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Xie J, Zhang L, Liu Z, Lu CL, Xu GH, Guo M, Lian X, Liu JQ, Zhang HW, Zheng SY. Advantages of McKeown minimally invasive oesophagectomy for the treatment of oesophageal cancer: propensity score matching analysis of 169 cases. World J Surg Oncol 2022; 20:52. [PMID: 35216598 PMCID: PMC8881864 DOI: 10.1186/s12957-022-02527-z] [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: 08/24/2021] [Accepted: 02/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Oesophagectomy, the gold standard for oesophageal cancer treatment, causes significantly high morbidity and mortality. McKeown minimally invasive oesophagectomy (MIE) is preferred for treating oesophageal malignancies; however, limited studies with large sample sizes focusing on the surgical and oncological outcomes of this procedure have been reported. We aimed to compare the clinical safety and efficacy of McKeown MIE with those of open oesophagectomy (OE). PATIENTS AND METHODS Overall, 338 oesophageal cancer patients matched by gender, age, location, size, and T and N stages (McKeown MIE: 169 vs OE: 169) were analysed. The clinicopathologic features, operational factors, postoperative complications, and prognoses were compared between the groups. RESULTS McKeown MIE resulted in less bleeding (200 mL vs 300 mL, p<0.01), longer operation time (335.0 h vs 240.0 h, p<0.01), and higher number of harvested lymph nodes (22 vs 9, p<0.01) than OE did. Although the rate of recurrent laryngeal nerve injury in the two groups was not significantly different, incidence of anastomotic leakage (8 vs 24, p=0.003) was significantly lower in the McKeown MIE group. In addition, patients who underwent McKeown MIE had higher 5-year overall survival than those who underwent OE (69.9% vs 40.4%, p<0.001). CONCLUSION McKeown MIE is proved to be feasible and safe to achieve better surgical and oncological outcomes for oesophageal cancer compared with OE.
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Affiliation(s)
- Jun Xie
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Shizi Street No. 188, Suzhou, 215006, Jiangsu, China
| | - Lei Zhang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shanxi Province, China
| | - Zhen Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Chun-Lei Lu
- Digestive Diseases Center of Wuxi Mingci Hospital, No. 599 Zhongnan Road, Jinxing Street, Wuxi City, 214000, Jiangsu Province, China
| | - Guang-Hui Xu
- Department of General Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, 710033, Shan Xi Province, China
| | - Man Guo
- Department of General Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, 710033, Shan Xi Province, China
| | - Xiao Lian
- Department of General Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, 710033, Shan Xi Province, China
| | - Jin-Qiang Liu
- Department of General Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, 710033, Shan Xi Province, China
| | - Hong-Wei Zhang
- Digestive Diseases Center of Wuxi Mingci Hospital, No. 599 Zhongnan Road, Jinxing Street, Wuxi City, 214000, Jiangsu Province, China.
| | - Shi-Ying Zheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Shizi Street No. 188, Suzhou, 215006, Jiangsu, China.
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Zheng Y, Li Y, Liu X, Sun H, Shen S, Ba Y, Wang Z, Liu S, Xing W. Minimally Invasive Versus Open McKeown for Patients with Esophageal Cancer: A Retrospective Study. Ann Surg Oncol 2021; 28:6329-6336. [PMID: 33987755 DOI: 10.1245/s10434-021-10105-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/17/2021] [Indexed: 12/07/2022]
Abstract
INTRODUCTION McKeown minimally invasive esophagectomy (McKeown-MIE) offers advantages in short-term outcomes compared with McKeown open esophagectomy (McKeown-OE); however, debate as to whether MIE is equivalent or better than OE regarding survival outcomes is ongoing. OBJECTIVE The aim of this study was to compare long-term survival between McKeown-MIE and McKeown-OE in a large cohort of esophageal cancer (EC) patients. METHODS We used a prospective database (independently managed by LinkDoc company) of the Thoracic Surgery Department at Henan Cancer Hospital and included patients who underwent McKeown-MIE and McKeown-OE for EC from 1 January 2015 to 6 January 2018. The perioperative data and overall survival (OS) rate in the two groups were retrospectively compared. RESULTS We included 502 patients who underwent McKeown-MIE (n = 306) or McKeown-OE (n = 196) for EC. The median age in the total patient population was 63 years. All baseline characteristics were well-balanced between the two groups. There was a significantly shorter mean operative time (269.76 min vs. 321.14 min, p < 0.001) in the OE group. The 30-day and in-hospital mortality rates were 0, and there was no difference in 90-day mortality (p = 0.053) between the groups. The postoperative stay was shