6-320.6), hospital LOS (18.1 days, 95 %CI 14.4-21.8), and operative time (301.5 min, 95 %CI 238.4-364.6). There was moderate-to-high statistical heterogeneity. Findings were robust to sensitivity analyses. CONCLUSION MATHE is associated with encouraging post-operative mortality and complication rates, while allowing for radical mediastinal lymphadenectomy with reasonable lymph node harvest.
Collapse
Affiliation(s)
- Yoshio Masuda
- Ministry of Health Holdings Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Jimmy Bok Yan So
- Upper Gastrointestinal Surgery, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Asim Shabbir
- Upper Gastrointestinal Surgery, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Daryl Kai Ann Chia
- Upper Gastrointestinal Surgery, National University Hospital, Singapore.
| | - Guowei Kim
- Upper Gastrointestinal Surgery, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
13
|
Milone M, Bianchi PP, Cianchi F, Coratti A, D'Amore A, De Manzoni G, De Pasqual CA, Formisano G, Jovine E, Morelli L, Offi M, Peri A, Pietrabissa A, Staderini F, Tribuzi A, Giacopuzzi S. Fashioning esophagogastric anastomosis in robotic Ivor-Lewis esophagectomy: a multicenter experience. Langenbecks Arch Surg 2024; 409:103. [PMID: 38517543 PMCID: PMC10959816 DOI: 10.1007/s00423-024-03290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/15/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND The aim of the present study is to compare outcomes of the robotic hand-sewn, linear- and circular-stapled techniques performed to create an intrathoracic esophagogastric anastomosis in patients who underwent Ivor-Lewis esophagectomy. METHODS Patients who underwent a planned Ivor-Lewis esophagectomy were retrospectively analysed from prospectively maintained databases. Only patients who underwent a robotic thoracic approach with the creation of an intrathoracic esophagogastric anastomosis were included in the study. Patients were divided into three groups: hand-sewn-, circular stapled-, and linear-stapled anastomosis group. Demographic information and surgery-related data were extracted. The primary outcome was the rate of anastomotic leakages (AL) in the three groups. Moreover, the rate of grade A, B and C anastomotic leakage were evaluated. In addition, patients of each group were divided in subgroups according to the characteristics of anastomotic fashioning technique. RESULTS Two hundred and thirty patients were enrolled in the study. No significant differences were found between the three groups about AL rate (p = 0.137). Considering the management of the AL for each of the three groups, no significant differences were found. Evaluating the correlation between AL rate and the characteristics of anastomotic fashioning technique, no significant differences were found. CONCLUSIONS No standardized anastomotic fashioning technique has yet been generally accepted. This study could be considered a call to perform ad hoc high-quality studies involving high-volume centers for upper gastrointestinal surgery to evaluate what is the most advantageous anastomotic technique.
Collapse
Affiliation(s)
- Marco Milone
- Department of Clinical Medicine and Surgery, ″Federico II″ University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | | | - Fabio Cianchi
- Chirurgia Dell'Apparato Digerente Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Anna D'Amore
- Department of Clinical Medicine and Surgery, ″Federico II″ University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Giovanni De Manzoni
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | - Carlo Alberto De Pasqual
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | | | - Elio Jovine
- Department of General Surgery, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, Maggiore Hospital, 40133, Bologna, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Mariafortuna Offi
- Department of General Surgery, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, Maggiore Hospital, 40133, Bologna, Italy
| | - Andrea Peri
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Surgery, University of Pavia, Pavia, Italy
| | | | - Fabio Staderini
- Chirurgia Dell'Apparato Digerente Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Simone Giacopuzzi
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| |
Collapse
|
14
|
Dohrn N, Burgdorf SK, de Heer P, Klein MF, Jensen KK. The current application and evidence for robotic approach in abdominal surgery: A narrative literature review. Scand J Surg 2024; 113:21-27. [PMID: 38497506 DOI: 10.1177/14574969241232737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The current application of robotic surgery is evolving at a high pace in the current years. The technical advantages enable several abdominal surgical procedures to be performed minimally invasive instead of open surgery. Furthermore, procedures previously performed successfully using standard laparoscopy are now performed with a robotic approach, with conflicting results. The present narrative review reports the current literature on the robotic surgical procedures typically performed in a typical Scandinavian surgical department: colorectal, hernia, hepato-biliary, and esophagogastric surgery.
Collapse
Affiliation(s)
- Niclas Dohrn
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen, Blegdamsvej 9,2100 København Ø, Denmark
| | | | - Pieter de Heer
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark
| | - Mads Falk Klein
- Department of Surgery, Copenhagen University Hospital-Herlev & Gentofte, Herlev, Denmark
| | | |
Collapse
|
15
|
Dyas AR, Mungo B, Bronsert MR, Stuart CM, Mungo AH, Mitchell JD, Randhawa SK, David E, Stewart CL, McCarter MD, Meguid RA. National trends in technique use for esophagectomy: Does primary surgeon specialty matter? Surgery 2024; 175:353-359. [PMID: 38030524 DOI: 10.1016/j.surg.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/04/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Cardiothoracic surgeons and general surgeons (including surgical oncologists) perform most esophagectomies. The purpose of this study was to explore whether specialty-driven differences in surgical techniques and the use of minimally invasive surgical approaches exist and are associated with postoperative outcomes after esophagectomy. METHODS This was a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program esophagectomy-targeted participant user file (2016-2018). Patients who underwent esophagectomy were sorted into cardiothoracic and general surgeon cohorts based on surgeon specialty. Perioperative characteristics and postoperative outcomes were compared using the χ2 analysis or independent t test. Multivariable logistic regression controlling for perioperative variables was performed to generate risk-adjusted rates of postoperative outcomes compared by surgical specialty. RESULTS Of 3,247 patients included, 1,792 (55.2%) underwent esophagectomy by cardiothoracic surgeons and 1,455 (44.5%) by general surgeons as the primary surgeon. Cardiothoracic surgeons were more likely to use traditional minimally invasive surgical (P = .0004) or open approaches (P < .0001) and less likely to use robotic (P = .04) or a hybrid robotic and traditional approaches (P < .0001). Cardiothoracic surgeons performed more Ivor Lewis esophagectomies and fewer transhiatal and McKeown esophagectomies (P < .0001). After risk adjustment, there were no differences in rates of postesophagectomy complications, such as anastomotic leaks or positive margins, between cardiothoracic surgeons and general surgeons (all P > .05). However, cardiothoracic surgeons were more likely than general surgeons to treat anastomotic leaks with surgery rather than procedural interventions (odds ratio = 1.76; 95% confidence interval, 1.24-2.52). CONCLUSION Cardiothoracic surgeons and general surgeons use minimally invasive surgical subtypes differently when performing esophagectomy. However, there were no risk-adjusted differences in postoperative complications when compared by surgical subspecialty. Esophagectomy is being performed safely by surgeons with different specialties and training pathways.
Collapse
Affiliation(s)
- Adam R Dyas
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO.
| | - Benedetto Mungo
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Christina M Stuart
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO
| | - Alison H Mungo
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - John D Mitchell
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Simran K Randhawa
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Elizabeth David
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Camille L Stewart
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Martin D McCarter
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Robert A Meguid
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| |
Collapse
|
16
|
Cizmic A, Romic I, Balla A, Barabino N, Anania G, Baiocchi GL, Bakula B, Balagué C, Berlth F, Bintintan V, Bracale U, Egberts JH, Fuchs HF, Gisbertz SS, Gockel I, Grimminger P, van Hillegersberg R, Inaki N, Immanuel A, Korr D, Lingohr P, Mascagni P, Melling N, Milone M, Mintz Y, Morales-Conde S, Moulla Y, Müller-Stich BP, Nakajima K, Nilsson M, Reeh M, Sileri P, Targarona EM, Ushimaru Y, Kim YW, Markar S, Nickel F, Mitra AT. An international Delphi consensus for surgical quality assessment of lymphadenectomy and anastomosis in minimally invasive total gastrectomy for gastric cancer. Surg Endosc 2024; 38:488-498. [PMID: 38148401 PMCID: PMC10830761 DOI: 10.1007/s00464-023-10614-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/26/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Minimally invasive total gastrectomy (MITG) is a mainstay for curative treatment of patients with gastric cancer. To define and standardize optimal surgical techniques and further improve clinical outcomes through the enhanced MITG surgical quality, there must be consensus on the key technical steps of lymphadenectomy and anastomosis creation, which is currently lacking. This study aimed to determine an expert consensus from an international panel regarding the technical aspects of the performance of MITG for oncological indications using the Delphi method. METHODS A 100-point scoping survey was created based on the deconstruction of MITG into its key technical steps through local and international expert opinion and literature evidence. An international expert panel comprising upper gastrointestinal and general surgeons participated in multiple rounds of a Delphi consensus. The panelists voted on the issues concerning importance, difficulty, or agreement using an online questionnaire. A priori consensus standard was set at > 80% for agreement to a statement. Internal consistency and reliability were evaluated using Cronbach's α. RESULTS Thirty expert upper gastrointestinal and general surgeons participated in three online Delphi rounds, generating a final consensus of 41 statements regarding MITG for gastric cancer. The consensus was gained from 22, 12, and 7 questions from Delphi rounds 1, 2, and 3, which were rephrased into the 41 statetments respectively. For lymphadenectomy and aspects of anastomosis creation, Cronbach's α for round 1 was 0.896 and 0.886, and for round 2 was 0.848 and 0.779, regarding difficulty or importance. CONCLUSIONS The Delphi consensus defined 41 steps as crucial for performing a high-quality MITG for oncological indications based on the standards of an international panel. The results of this consensus provide a platform for creating and validating surgical quality assessment tools designed to improve clinical outcomes and standardize surgical quality in MITG.
Collapse
Affiliation(s)
- Amila Cizmic
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Ivan Romic
- Department of Hepatobiliary Surgery & Liver Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Andrea Balla
- Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Barabino
- Department of Surgical Sciences & Integrated Diagnostic, University of Genoa, Genoa, Italy
| | - Gabriele Anania
- Department of Medical Science, University of Ferrara, 4121, Ferrara, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Branko Bakula
- Department of Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - Carmen Balagué
- Department of General and Digestive Surgery, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Felix Berlth
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Vasile Bintintan
- Department of Surgery, University Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Umberto Bracale
- General and Emergency Surgical Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, AOU San Giovanni and Ruggi D'Aragona, Salerno, Italy
| | | | - Hans F Fuchs
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Cologne, Germany
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC Location, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Peter Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery/Breast Surgery, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Arul Immanuel
- Northern Oesophago-Gastric Unit, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - Daniel Korr
- Department of Surgery, Israelit Hospital, Hamburg, Germany
| | - Philipp Lingohr
- Department for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Pietro Mascagni
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France
| | - Nathaniel Melling
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marco Milone
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131, Naples, Italy
| | - Yoav Mintz
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Salvador Morales-Conde
- Department of General and Digestive Surgery, University Hospital Virgen Macarena, School of Medicine of the University of Seville, Seville, Spain
- Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazon, Seville, Spain
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Beat P Müller-Stich
- Department of Digestive Surgery, University Digestive Healthcare Center Basel, Basel, Switzerland
| | - Kiyokazu Nakajima
- Department of Next Generation Endoscopic Intervention, Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Magnus Nilsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Matthias Reeh
- Department of General, Visceral and Vascular Surgery, Marienkrankenhaus, Hamburg, Germany
| | - Pierpaolo Sileri
- Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | | | - Yuki Ushimaru
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - Sheraz Markar
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Felix Nickel
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Anuja T Mitra
- Department of Surgery & Cancer, Imperial College London, London, UK
| |
Collapse
|
17
|
Mengardo V, Weindelmayer J, Ceccherini G, Wilkinson M, de Manzoni G, Allum W, Giacopuzzi S. The effect of aging on short- and long-term results after esophagectomy: an international multicenter retrospective analysis. Dis Esophagus 2024; 37:doad057. [PMID: 38300628 DOI: 10.1093/dote/doad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/14/2023] [Indexed: 02/02/2024]
Abstract
The optimal treatment for esophageal cancer in elderly patients is still debated and data on postoperative results are limited. This retrospective international study aims to clarify the impact of age on clinical and oncological outcomes after esophagectomy. All patients that underwent esophagectomy for cancer between 2007 and 2016 at two European high-volume Centers have been included in the study. Patients were divided into three groups according to their age: young-age group (YAG) (18-69), middle-age group (70-74) and old-age group (>74). Primary outcome was 5-year overall survival (OS), while secondary outcomes considered were 5-year disease free survival and disease related survival, 90-day morbidity and mortality, readmission rate and radicality. A total of 575 patients were included. No differences emerged in terms of morbidity and length of stay, while mortality increased with aging from 2% in YAG to 4.8% in old-aged (P = 0.003). Old-age patients had less neoadjuvant treatment (P < 0.001), a less aggressive mediastinal lymphadenectomy and presented a more advanced pathological stage. As expected, OS decreased significantly for older patients compared with the other two age groups (P = 0.044) but, on the other hand, disease free and disease related survival were comparable between the groups. Age itself should not be considered a contraindication to esophagectomy. Although in patients older than 75 years postoperative mortality is significantly increased, esophagectomy could be still an option in selected patients, favoring the use of minimally invasive techniques and enhanced recovery protocols.
Collapse
Affiliation(s)
- Valentina Mengardo
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Borgo Trento, University of Verona, Verona, Italy
| | - Jacopo Weindelmayer
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Borgo Trento, University of Verona, Verona, Italy
| | - Giovanni Ceccherini
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Borgo Trento, University of Verona, Verona, Italy
| | - Michelle Wilkinson
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - Giovanni de Manzoni
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Borgo Trento, University of Verona, Verona, Italy
| | - William Allum
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - Simone Giacopuzzi
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Borgo Trento, University of Verona, Verona, Italy
| |
Collapse
|
18
|
Kim JH, Yun JK, Kim CW, Kim HR, Kim YH. Long-Term Outcomes of Colon Conduits in Surgery for Primary Esophageal Cancer: A Propensity Score-Matched Comparison to Gastric Conduits. J Chest Surg 2024; 57:53-61. [PMID: 38174891 DOI: 10.5090/jcs.23.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 01/05/2024] Open
Abstract
Background In the treatment of esophageal cancer, a gastric conduit is typically the first choice. However, when the stomach is not a viable option, the usual alternative is a colon conduit. This study compared the long-term surgical outcomes of gastric and colon conduits over the same interval and aimed to identify factors influencing the prognosis. Methods A retrospective review was conducted of patients who underwent esophagectomy followed by reconstruction for primary esophageal cancer between January 2006 and December 2020. Results The study included 1,545 patients, with a gastric conduit used for 1,429 (92.5%) and a colon conduit for 116 (7.5%). Using propensity-matched analysis, 116 patients were selected from each group for comparison. No significant difference was observed in long-term survival between the gastric and colon conduit groups, irrespective of anastomosis level and pathological stage. A higher proportion of patients in the colon conduit group experienced postoperative complications compared to the gastric conduit group (57.8% vs. 25%, p<0.001). Multivariable analysis revealed that age over 65 years, body mass index below 22.0 kg/m2, neoadjuvant therapy, postoperative anastomotic leakage, and renal failure were risk factors for overall survival in patients with a colon conduit. Regarding conduit-related complications, cervical anastomosis was the only significant risk factor among those with a colon conduit. Conclusion Despite the association of colon conduits with high morbidity rates relative to gastric conduits, the long-term outcomes of colon conduits were acceptable. More consideration should be given perioperatively to the use of a colon conduit, particularly in cases involving cervical anastomosis.
Collapse
Affiliation(s)
- Jae Hoon Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan Wook Kim
- Department of Colorectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
19
|
Veziant J, Bouché O, Aparicio T, Barret M, El Hajbi F, Lepilliez V, Lesueur P, Maingon P, Pannier D, Quero L, Raoul JL, Renaud F, Seitz JF, Serre AA, Vaillant E, Vermersch M, Voron T, Tougeron D, Piessen G. Esophageal cancer - French intergroup clinical practice guidelines for diagnosis, treatments and follow-up (TNCD, SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, SFP, RENAPE, SNFCP, AFEF, SFR). Dig Liver Dis 2023; 55:1583-1601. [PMID: 37635055 DOI: 10.1016/j.dld.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION This document is a summary of the French intergroup guidelines regarding the management of esophageal cancer (EC) published in July 2022, available on the website of the French Society of Gastroenterology (SNFGE) (www.tncd.org). METHODS This collaborative work was conducted under the auspices of several French medical and surgical societies involved in the management of EC. Recommendations were graded in three categories (A, B and C), according to the level of evidence found in the literature until April 2022. RESULTS EC diagnosis and staging evaluation are mainly based on patient's general condition assessment, endoscopy plus biopsies, TAP CT-scan and 18F FDG-PET. Surgery alone is recommended for early-stage EC, while locally advanced disease (N+ and/or T3-4) is treated with perioperative chemotherapy (FLOT) or preoperative chemoradiation (CROSS regimen) followed by immunotherapy for adenocarcinoma. Preoperative chemoradiation (CROSS regimen) followed by immunotherapy or definitive chemoradiation with the possibility of organ preservation are the two options for squamous cell carcinoma. Salvage surgery is recommended for incomplete response or recurrence after definitive chemoradiation and should be performed in an expert center. Treatment for metastatic disease is based on systemic therapy including chemotherapy, immunotherapy or combined targeted therapy according to biomarkers testing such as HER2 status, MMR status and PD-L1 expression. CONCLUSION These guidelines are intended to provide a personalised therapeutic strategy for daily clinical practice and are subject to ongoing optimization. Each individual case should be discussed by a multidisciplinary team.
Collapse
Affiliation(s)
- Julie Veziant
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, CHU Lille, University of Lille, Lille F-59000, France.
| | - Olivier Bouché
- Department of Digestive Oncology, CHU Reims, Reims, France
| | - T Aparicio
- Department of Gastroenterology and Digestive Oncology, AP-HP, Saint-Louis Hospital, Paris, France
| | - M Barret
- Gastroenterology Department, Cochin Hospital, APHP, Paris, France
| | - F El Hajbi
- Department of Oncology, Centre Oscar Lambret, Lille, France
| | - V Lepilliez
- Gastroenterology Department, Jean Mermoz Private Hospital, Ramsay Santé, Lyon, France
| | - P Lesueur
- Department of Radiation Oncology, Centre Guillaume le Conquérant, Le Havre, France
| | - P Maingon
- Department of Radiation Oncology, La Pitié-Salpêtrière, APHP, Sorbonne University, Paris, France
| | - D Pannier
- Department of Oncology, Centre Oscar Lambret, Lille, France
| | - L Quero
- Department of Radiation Oncology, Saint-Louis Hospital, APHP, Paris, France
| | - J L Raoul
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - F Renaud
- Department of Pathology, La Pitié-Salpêtrière, APHP, Sorbonne University, Paris, France
| | - J F Seitz
- Department of Digestive Oncology, La Timone, Aix Marseille Université, Marseille, France
| | - A A Serre
- Department of Radiotherapy, Centre Léon Bérard, Lyon, France
| | | | - M Vermersch
- Medical Imaging Department, Valencienne Hospital Centre, Valencienne 59300, France
| | - T Voron
- Department of General and Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, 184 rue du faubourg Saint-Antoine, Paris 75012, France
| | - D Tougeron
- Department of Gastro-Enterology and Hepatology, Poitiers University Hospital, Poitiers, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, CHU Lille, University of Lille, Lille F-59000, France
| |
Collapse
|
20
|
Li X, Dong H, Zheng Y, Ding S, Li Y, Li H, Huang H, Zhong C, Xie T, Xu Y. AKAP12 inhibits esophageal squamous carcinoma cell proliferation, migration, and cell cycle via the PI3K/AKT signaling pathway. Mol Cell Probes 2023; 72:101939. [PMID: 37879503 DOI: 10.1016/j.mcp.2023.101939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
Esophageal squamous cell carcinoma (ESCC) consistently ranks as one of the most challenging variants of squamous cell carcinomas, primarily due to the lack of effective early detection strategies. We herein aimed to elucidate the underlying mechanisms and biological role associated with A-kinase anchoring protein 12 (AKAP12) in the context of ESCC. Bioinformatic analysis had revealed significantly lower expression level of AKAP12 in ESCC tissue samples than in their non-cancerous counterparts. To gain deeper insights into the potential role of AKAP12 in the progression of ESCC, we conducted a single-gene set enrichment analysis of AKAP12 on ESCC datasets. Our findings suggested that AKAP12 exhibits functions inhibiting cell cycle progression, tumor proliferation, and epithelial-mesenchymal transition. To further validate our findings, we subjected ESCC cell lines to AKAP12 overexpression using CRISPR/Cas9-SAM. In vitro analyses demonstrated that increased expression of AKAP12 significantly reduced cell proliferation, migration, and cell cycle progression. Simultaneously, genes associated with this biological role undergo corresponding regulatory shifts. These observations provided valuable insights into the biological role played by AKAP12 in ESCC progression. In summary, AKAP12 shows promise as a new potential biomarker for early ESCC diagnosis, offering potential advantages for subsequent therapeutic intervention and disease management.
Collapse
Affiliation(s)
- Xingyi Li
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, The First People's Hospital of Nantong, 226001, Nantong, China; Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Huzhou Teachers College, The First Hospital of Huzhou, 313000, Huzhou, China
| | - Hao Dong
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, The First People's Hospital of Nantong, 226001, Nantong, China
| | - Yifan Zheng
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, The First People's Hospital of Nantong, 226001, Nantong, China
| | - Shengguang Ding
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, The First People's Hospital of Nantong, 226001, Nantong, China
| | - Yan Li
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, The First People's Hospital of Nantong, 226001, Nantong, China
| | - Hefei Li
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Nantong University, The Third People's Hospital of Nantong, 226001, Nantong, China
| | - HaiTao Huang
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, The First People's Hospital of Nantong, 226001, Nantong, China
| | - Congjun Zhong
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, The First People's Hospital of Nantong, 226001, Nantong, China
| | - Tian Xie
- Department of Cardiothoracic Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
| | - Yiming Xu
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, The First People's Hospital of Nantong, 226001, Nantong, China.
| |
Collapse
|
21
|
Han D, Tian J, Zhao J, Hao S. Optimal Treatment Strategies for Resectable Locally Advanced Esophageal Squamous Cell Carcinoma: A Real-World Triple Cohort Analysis Using Propensity Score Matching. Int J Gen Med 2023; 16:5467-5479. [PMID: 38021055 PMCID: PMC10676642 DOI: 10.2147/ijgm.s440270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose This study aims to identify the most effective treatment approach and compares the survival rates, along with complications, in patients with locally resectable esophageal squamous cell carcinoma (ESCC) who were treated with one of the three treatment patterns: neoadjuvant chemotherapy followed by surgery (NCT+S), neoadjuvant chemoradiotherapy followed by surgery (NCRT+S), or surgery followed by chemoradiotherapy (S+CRT). Methods We conducted a retrospective analysis of the medical records of ESCC patients who received one of these treatments between March 2015 and March 2022. This analysis aimed to identify differences in long-term survival, pathological responses, and complications across the three treatment groups. To address potential confounding factors, propensity score matching (PSM) and Cox proportional hazards models were utilized. Results This study included a cohort of 715 patients: 197 in the NCT+S group, 188 in the NCRT+S group, and 330 in the S+CRT group, all meeting the selection criteria. After PSM, the median disease-free survival (DFS) time was 38.9 months, 25.6 months, and 15.3 months for NCRT+S, NCT+S, and S+CRT groups, respectively. There were statistically significant differences in the 5-year DFS and 5-year OS among the three groups (P=0.04 and P=0.02, post-matching, respectively). Notably, neoadjuvant therapy showed a correlation with increased postoperative anastomotic leakage rates (17.5% in NCRT+S, 10% in NCT+S, and 5% in S+CRT; P=0.03, post-matching), regardless of the PSM adjustment. Conclusion The findings indicate that neoadjuvant therapy before surgery offers a significant survival advantage over postoperative adjuvant therapy for patients with locally advanced resectable ESCC. Despite similar safety profiles, neoadjuvant therapy appears to be associated with a higher incidence of anastomotic leakage after surgery.
Collapse
Affiliation(s)
- Dan Han
- Department of Radiation Oncology, Shandong University Cancer Center, Jinan, Shandong, People’s Republic of China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, and Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of China
| | - Jing Tian
- Department of Radiation Oncology, Jinan Zhangqiu District People’s Hospital, Jinan, Shandong, People’s Republic of China
| | - Junfeng Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, and Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of China
| | - Shaoyu Hao
- Department of Thoracic Surgery, Shandong University Cancer Center, Jinan, Shandong, People’s Republic of China
- Department of Thoracic Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University, and Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of China
| |
Collapse
|
22
|
Thavanesan N, Bodala I, Walters Z, Ramchurn S, Underwood TJ, Vigneswaran G. Machine learning to predict curative multidisciplinary team treatment decisions in oesophageal cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106986. [PMID: 37463827 DOI: 10.1016/j.ejso.2023.106986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Rising workflow pressures within the oesophageal cancer (OC) multidisciplinary team (MDT) can lead to variability in decision-making, and health inequality. Machine learning (ML) offers a potential automated data-driven approach to address inconsistency and standardize care. The aim of this experimental pilot study was to develop ML models able to predict curative OC MDT treatment decisions and determine the relative importance of underlying decision-critical variables. METHODS Retrospective complete-case analysis of oesophagectomy patients ± neoadjuvant chemotherapy (NACT) or chemoradiotherapy (NACRT) between 2010 and 2020. Established ML algorithms (Multinomial Logistic regression (MLR), Random Forests (RF), Extreme Gradient Boosting (XGB)) and Decision Tree (DT) were used to train models predicting OC MDT treatment decisions: surgery (S), NACT + S or NACRT + S. Performance metrics included Area Under the Curve (AUC), Accuracy, Kappa, LogLoss, F1 and Precision -Recall AUC. Variable importance was calculated for each model. RESULTS We identified 399 cases with a male-to-female ratio of 3.6:1 and median age of 66.1yrs (range 32-83). MLR outperformed RF, XGB and DT across performance metrics (mean AUC of 0.793 [±0.045] vs 0.757 [±0.068], 0.740 [±0.042], and 0.709 [±0.021] respectively). Variable importance analysis identified age as a major factor in the decision to offer surgery alone or NACT + S across models (p < 0.05). CONCLUSIONS ML techniques can use limited feature-sets to predict curative UGI MDT treatment decisions. Explainable Artificial Intelligence methods provide insight into decision-critical variables, highlighting underlying subconscious biases in cancer care decision-making. Such models may allow prioritization of caseload, improve efficiency, and offer data-driven decision-assistance to MDTs in the future.
Collapse
Affiliation(s)
| | - Indu Bodala
- School of Electronics and Computer Science, University of Southampton, UK
| | - Zoë Walters
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, UK
| | - Sarvapali Ramchurn
- School of Electronics and Computer Science, University of Southampton, UK
| | - Timothy J Underwood
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, UK
| | - Ganesh Vigneswaran
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, UK
| |
Collapse
|
23
|
Li F, Zhang F, Liu W, Zheng Q, Zhang M, Wang Z, Zhang X, Qi L, Li Y. Is laparoscope surgery feasible for upper gastrointestinal cancer patients with a history of abdominal surgery? Front Surg 2023; 10:1214175. [PMID: 37876723 PMCID: PMC10590912 DOI: 10.3389/fsurg.2023.1214175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
Objective To investigate the feasibility of laparoscopic abdominal mobilization in patients with cancers of the esophagus or gastroesophageal junction who have a history of abdominal surgery. Methods A total of 132 patients who underwent resection for cancers of the esophagus or gastroesophageal junction from August 2018 to March 2022 in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, were selected (66 patients with a history of abdominal surgery (observation group) and 66 patients without a history of abdominal surgery (control group)). All patients were treated with preoperative neoadjuvant therapy, based on the clinical stage. Thoracoscopic and laparoscopic resection was performed under general anesthesia. The intraoperative and postoperative conditions and surgical complications were compared between the two groups. Results No significant differences were found in baseline data between the observation group and the control group (p > 0.05). Laparoscopic abdominal mobilization was completed in both groups, and there were no significant differences between the two groups in the total operation time [(272.50 ± 86.45) min vs. (257.55 ± 67.96) min], abdominal mobilization time [(25.03 ± 9.82) min vs. (22.53 ± 3.88) min], blood loss [(119.09 ± 72.17) ml vs. (104.39 ± 43.82) ml], and postoperative time to first flatus [(3.44 ± 0.73) d vs. (3.29 ± 0.60) d] (p > 0.05). The abdominal mobilization time was longer in observation group than that in control group (p = 0.057). After excluding the patients (31/66) with a history of simple appendectomy from the observation group, the abdominal mobilization time was significantly longer in observation group than that in control group [(27.97 ± 12.16) min vs. (22.53 ± 3.88) min] (p < 0.05). There were significantly fewer dissected abdominal lymph nodes in the observation group than in the control group [(18.44 ± 10.87) vs. (23.09 ± 10.95), p < 0.05]. After excluding the patients (15/66) with a history of abdominal tumor surgery from the observation group, there was no significant difference in the number of dissected abdominal lymph nodes between the two groups [(20.62 ± 10.81) vs. (23.09 ± 10.95)] (p > 0.05).In addition, no postoperative complications, such as intestinal obstruction, abdominal infection and bleeding, occurred in either group. Conclusion Patients with cancers of the esophagus or gastroesophageal junction who have a history of abdominal surgery are suitable for minimally invasive laparoscopic mobilization.
Collapse
Affiliation(s)
- Feng Li
- Department of Cardiothoracic Surgery, Neijiang Hospital of Traditional Chinese Medicine, Neijiang, China
| | - Fan Zhang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Weixin Liu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Hebei Hospital, Chinese Academy of Medical Sciences, Langfang, China
| | - Qingfeng Zheng
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Moyan Zhang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhen Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuefeng Zhang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Hebei Hospital, Chinese Academy of Medical Sciences, Langfang, China
| | - Ling Qi
- Department of Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yong Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
24
|
Noordman BJ, Gisbertz SS. Minimally invasive oesophagectomy as standard of care. Br J Surg 2023; 110:1118-1119. [PMID: 37438257 DOI: 10.1093/bjs/znad209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/18/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Bo J Noordman
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Treatment and Quality of Life, Cancer Centre Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Treatment and Quality of Life, Cancer Centre Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
25
|
Laydi M, Doussot A, Lakkis Z, Mathieu P, Gandon A, Dubois C, Degisors S, Martin L, Heyd B, Piessen G. Anatomic patterns of anastomotic leaks after Ivor Lewis esophagectomy for cancer: Impact on management and outcomes. Surgery 2023; 174:247-251. [PMID: 37270298 DOI: 10.1016/j.surg.2023.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/14/2023] [Accepted: 04/25/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Anastomotic leakage presentation after Ivor Lewis esophagectomy may vary on imaging. Such variations may influence anastomotic leakage management and outcomes. METHODS All consecutive patients who underwent Ivor Lewis esophagectomy for cancer between 2012 and 2019 in 2 referral centers were included. Anatomical patterns of anastomotic leakage were defined on imaging as follows: eso-mediastinal anastomotic leakage was a leak contained in the posterior mediastinum, eso-pleural anastomotic leakage was a leak involving the pleural cavity, and eso-bronchial anastomotic leakage was a leak communicating with the tracheobronchial tract. According to the Esophageal Complications Consensus Group definition, management and 90-day mortality were evaluated according to these patterns. RESULTS Among 731 patients, 111 (15%) developed anastomotic leakage consisting of eso-mediastinal anastomotic leakage (n = 87, 79%), eso-pleural anastomotic leakage (n = 16, 14%) and eso-bronchial anastomotic leakage (n = 8, 7%). There was no difference among these groups regarding preoperative characteristics or time to anastomotic leakage diagnosis. There was a significant difference in initial management according to anastomotic leakage anatomic patterns (P = .001). More than half of patients who experienced eso-mediastinal anastomotic leakage (n = 46, 53%) were initially treated conservatively without requiring intervention (Esophageal Complications Consensus Group type I), whereas most patients with eso-pleural anastomotic leakage (n = 14, 87.5%) and all with eso-bronchial anastomotic leakage (n = 8, 100%) initially required interventional or surgical treatment (Esophageal Complications Consensus Group type II-III). Anastomotic leakage anatomic patterns had a statistically significant impact on 90-day mortality, intensive care unit stay, and total hospital stay (P < .001). CONCLUSION Anastomotic leakage anatomic patterns after Ivor Lewis esophagectomy influence outcomes. Further studies are warranted to validate it in a prospective setting. Anastomotic leakage anatomic patterns may help in guiding anastomotic leakage management.
Collapse
Affiliation(s)
- Maxime Laydi
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France.
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
| | - Pierre Mathieu
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
| | - Anne Gandon
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, CHU Lille, France
| | - Clément Dubois
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, CHU Lille, France
| | - Sébastien Degisors
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, CHU Lille, France
| | - Louis Martin
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, CHU Lille, France
| | - Bruno Heyd
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, CHU Lille, France; Univ. Lille, CNRS, Inserm, Chu Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, France
| |
Collapse
|
26
|
Francischetto T, Pinheiro VPDSF, Viana EF, Moraes EDD, Protásio BM, Lessa MAO, Almeida GLD, Barretto VRD, Albuquerque AFD. EARLY POSTOPERATIVE OUTCOMES OF THE ESOPHAGECTOMY MINIMALLY INVASIVE IN ESOPHAGEAL CANCER. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1743. [PMID: 37436277 DOI: 10.1590/0102-672020230025e1743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/20/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND The incidence of esophageal cancer is high in some regions and the surgical treatment requires reference centers, with high volume, to make surgery feasible. AIMS To evaluate patients undergoing minimally invasive esophagectomy by thoracoscopy in prone position for the treatment of esophageal cancer and to recognize the experience acquired over time in our service after the introduction of this technique. METHODS From January 2012 to August 2021, all patients who underwent the minimally invasive esophagectomy for esophageal cancer were retrospectively analyzed. In order to assess the factors associated with the predefined outcomes as fistula, pneumonia, and intrahospital death, we performed univariate and multivariate logistic regression analyses, accounting for age as an important factor. RESULTS Sixty-six patients were studied, with mean age of 59.5 years. The main histological type was squamous cell carcinoma (81.8%). The incidence of postoperative pneumonia and fistula was 38% and 33.3%, respectively. Eight patients died during this period. The patient's age, T and N stages, the year the procedure was performed, and postoperative pneumonia development were factors that influenced postoperative death. There was a 24% reduction in the chance of mortality each year, associated with the learning curve of our service. CONCLUSIONS The present study presented the importance of the team's experience and the concentration of the treatment of patients with esophageal cancer in reference centers, allowing to significantly improve the postoperative outcomes.
Collapse
Affiliation(s)
- Thiago Francischetto
- Aristides Maltez Hospital, Bahia League Against Cancer - Salvador (BA), Brazil
- Universidade Federal da Bahia, Bahia School of Medicine - Salvador (BA), Brazil
- Santa Casa de Misericórdia da Bahia, Santa Izabel Hospital - Salvador (BA), Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Kanchodu S, Nag HH. Laparoscopic-assisted transhiatal oesophagectomy: An experience from a tertiary care centre over 10 years. J Minim Access Surg 2023; 19:378-383. [PMID: 36695239 PMCID: PMC10449055 DOI: 10.4103/jmas.jmas_169_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/08/2022] [Indexed: 01/22/2023] Open
Abstract
Background Minimally invasive surgeries have become the standard of care in oesophageal surgeries, but the transhiatal approach is still not widely in practice. As in the open surgical approach, laparoscopic transhiatal oesophagectomy has been accepted by many centres worldwide. The laparoscopic-assisted transhiatal oesophagectomy (LATE) has become a time-tested surgery. Many centres across the world have shown its feasibility and superiority regarding the lymph node yield with less morbidity with the added advantage of laparoscopy. We are pleased to share our 10-year experience with LATE and the long-term follow-up. Materials and Methods Retrospective analysis of prospectively maintained data from our tertiary care centre from January 2010 to January 2021. Forty-six out of 74 patients with carcinoma of the lower end of the oesophagus who underwent LATE were analysed retrospectively. Results Our study group included 46 patients. Six patients who required conversion to open surgery and those who underwent different procedures were excluded. The mean operative time was 220 (140-360) min. The mean blood loss was 230 (100-500) ml. Four (8.69%) patients had neck leaks. Twelve (26.08%) patients had minor pulmonary complications and one (2.17%) patient had a major pulmonary complication in the form of acute respiratory distress syndrome. The median hospital stay was 10.5 (8-28) days and 90-day mortality was 2.17%. 45 (97.82%) patients had an R0 resection rate with a median lymph node yield of 21 (16-28). The median overall survival was 44 months, with a 3 years disease-free survival rate of 63.04% and a 5-year overall survival rate of 36.50%. Conclusion LATE is feasible and safe for adenocarcinoma of lower third esophagus and GEJ (gastroesophageal junction). The laparoscopic magnified view of lower mediastinum provides a better vision for lymphadenectomy especially in the neoadjuvant group. It has all the added benefits of minimal invasive surgery with acceptable short and long term oncological results.
Collapse
Affiliation(s)
- Sudheer Kanchodu
- Department of GI Surgery, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Hirdaya Hulas Nag
- Department of GI Surgery, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| |
Collapse
|
28
|
Bartella I, Brunner S, Schiffmann LM, Schiller P, Schmidt T, Fuchs HF, Chon S, Bruns CJ, Schröder W. Clinical utility and applicability of the,Esophagus Complication Consensus Group' (ECCG) classification of anastomotic leakage following hybrid Ivor-Lewis esophagectomy. Langenbecks Arch Surg 2023; 408:258. [PMID: 37391512 DOI: 10.1007/s00423-023-03001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/25/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Anastomotic leakage (AL) remains the leading surgical complication following Ivor-Lewis (IL) esophagectomy. Different treatment options of AL exist but outcome is difficult to compare due to a lack of generally accepted classifications. This retrospective study was conducted to analyze the clinical significance of a recently proposed classification based on the management of AL. PATIENTS AND METHODS A cohort of 954 consecutive patients undergoing hybrid IL esophagectomy (laparoscopy/thoracotomy) was analysed. AL was defined according to the,Esophagus Complication Consensus Group' (ECCG) criteria depending on its treatment: conservative (AL type I), interventional endoscopic (AL type II), and surgical (AL type III). Primary outcome was single or multiple organ failure (Clavien-Dindo IVA/B) associated with AL. RESULTS Overall morbidity was 63.0% and 8.8% (84/954 patients) developed an AL postoperatively. Three patients (3.5%) had an AL type I, 57 patients (67.9%) an AL type II and 24 patients (28.6%) an AL type III. For patients managed surgically, AL was diagnosed significantly earlier (median days: AL type III: 2 vs AL type II: 6, p < 0.001). Associated organ failure (CD IVA/B) was significantly lower for AL type II as compared to AL type III (21.1% versus 45.8%, p < 0.0001). In-hospital mortality was 3.5% for AL type II and 8.3% for AL type III (p = 0.789). There was no difference for re-admission to ICU and overall length of hospital stay. CONCLUSION The proposed ECCG classification is simply to apply and discriminates the post-treatment severity of AL but does not aid to implement a treatment algorithm.
Collapse
Affiliation(s)
- Isabel Bartella
- Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 32, 50937, Cologne, Germany
| | - Stefanie Brunner
- Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 32, 50937, Cologne, Germany
| | - Lars M Schiffmann
- Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 32, 50937, Cologne, Germany
| | - Petra Schiller
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany
| | - Thomas Schmidt
- Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 32, 50937, Cologne, Germany
| | - Hans F Fuchs
- Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 32, 50937, Cologne, Germany
| | - Seung Chon
- Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 32, 50937, Cologne, Germany
| | - Christiane J Bruns
- Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 32, 50937, Cologne, Germany
| | - Wolfgang Schröder
- Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 32, 50937, Cologne, Germany.
| |
Collapse
|
29
|
Ozawa S, Uchi Y, Ando T, Hayashi K, Aoki T. Essential updates 2020/2021: Recent topics in surgery and perioperative therapy for esophageal cancer. Ann Gastroenterol Surg 2023; 7:346-357. [PMID: 37152779 PMCID: PMC10154818 DOI: 10.1002/ags3.12657] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 05/09/2023] Open
Abstract
In this review, we focused on four topics, namely, minimally invasive esophagectomy (MIE), robot-assisted minimally invasive esophagectomy (RAMIE), conversion and salvage surgery, and neoadjuvant and adjuvant therapy, based on notable reports published in the years 2020 and 2021. It seems that while the short-term outcomes of minimally invasive Ivor Lewis esophagectomy (MIE-IL) were better than those of open Ivor Lewis esophagectomy (OE-IL), there were no significant differences in the long-term outcomes between MIE-IL and OE-IL. Similarly, the short-term outcomes of minimally invasive McKeown esophagectomy (MIE-MK) were better than those of open McKeown esophagectomy (OE-MK), while there were no significant differences in the long-term outcomes between MIE-MK and OE-MK. Furthermore, the short-term outcomes of robot-assisted minimally invasive Ivor Lewis esophagectomy (RAMIE-IL) were superior to those of completely minimally invasive Ivor Lewis esophagectomy (CMIE-IL). On the other hand, there were advantages and disadvantages in relation to the short-term outcomes of robot-assisted minimally invasive McKeown esophagectomy (RAMIE-MK) as compared with completely minimally invasive McKeown esophagectomy (CMIE-MK). However, there were no significant differences in the long-term outcomes between RAMIE-MK and CMIE-MK. Further research is needed to evaluate of short-term and long-term outcomes of transmediastinal esophagectomy with and without robotic assistance. Both induction chemotherapy and induction chemoradiotherapy appear to be promising to secure a higher rate of conversion surgery. Neoadjuvant chemoimmunotherapy and chemoimmunoradiotherapy have shown promising results and are expected as new powerful therapies.
Collapse
Affiliation(s)
- Soji Ozawa
- Department of SurgeryTamakyuryo HospitalMachidaJapan
| | - Yusuke Uchi
- Department of SurgeryTamakyuryo HospitalMachidaJapan
| | - Tomofumi Ando
- Department of SurgeryTamakyuryo HospitalMachidaJapan
| | - Koki Hayashi
- Department of SurgeryTamakyuryo HospitalMachidaJapan
| | - Takuma Aoki
- Department of SurgeryTamakyuryo HospitalMachidaJapan
| |
Collapse
|
30
|
Shah MA, Altorki N, Patel P, Harrison S, Bass A, Abrams JA. Improving outcomes in patients with oesophageal cancer. Nat Rev Clin Oncol 2023; 20:390-407. [PMID: 37085570 DOI: 10.1038/s41571-023-00757-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/23/2023]
Abstract
The care of patients with oesophageal cancer or of individuals who have an elevated risk of oesophageal cancer has changed dramatically. The epidemiology of squamous cell and adenocarcinoma of the oesophagus has diverged over the past several decades, with a marked increase in incidence only for oesophageal adenocarcinoma. Only in the past decade, however, have molecular features that distinguish these two forms of the disease been identified. This advance has the potential to improve screening for oesophageal cancers through the development of novel minimally invasive diagnostic technologies predicated on cancer-specific genomic or epigenetic alterations. Surgical techniques have also evolved towards less invasive approaches associated with less morbidity, without compromising oncological outcomes. With improvements in multidisciplinary care, advances in radiotherapy and new tools to detect minimal residual disease, certain patients may no longer even require surgical tumour resection. However, perhaps the most anticipated advance in the treatment of patients with oesophageal cancer is the advent of immune-checkpoint inhibitors, which harness and enhance the host immune response against cancer. In this Review, we discuss all these advances in the management of oesophageal cancer, representing only the beginning of a transformation in our quest to improve patient outcomes.
Collapse
Affiliation(s)
- Manish A Shah
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Nasser Altorki
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Pretish Patel
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sebron Harrison
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Adam Bass
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Julian A Abrams
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
31
|
Liu F, Yang W, Yang W, Xu R, Chen L, He Y, Liu Z, Zhou F, Hou B, Zhang L, Zhang L, Zhang F, Cai F, Xu H, Lin M, Liu M, Pan Y, Liu Y, Hu Z, Chen H, He Z, Ke Y. Minimally Invasive or Open Esophagectomy for Treatment of Resectable Esophageal Squamous Cell Carcinoma? Answer From a Real-world Multicenter Study. Ann Surg 2023; 277:e777-e784. [PMID: 35129490 DOI: 10.1097/sla.0000000000005296] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the long-term and short-term outcomes of MIE compared with OE in localized ESCC patients in real-world settings. BACKGROUND MIE is an alternative to OE, despite the limited evidence regarding its effect on long-term survival. METHODS We recruited 5822 consecutive patients with resectable ESCC in 2 typical high-volume centers in southern and northern China, 1453 of whom underwent MIE. Propensity score-based overlap weighted regression adjusted for multifaceted confounding factors was used to compare outcomes in the MIE and OE groups. RESULTS Five-year OS was 62.7% in the MIE group and 57.7% in the OE group. The overlap weighted Cox regression showed slightly better OS in the MIE group (hazard ratio 0.93, 95% confidence interval: 0.82-1.06). Although duration of surgery was longer and treatment cost higher in the MIE group than in the OE group, the number of lymph nodes harvested was larger, the proportion of intraoperative blood transfusions lower, and postoperative complications less in the MIE group. 30-day (risk ratio [RR] 0.77, 0.381.55) and 90-day (RR 0.79, 0.46-1.35) mortality were lower in the MIE group versus the OE group, although not statistically significant. These findings were consistent across different analytic approaches and subgroups, notably in the subset of ESCC patients with large tumors. CONCLUSIONS MIE can be performed safely with OS comparable to OE for patients with localized ESCC, indicating MIE may be recommended as the primary surgical approach for resectable ESCC in health facilities with requisite technical capacity.
Collapse
Affiliation(s)
- Fangfang Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Wenlei Yang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Wei Yang
- Cancer Hospital of Shantou University Medical College, Guangdong Province, People's Republic of China
| | - Ruiping Xu
- Anyang Cancer Hospital, Henan Province, People's Republic of China
| | - Lei Chen
- Cancer Hospital of Shantou University Medical College, Guangdong Province, People's Republic of China
| | - Yu He
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Zhen Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Fuyou Zhou
- Anyang Cancer Hospital, Henan Province, People's Republic of China
| | - Bolin Hou
- Linkdoc AI Research (LAIR), Beijing, People's Republic of China
| | - Liqun Zhang
- Cancer Hospital of Shantou University Medical College, Guangdong Province, People's Republic of China
| | - Lixin Zhang
- Anyang Cancer Hospital, Henan Province, People's Republic of China
| | - Fan Zhang
- Cancer Hospital of Shantou University Medical College, Guangdong Province, People's Republic of China
| | - Fen Cai
- Cancer Hospital of Shantou University Medical College, Guangdong Province, People's Republic of China
| | - Huawen Xu
- Cancer Hospital of Shantou University Medical College, Guangdong Province, People's Republic of China
| | - Miaoping Lin
- Cancer Hospital of Shantou University Medical College, Guangdong Province, People's Republic of China
| | - Mengfei Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yaqi Pan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Ying Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Zhe Hu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Huanyu Chen
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Zhonghu He
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yang Ke
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| |
Collapse
|
32
|
Vagliasindi A, Franco FD, Degiuli M, Papis D, Migliore M. Extension of lymph node dissection in the surgical treatment of esophageal and gastroesophageal junction cancer: seven questions and answers. Future Oncol 2023; 19:327-339. [PMID: 36942741 DOI: 10.2217/fon-2021-0545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
The role of two- or three-field nodal dissection in the surgical treatment of esophageal and gastroesophageal junction cancer in the minimally invasive era is still controversial. This review aims to clarify the extension of nodal dissection in esophageal and gastroesophageal junctional cancer. A basic evidence-based analysis was designed, and seven research questions were formulated and answered with a narrative review. Reports with little or no data, single cases, small series and review articles were not included. Three-field lymph node dissection improves staging accuracy, enhances locoregional disease control and might improve survival in the group of patients with cervical and upper mediastinal metastatic lymph nodal involvement from middle and proximal-third esophageal cancer.
Collapse
Affiliation(s)
- Alessio Vagliasindi
- Department of General Surgery & Emergency Unit, S. Maria delle Croci Hospital, Ravenna, Italy
- Unit of abdominal Oncological Surgery, IRCS CROB, Rionero del Vulture(PZ), ITALY
| | - Filippo Di Franco
- Department of Surgery, North West Anglia NHS Foundation Trust, Huntingdon, PE29 6NT, UK
| | - Maurizio Degiuli
- Department of Oncology, Surgical Oncology & Digestive Surgery, San Luigi University Hospital, University of Torino, Orbassano Torino, Italy
| | - Davide Papis
- Department of General Surgery, Sant'Anna Hospital, ASST Lariana, Como
| | - Marcello Migliore
- Department of Surgery & Medical Specialties, Section of Thoracic Surgery, University of Catania, Catania, Italy
- Thoracic Surgery & Lung Transplant, Lung Health Centre, Organ Transplant Center of Excellence (OTCoE), King Faisal Specialist Hospital & Research Center, Riyadh, KSA
| |
Collapse
|
33
|
Patterns of Recurrence and Long-Term Survival of Minimally Invasive Esophagectomy Versus Open Esophagectomy for Locally Advanced Esophageal Cancer Treated with Neoadjuvant Chemotherapy: a Propensity Score-Matched Analysis. J Gastrointest Surg 2023:10.1007/s11605-023-05615-x. [PMID: 36749557 DOI: 10.1007/s11605-023-05615-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/27/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND The use of minimally invasive esophagectomy (MIE) as a treatment for patients with esophageal cancer has recently become more common worldwide. However, differences in the pattern of recurrence between MIE and open esophagectomy (OE) using the transthoracic approach have not been fully investigated, particularly in patients treated with neoadjuvant chemotherapy. METHODS We searched the prospective databases of two institutes for patients with esophageal cancer who underwent neoadjuvant chemotherapy followed by esophagectomy between 2011 and 2018. Propensity score-matched analysis was performed to reduce bias from confounding patient-related variables. Operative outcomes, regionally harvested lymph nodes (LNs), recurrence pattern, and prognosis were investigated in two groups. RESULTS We identified 410 patients who underwent OE (n = 263) and MIE (n = 147). After propensity score matching, 131 pairs of patients were selected. There were no significant differences in baseline characteristics after matching. The total number of harvested LNs in both groups was similar (55.1 vs. 58.9, P = 0.132). The incidence of LN recurrence in the MIE group was significantly lower than that in the OE group (27% vs. 15%, P = 0.010). In particular, the incidence of mediastinal LN recurrence in the MIE group was significantly lower than that in the OE group (16% vs. 6%, P = 0.017). There were no significant differences between the two groups in hematogenous (19% vs.12%, P = 0.173), dissemination (5% vs. 4%, P = 0.769), local (4% vs. 1%. P = 0.213), and other recurrence (3% vs. 3%, P = 1.000). The 3-year disease-free and overall survival of MIE were significantly better than OE (71.4% vs. 50.5%, P = 0.004 and 80.3% vs. 61.2%, P = 0.002, respectively). Multivariate analysis showed that the thoracic approach (OE vs. MIE) (HR 1.93, P = 0.004) was an independent prognostic factor, along with the pathological N stage (HR 3.05, P < 0.001). CONCLUSIONS MIE has less intramediastinal LN recurrence than OE and may lead to a better long-term prognosis in patients with advanced esophageal cancer who underwent neoadjuvant chemotherapy.
Collapse
|
34
|
State of the art of enhanced recovery after surgery (ERAS) protocols in esophagogastric cancer surgery: the Western experience. Updates Surg 2023; 75:373-382. [PMID: 35727482 DOI: 10.1007/s13304-022-01311-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/26/2022] [Indexed: 01/24/2023]
Abstract
Enhanced recovery after surgery (ERAS) programs provide a framework to standardize care processes and improve outcomes. The results of this multimodal and multidisciplinary approach based on actions focused on reducing physiological surgical stress in the preoperative, intraoperative, and postoperative periods are beneficial in reducing morbidity and hospital stay, without increasing readmissions across different surgical settings. The implementation of ERAS in resection procedures of esophageal and gastric cancer has been challenging due to the complexity of these surgical techniques and the high risk of complications. Despite the limited evidence of ERAS in esophagectomy operations, systematic reviews and meta-analysis have confirmed a reduction of pulmonary complications and hospital stay without increasing readmissions. In gastrectomy operations, the implementation of ERAS reduces the use of nasogastric tubes and intraabdominal drains, facilitates early diet, and reduces the length of hospital stay, without increasing complications. There is, however, wide heterogeneity and absence of standardization in the number and definition of the ERAS components. The development of ERAS consensus guidelines including procedure-specific components may reduce this variability. Regardless growing evidence of the effectiveness of ERAS, the adherence rate is still low. The commitment of the multidisciplinary team and leadership is critical in the application and refinement of ERAS protocols in parallel with periodic audits. Pre- and post-habilitation methods are emerging concepts to be incorporated in ERAS protocols.
Collapse
|
35
|
El-Sourani N, Miftode S, Troja A, Alfarawan F, Bockhorn M. Changes in diagnosis and management of anastomotic leakage after esophagectomy for underlying malignancy reduce postoperative mortality and improve patient outcome. Eur Surg 2023. [DOI: 10.1007/s10353-022-00790-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
36
|
Kuwabara S, Kobayashi K, Sudo N. Outcomes of elderly patients following thoracoscopic esophagectomy for esophageal cancer. Langenbecks Arch Surg 2023; 408:56. [PMID: 36689075 DOI: 10.1007/s00423-023-02797-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/22/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Thoracoscopic esophagectomy (TE) is widely used for esophageal cancer treatment. However, the short- and long-term outcomes of TE in older patients remain unknown. Thus, we investigated those outcomes as well as the effectivity of TE in this patient cohort. METHODS A total of 228 consecutive patients who underwent TE for esophageal cancer from 2002 to 2015 were included in the study and categorized into the elderly (≥ 75 years) and non-elderly (< 75 years) groups. The background was adjusted by propensity score matching. The short- and long-term outcomes were then compared between the two groups. RESULTS There was no difference in the short-term outcomes between the two groups. The elderly group had significantly lower overall survival (OS) and relapse-free survival (RFS) than the non-elderly group. When pulmonary complications occurred, the OS and RFS were significantly decreased in the elderly group but not in the non-elderly group. Without pulmonary complications, the OS and RFS in the elderly group did not differ from those in the non-elderly group. The multivariate analysis showed that pulmonary complications were independent poor prognostic factors for OS and RFS in the elderly group but not in the non-elderly group. CONCLUSION TE is safe and feasible for older patients. However, the OS and RFS of the elderly group were significantly worse than those of the non-elderly group, especially when pulmonary complications occurred. Therefore, perioperative management to prevent pulmonary complications is essential to improve the long-term outcomes of older patients receiving TE.
Collapse
Affiliation(s)
- Shirou Kuwabara
- Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-Ku, Niigata prefecture, 950-1197, Niigata city, Japan.
| | - Kazuaki Kobayashi
- Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-Ku, Niigata prefecture, 950-1197, Niigata city, Japan
| | - Natsuru Sudo
- Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-Ku, Niigata prefecture, 950-1197, Niigata city, Japan
| |
Collapse
|
37
|
Yuan S, Wei C, Wang M, Deng W, Zhang C, Li N, Luo S. Prognostic impact of examined lymph-node count for patients with esophageal cancer: development and validation prediction model. Sci Rep 2023; 13:476. [PMID: 36627338 PMCID: PMC9831985 DOI: 10.1038/s41598-022-27150-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023] Open
Abstract
Esophageal cancer (EC) is a malignant tumor with high mortality. We aimed to find the optimal examined lymph node (ELN) count threshold and develop a model to predict survival of patients after radical esophagectomy. Two cohorts were analyzed: the training cohort which included 734 EC patients from the Chinese registry and the external testing cohort which included 3208 EC patients from the Surveillance, Epidemiology, and End Results (SEER) registry. Cox proportional hazards regression analysis was used to determine the prognostic value of ELNs. The cut-off point of the ELNs count was determined using R-statistical software. The prediction model was developed using random survival forest (RSF) algorithm. Higher ELNs count was significantly associated with better survival in both cohorts (training cohort: HR = 0.98, CI = 0.97-0.99, P < 0.01; testing cohort: HR = 0.98, CI = 0.98-0.99, P < 0.01) and the cut-off point was 18 (training cohort: P < 0.01; testing cohort: P < 0.01). We developed the RSF model with high prediction accuracy (AUC: training cohort: 87.5; testing cohort: 79.3) and low Brier Score (training cohort: 0.122; testing cohort: 0.152). The ELNs count beyond 18 is associated with better overall survival. The RSF model has preferable clinical capability in terms of individual prognosis assessment in patients after radical esophagectomy.
Collapse
Affiliation(s)
- Shasha Yuan
- grid.414008.90000 0004 1799 4638Department of Internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008 Henan People’s Republic of China
| | - Chen Wei
- grid.414008.90000 0004 1799 4638Department of Internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008 Henan People’s Republic of China
| | - Mengyu Wang
- grid.493088.e0000 0004 1757 7279Department of Radiotherapy, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan People’s Republic of China
| | - Wenying Deng
- grid.414008.90000 0004 1799 4638Department of Internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008 Henan People’s Republic of China
| | - Chi Zhang
- grid.414008.90000 0004 1799 4638Department of Internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008 Henan People’s Republic of China
| | - Ning Li
- Department of Internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, People's Republic of China.
| | - Suxia Luo
- Department of Internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, People's Republic of China.
| |
Collapse
|
38
|
Petric J, Handshin S, Bright T, Watson DI. Planned oesophagectomy after chemoradiotherapy versus salvage oesophagectomy following definitive chemoradiotherapy: a systematic review and meta-analysis. ANZ J Surg 2022; 93:829-839. [PMID: 36582046 DOI: 10.1111/ans.18225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/05/2022] [Accepted: 12/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Oesophageal cancer is the eighth most common cancer and sixth leading cause of cancer-related mortality worldwide. Salvage oesophagectomies are associated with an increased risk of mortality, although recent data suggests that long-term survival rates following salvage oesophagectomy are similar to planned oesophagectomy. The aim was therefore to meta-analyse outcomes for patients undergoing salvage versus planned oesophagectomies to assess the differences in short-term mortality and long-term survival. METHODS A systematic review of Medline, Scopus, Web of Science and PubMed was performed to identify relevant studies. Data were extracted and compared by meta-analysis, using odds ratio and mean differences with 95% confidence intervals. RESULTS Nineteen studies meeting inclusion criteria were included in the meta-analysis, which compared patients in the planned oesophagectomy group (n = 23 555) to patients in the salvage oesophagectomy group (n = 2227). There were significant differences between the groups in terms of rates of postoperative mortality (5.7% salvage oesophagectomy versus 3.1% planned oesophagectomy, P = 0.0004), anastomotic leak (20.6% salvage oesophagectomy versus 14.5% planned oesophagectomy, P < 0.00001), pulmonary complications (37.1% salvage oesophagectomy versus 24.2% planned oesophagectomy, P < 0.0001) and R0 margin (87.6% salvage oesophagectomy versus 91.3% planned oesophagectomy, P < 0.0001). There was no statistical difference between long-term survival rates at 5 years with 39.2% for salvage and 42.6% for planned oesophagectomy (P = 0.28). CONCLUSIONS Salvage oesophagectomies do offer a meaningful chance of long-term survival (at 5 years) for select patients with oesophageal cancer, but the elevated risk of post-operative complications and mortality following salvage oesophagectomy should be recognized.
Collapse
Affiliation(s)
- Josipa Petric
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Samuel Handshin
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tim Bright
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David I Watson
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
39
|
Marano A, Salomone S, Pellegrino L, Geretto P, Robella M, Borghi F. Robot-assisted esophagectomy with robot-sewn intrathoracic anastomosis (Ivor Lewis): surgical technique and early results. Updates Surg 2022:10.1007/s13304-022-01439-7. [PMID: 36510101 PMCID: PMC9744375 DOI: 10.1007/s13304-022-01439-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Esophagectomy is the selected treatment for nonmetastatic esophageal and esophagogastric junction cancer, although high perioperative morbidity and mortality incur. Robot-assisted minimally invasive esophagectomy (RAMIE) effectively reduces cardiopulmonary complications compared to open esophagectomy and offers a technical advantage, especially for lymph node dissection and intrathoracic anastomosis. This article aims at describing our initial experience of Ivor Lewis RAMIE, focusing on the technique's main steps and robotic-sewn esophagogastrostomy. Prospectively collected data from all consecutive patients who underwent Ivor Lewis RAMIE for cancer was reviewed. Reconstruction was performed with a gastric conduit pull-up and a robotic-sewn intrathoracic anastomosis. Intraoperative and postoperative complications were recorded as prescribed by the Esophagectomy Complications Consensus Group (ECCG). Thirty patients underwent Ivor Lewis RAMIE with complete mediastinal lymph node dissection and robot-sewn anastomosis. No intraoperative complications nor conversion occurred. Pulmonary complications totaled 26.7%. Anastomotic leakage (ECCG, type III) and conduit necrosis (ECCG, type III) both occurred in one patient (3.3%). Chylothorax appeared in 2 patients (6.7%) (ECCG, Type IIA). Anastomotic stricture, successfully treated with endoscopic dilatations, occurred in 8 cases (26.7%). Median overall postoperative stay was 11 days (range, 6-51 days). 30 day and 90 day mortality was 0%. R0 resection was performed in 96.7% of patients with a median number of 47 retrieved lymph nodes. RAMIE with robot-sewn intrathoracic anastomosis appears to be feasible, safe and effective, with favorable perioperative results. Nevertheless, further high-quality studies are needed to define the best anastomotic technique for Ivor Lewis RAMIE.
Collapse
Affiliation(s)
- Alessandra Marano
- grid.413179.90000 0004 0486 1959Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100 Cuneo, Italy
| | - Sara Salomone
- grid.413179.90000 0004 0486 1959Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100 Cuneo, Italy
| | - Luca Pellegrino
- grid.419555.90000 0004 1759 7675Department of Oncologic Surgery, Candiolo Cancer Institute, FPO - IRCCS - Str. Prov. 142, Km 3,95, Candiol, TO Italy
| | - Paolo Geretto
- grid.413179.90000 0004 0486 1959Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100 Cuneo, Italy
| | - Manuela Robella
- grid.419555.90000 0004 1759 7675Department of Oncologic Surgery, Candiolo Cancer Institute, FPO - IRCCS - Str. Prov. 142, Km 3,95, Candiol, TO Italy
| | - Felice Borghi
- grid.419555.90000 0004 1759 7675Department of Oncologic Surgery, Candiolo Cancer Institute, FPO - IRCCS - Str. Prov. 142, Km 3,95, Candiol, TO Italy
| |
Collapse
|
40
|
Dyas AR, Stuart CM, Bronsert MR, Schulick RD, McCarter MD, Meguid RA. Minimally invasive surgery is associated with decreased postoperative complications after esophagectomy. J Thorac Cardiovasc Surg 2022:S0022-5223(22)01269-7. [PMID: 36577613 DOI: 10.1016/j.jtcvs.2022.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/06/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although some studies have compared esophagectomy outcomes by technique or approach, there is opportunity to strengthen our knowledge surrounding these outcomes. We aimed to perform a comprehensive comparison of esophagectomy postoperative complications. METHODS We retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program database (2007-2018). Esophagectomies were identified using Current Procedural Terminology codes and grouped by operative technique (Ivor Lewis, transhiatal, McKeown) and surgical approach (minimally invasive vs open esophagectomy). Twelve postoperative complications were compared. Significant complications underwent risk adjustment using multivariate logistic regression. RESULTS Analysis was performed on 13,457 esophagectomies: 11,202 (83.2%) open and 2255 (16.8%) minimally invasive. There were 7611 (56.6%) Ivor Lewis, 3348 (24.9%) transhiatal, and 2498 (18.6%) McKeown procedures. There were significant differences among the surgical techniques in 6 of 12 risk-adjusted complications. When comparing the outcomes of minimally invasive techniques, there were only significant differences in 2 of 12 complications: overall morbidity (minimally invasive Ivor Lewis 30.5%, minimally invasive transhiatal 43.4%, minimally invasive McKeown 40.3%, P = .0009) and infections (minimally invasive Ivor Lewis 15.4%, minimally invasive transhiatal 26.0%, minimally invasive McKeown 25.3%, P = .0003). Patients who underwent minimally invasive surgery were less likely to have overall morbidity (odds ratio, 0.68; 95% confidence interval, 0.62-0.75), respiratory complications (odds ratio, 0.77; 95% confidence interval, 0.68-0.87), urinary tract infection (odds ratio, 0.61; 95% confidence interval, 0.43-0.88), renal complications (odds ratio, 0.52; 95% confidence interval, 0.34-0.81), bleeding complications (odds ratio, 0.36; 95% confidence interval, 0.30-0.43), and nonhome discharge (odds ratio, 0.54; 95% confidence interval, 0.45-0.64), and had shorter length of stay (9.7 vs 13.2 days, P < .0001). CONCLUSIONS Patients undergoing minimally invasive esophagectomy have lower rates of postoperative complications regardless of esophagectomy techniques. The minimally invasive approach was associated with reduced complication variance among 3 common esophagectomy techniques.
Collapse
Affiliation(s)
- Adam R Dyas
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo.
| | - Christina M Stuart
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colo
| | - Richard D Schulick
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo
| | - Martin D McCarter
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo
| | - Robert A Meguid
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colo
| |
Collapse
|
41
|
Risk Factors and Effect of Intrathoracic Anastomotic Leakage after Esophagectomy for Underlying Malignancy-A Ten-Year Analysis at a Tertiary University Centre. Clin Pract 2022; 12:782-787. [PMID: 36286067 PMCID: PMC9600250 DOI: 10.3390/clinpract12050081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 11/24/2022] Open
Abstract
Aim: Surgical resection remains the treatment of choice for curable esophageal cancer patients. Anastomotic leakage after esophagectomy with an intrathoracic anastomosis is the most feared complication, and is the main cause of postoperative morbidity and mortality. The aim of this study was to identify risk factors associated with anastomotic leakage and its effect on the postoperative outcome. Methods: Between 2012 and 2022, all patients who underwent Ivor Lewis esophagectomy for underlying malignancy were included in this study. We performed a retrospective analysis of 174 patients. The dataset was analyzed to identify risk factors for the occurrence of anastomotic leakage. Results: A total of 174 patients were evaluated. The overall anastomotic leakage rate was 18.96%. The 30-day mortality rate was 8.62%. Multivariate logistic regression analysis identified diabetes (p = 0.0020) and obesity (p = 0.027) as independent risk factors associated with anastomotic leakage. AL had a drastic effect on the combined ICU/IMC and overall hospital stay (p < 0.001. Conclusion: Anastomotic leakage after esophagectomy with intrathoracic anastomosis is the most feared complication and major cause of morbidity and mortality. Identifying risk factors preoperatively can contribute to better patient management.
Collapse
|
42
|
Reinstaller T, Adolf D, Lorenz E, Croner RS, Benedix F. Robot-assisted transthoracic hybrid esophagectomy versus open and laparoscopic hybrid esophagectomy: propensity score matched analysis of short-term outcome. Langenbecks Arch Surg 2022; 407:3357-3365. [PMID: 36066670 DOI: 10.1007/s00423-022-02667-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Minimally invasive en-bloc esophagectomy is associated with a reduction of postoperative morbidity. This was demonstrated for both total minimally invasive and hybrid esophagectomy. However, little is known about any benefits of robotic assistance compared to the conventional minimally invasive technique, especially in hybrid procedures. METHODS For this retrospective study, all consecutive patients who had undergone elective esophagectomy with circular stapled intrathoracic anastomosis using the open and the minimally invasive hybrid technique at the University Hospital Magdeburg, from January 2010 to March 2021 were considered for analysis. RESULTS In total, 137 patients (60.4%) had undergone open esophagectomy. In 45 patients (19.8%), the laparoscopic hybrid technique and in 45 patients (19.8%), the robot-assisted hybrid technique were applied. In propensity score matching analysis comparing the open with the robotic hybrid technique, significant differences were found in favor of the robotic technique (postoperative morbidity, p < 0.01; hospital length of stay, p < 0.01; number of lymph nodes retrieved, p = 0.048). In propensity score matching analysis comparing the laparoscopic with the robotic hybrid technique, a significant reduction of the rate of postoperative delayed gastric emptying (p = 0.02) was found for patients who had undergone robotic esophagectomy. However, the operation time was significantly longer (p < 0.01). CONCLUSIONS En-bloc esophagectomy using the robotic hybrid technique is associated with a significant reduction of postoperative morbidity and of the hospital length of stay when compared to the open approach. However, when compared to the laparoscopic hybrid technique, only few advantages could be demonstrated.
Collapse
Affiliation(s)
- Therese Reinstaller
- Department of Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Daniela Adolf
- StatConsult GmbH, Halberstädter Strasse 40a, 39112, Magdeburg, Germany
| | - Eric Lorenz
- Department of Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Roland S Croner
- Department of Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Frank Benedix
- Department of Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| |
Collapse
|
43
|
Rao Z, Xie X, Tang X, Peng H, Zheng Z, Hu Z, Peng X. The spatiotemporal correlation of PM 2.5 concentration on esophageal cancer hospitalization rate in Fujian province of China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:67325-67335. [PMID: 35524092 DOI: 10.1007/s11356-022-20587-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/29/2022] [Indexed: 06/14/2023]
Abstract
This paper aimed to explore the correlation between PM2.5 concentration and hospitalization rate of esophageal cancer in Fujian province, and tried to find out the accurate lag effect between PM2.5 and hospitalization rate in 70 counties from the linear and nonlinear aspects. We extracted inpatients data of esophageal cancer from the New Rural Cooperative Medical Scheme (NRCMS) database and air pollutant PM2.5 grid data published by the atmospheric composition analysis group. The study showed that the hospitalization rate of esophageal cancer presented spatial aggregation in 70 counties of Fujian province. Southeast urban agglomerations had high hospitalization rates, while central and western regions had low hospitalization rates. The study found that the spatial distribution of the hospitalization rate of esophageal cancer in 2016 was not consistent with that of the PM2.5 concentration in the same year. The concentration of PM2.5 in 2003 and 2004 had the strongest correlation with the hospitalization rate of esophageal cancer in 2016, with Pearson correlation coefficient r value of - 0.365 and Geodetector q-statistic value of 0.148 (p < 0.05). Our findings showed that there existed a 13-year lag period of air pollutant PM2.5 on the esophageal cancer hospitalization rate, which can provide helpful guidance in the early screening strategy of esophageal cancer in Fujian. The research progress of this paper will help to understand the lag period of the impact of air pollutants on the hospitalization rate of esophageal cancer, provide valuable information for the prevention and treatment strategy of esophageal cancer in Fujian province, and provide relevant experience for alike regions.
Collapse
Affiliation(s)
- Zhixiang Rao
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xiaoxu Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xuwei Tang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Hewei Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zhenquan Zheng
- School of Public Health, Institute of Health Research, Fujian Medical University, Fuzhou, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China.
| | - Xiane Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China.
| |
Collapse
|
44
|
Outcomes of Minimally Invasive and Robot-Assisted Esophagectomy for Esophageal Cancer. Cancers (Basel) 2022; 14:cancers14153667. [PMID: 35954331 PMCID: PMC9367610 DOI: 10.3390/cancers14153667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary This is an invited review for the special edition, “Minimally Invasive Surgery for Cancer: Indications and Outcomes.” Indications to perform minimally invasive techniques for esophagectomy rather than the classic open technique do not exist. This review outlines the current research by comparing outcomes among minimally invasive esophagectomy, robot-assisted esophagectomy, and open esophagectomy. After determining the benefits of each technique in terms of each outcome, the discussion focuses on how surgeons may use the presented information to determine which approach is most appropriate. We hope this study provides a comprehensive review of the current state of the literature regarding minimally invasive esophagectomy, as well as a guide for surgeons who treat patients with esophageal cancer. Abstract With the evolution of minimally invasive esophagectomy (MIE) and robot-assisted minimally invasive esophagectomy (RAMIE), questions remain regarding the benefits and indications of these methods. Given that set indications do not exist, this article aims first to review the reported outcomes of MIE, RAMIE, and open esophagectomy. Then, considerations based on the reported outcomes are discussed to guide surgeons in selecting the best approach. MIE and RAMIE offer the potential to improve outcomes for esophagectomy patients; however, surgeon experience as well as individual patient factors play important roles when deciding upon the surgical approach.
Collapse
|
45
|
Garbarino GM, van Berge Henegouwen MI, Gisbertz SS, Eshuis WJ. Today's Mistakes and Tomorrow's Wisdom in the Surgical Treatment of Barrett's Adenocarcinoma. Visc Med 2022; 38:203-211. [PMID: 35814974 PMCID: PMC9210033 DOI: 10.1159/000524928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/02/2022] [Indexed: 09/17/2023] Open
Abstract
Background Barrett's esophagus is a premalignant condition caused by longstanding gastroesophageal reflux disease and may progress to low-grade dysplasia, high-grade dysplasia (HGD), and finally esophageal adenocarcinoma. Summary Barrett's adenocarcinoma can be treated either by endoscopic or surgical resection, depending on the clinical staging. Endoscopic resection is a safe and adequate treatment option for HGD, mucosal tumors, and low-risk submucosal tumors. Its role in the treatment of high-risk submucosal tumors and the role of organ-preserving sentinel node navigated surgery are still under investigation. Esophagectomy with neoadjuvant chemoradiation or perioperative chemotherapy is considered the standard of care for locally advanced Barrett's adenocarcinoma. Regarding operative technique, there is no proven superiority of one technique over another, although a minimally invasive transthoracic technique seems most commonly applied nowadays. In this review, state-of-the-art evidence and future expectations are presented regarding indications for resection, neoadjuvant or perioperative therapy, type of surgery, and postoperative follow-up for Barrett's adenocarcinoma. Key Messages In Barrett's adenocarcinoma, endoscopic resection is the standard treatment option for low-risk mucosal and submucosal tumors. For high-risk submucosal tumors, endoscopic submucosal dissection with close surveillance and sentinel node navigated surgery are currently being studied. For locally advanced cancer, a multimodal therapy including esophagectomy is the standard of care. Nowadays, in high-volume centers, a minimally invasive transthoracic esophagectomy with an intrathoracic anastomosis is the most common procedure for Barrett's adenocarcinoma.
Collapse
Affiliation(s)
- Giovanni Maria Garbarino
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Surgical Science and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Mark Ivo van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Suzanne Sarah Gisbertz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Wietse Jelle Eshuis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
46
|
Hauge T, Førland DT, Johannessen HO, Johnson E. Short- and long-term outcomes in patients operated with total minimally invasive esophagectomy for esophageal cancer. Dis Esophagus 2022; 35:6365776. [PMID: 34491299 DOI: 10.1093/dote/doab061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/05/2021] [Accepted: 08/16/2021] [Indexed: 12/11/2022]
Abstract
At our hospital, the main treatment for resectable esophageal cancer (EC) has since 2013 been total minimally invasive esophagectomy (TMIE). The aim of this study was to present the short- and long-term results in patients operated with TMIE. This cross-sectional study includes all patients scheduled for TMIE from June 2013 to January 2016 at Oslo University Hospital. Data on morbidity, mortality, and survival were retrospectively collected from the patient administration system and the Norwegian Cause of Death Registry. Long-term postoperative health-related quality of life (HRQL) and level of dysphagia were assessed by patients completing the following questionaries: EORTC QLQ-OG25, QLQ-C30, and the Ogilvie grading scale. A total of 123 patients were included in this study with a median follow-up time of 58 months (1-88 months). 85% had adenocarcinoma, 15% squamous cell carcinoma. Seventeen patients (14%) had T1N0M0, 68 (55%) T2-T3N0M0, or T1-T2N1M0 and 38 (31%) had either T3N1M0 or T4anyNM0. Ninety-eight patients (80%) received neoadjuvant (radio)chemotherapy and 104 (85%) had R0 resection. Anastomotic leak rate and 90-days mortality were 14% and 2%, respectively. The 5-year overall survival was 53%. Patients with tumor free resection margins of >1 mm (R0) had a 5-year survival of 57%. Median 60 months (range 49-80) postoperatively the main symptoms reducing HRQL were anxiety, chough, insomnia, and reflux. Median Ogilvie score was 0 (0-1). In this study, we report relatively low mortality and good overall survival after TMIE for EC. Moreover, key symptoms reducing long-term HRQL were identified.
Collapse
Affiliation(s)
- Tobias Hauge
- Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical medicine, Department of Gastrointestinal and Children Surgery, University of Oslo, Oslo, Norway
| | - Dag T Førland
- Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Hans-Olaf Johannessen
- Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Egil Johnson
- Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical medicine, Department of Gastrointestinal and Children Surgery, University of Oslo, Oslo, Norway
| |
Collapse
|
47
|
Egberts JH, Welsch T, Merboth F, Korn S, Praetorius C, Stange DE, Distler M, Biebl M, Pratschke J, Nickel F, Müller-Stich B, Perez D, Izbicki JR, Becker T, Weitz J. Robotic-assisted minimally invasive Ivor Lewis esophagectomy within the prospective multicenter German da Vinci Xi registry trial. Langenbecks Arch Surg 2022; 407:1-11. [PMID: 35501604 PMCID: PMC9283356 DOI: 10.1007/s00423-022-02520-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/15/2022] [Indexed: 12/11/2022]
Abstract
Abstract Purpose Robotic-assisted minimally invasive esophagectomy (RAMIE) has become one standard approach for the operative treatment of esophageal tumors at specialized centers. Here, we report the results of a prospective multicenter registry for standardized RAMIE. Methods The German da Vinci Xi registry trial included all consecutive patients who underwent RAMIE at five tertiary university centers between Oct 17, 2017, and Jun 5, 2020. RAMIE was performed according to a standard technique using an intrathoracic circular stapled esophagogastrostomy. Results A total of 220 patients were included. The median age was 64 years. Total minimally invasive RAMIE was accomplished in 85.9%; hybrid resection with robotic-assisted thoracic approach was accomplished in an additional 11.4%. A circular stapler size of ≥28 mm was used in 84%, and the median blood loss and operative time were 200 (IQR: 80–400) ml and 425 (IQR: 335–527) min, respectively. The rate of anastomotic leakage was 13.2% (n=29), whereas the two centers with >70 cases each had rates of 7.0% and 12.0%. Pneumonia occurred in 19.5% of patients, and the 90-day mortality was 3.6%. Cumulative sum analysis of the operative time indicated the end of the learning curve after 22 cases. Conclusions High-quality multicenter registry data confirm that RAMIE is a safe procedure and can be reproduced with acceptable leak rates in a multicenter setting. The learning curve is comparably low for experienced robotic surgeons. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-022-02520-w.
Collapse
Affiliation(s)
- Jan-Hendrik Egberts
- Department of General, Visceral, Thoracic, Transplantation, and Pediatric Surgery, Kurt Semm Center for Minimally Invasive and Robotic Surgery, University Hospital Schleswig Holstein, 24105, Kiel, Germany
- Department of Surgery, Israelitisches Krankenhaus Hamburg, 22297, Hamburg, Germany
| | - Thilo Welsch
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), 01307, Dresden, Germany
| | - Felix Merboth
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
| | - Sandra Korn
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), 01307, Dresden, Germany
| | - Christian Praetorius
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), 01307, Dresden, Germany
| | - Daniel E Stange
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), 01307, Dresden, Germany
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), 01307, Dresden, Germany
| | - Matthias Biebl
- Department of Surgery, Charité University Hospital, 13353, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Charité University Hospital, 13353, Berlin, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120, Heidelberg, Germany
| | - Beat Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120, Heidelberg, Germany
| | - Daniel Perez
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Thomas Becker
- Department of General, Visceral, Thoracic, Transplantation, and Pediatric Surgery, Kurt Semm Center for Minimally Invasive and Robotic Surgery, University Hospital Schleswig Holstein, 24105, Kiel, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany.
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), 01307, Dresden, Germany.
| |
Collapse
|
48
|
Takeda FR, Sallum RAA, Ribeiro U, Cecconello I. Laparoscopic transhiatal esophagectomy in esophageal cancer patients with high-risk post-operative complications. Dis Esophagus 2022; 35:6231772. [PMID: 33870430 DOI: 10.1093/dote/doab022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/17/2021] [Accepted: 03/27/2021] [Indexed: 12/11/2022]
Abstract
Surgical treatment of esophageal cancer is challenging, due to considerable morbidity, especially in high surgical risk patients. While transhiatal esophagectomy leads to good oncological outcomes and reduced postoperative complications, less invasive techniques might further improve outcomes. Our goal was to compare results of laparoscopic transhiatal esophagectomy (LTE) with open transhiatal esophagectomy (OTE) in esophageal cancer patients at high surgical risk. From 2014 to 2020, 128 patients were identified. Seventy received OTE while 51 received LTE. After propensity score matching (1:1), postoperative complications, analysis of overall and disease-free survival, and survival-related prognostic factors were assessed in two groups of 48 patients. Ninety-one (77%) patients were men with a mean age of 65 ± 10.3 years. Those who underwent OTE experienced more clinical and surgical complications. In LTE patients, the number of mean resected lymph nodes was 25.9, and in patients who had OTE, it was 17.4 (P < 0.001). Overall survival was 56.0% in the LTE group and 33.6% (P = 0.023) in the OTE group. In multivariable analysis of overall survival, open surgery and incomplete pathological response were seen as worse negative factors. In multivariable analysis, metastatic lymph nodes, incomplete pathologic response, surgical complications, and a Charlson's index > 2 (P = 0.014) were associated with poor prognosis. Both surgical methods are safe with similar morbidity and mortality; however, LTE was associated with fewer complications, a higher number of resected lymph nodes, better overall survival, and more prognostic factors related to global and disease-free overall survival in high-risk patients.
Collapse
Affiliation(s)
- Flavio Roberto Takeda
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rubens Antonio Aissar Sallum
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ulysses Ribeiro
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ivan Cecconello
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
49
|
Harriott CB, Angeramo CA, Casas MA, Schlottmann F. Open vs. Hybrid vs. Totally Minimally Invasive Ivor Lewis Esophagectomy: Systematic Review and Meta-analysis. J Thorac Cardiovasc Surg 2022; 164:e233-e254. [DOI: 10.1016/j.jtcvs.2021.12.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/03/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023]
|
50
|
Sheng WG, Assogba E, Billa O, Meunier B, Gagnière J, Collet D, D'Journo XB, Brigand C, Piessen G, Dabakuyo-Yonli TS. Does baseline quality of life predict the occurrence of complications in resectable esophageal cancer? Surg Oncol 2021; 40:101707. [PMID: 35030410 DOI: 10.1016/j.suronc.2021.101707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to assess the impact of baseline health related quality of life (HRQOL) on the occurrence of postoperative complications and death in patients with resectable esophageal cancer. METHODS Existing data from a prospective, multicenter, open label, randomized, controlled phase III trial comparing hybrid versus open esophagectomy in patients with resectable esophageal cancer from 2009 to 2012 in France were used. A Cox regression model was used to assess the prognostic value of the baseline HRQOL score on the occurrence of major complications (MC), and major pulmonary complications (MPC) at 30 days post-surgery, as well as on 1-year postoperative overall survival (OS). RESULTS Every 10-point increase in the baseline role functioning score was associated with a 14% reduction in the risk of MC, while every 10-point increase in fatigue or pain score was associated with an 18% increase in the risk of MC. Similarly, higher scores on fatigue and pain were associated with a higher risk of MPC. Compared with the hybrid procedure, patients undergoing open esophagectomy had a significantly higher risk of MC and MPC. Patients diagnosed with esophageal adenocarcinoma were at significantly lower risk of MC or MPC compared to patients with esophageal squamous cell carcinoma. Higher pain (HR = 1.23, p = 0.035) and insomnia (HR = 1.16, P = 0.031) scores were associated with increased 1-year OS. CONCLUSION Fatigue, pain, insomnia, and squamous cell pathology were indicators of poor prognosis, and that the presence of these findings might possibly change the management plan towards other forms of treatment and warrant close attention.
Collapse
Affiliation(s)
- Wei Gilis Sheng
- Epidemiology and Quality of Life Unit, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France
| | - Emerline Assogba
- Epidemiology and Quality of Life Unit, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France
| | - Oumar Billa
- Epidemiology and Quality of Life Unit, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France
| | - Bernard Meunier
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes, France
| | - Johan Gagnière
- Department of Digestive Surgery, INSERM, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Denis Collet
- Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux, France
| | - Xavier Benoît D'Journo
- Department of Thoracic Surgery, Nord Hospital, University of Aix-Marseille, Public Assistance-Marseille Hospitals, Marseille, France
| | - Cécile Brigand
- Department of Digestive Surgery, Strasbourg University, Strasbourg, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, CHU Lille. Place de Verdun, 59037, Lille, Cedex, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- Epidemiology and Quality of Life Unit, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France; National Quality of Life and Cancer Clinical Research Platform, Dijon, France.
| |
Collapse
|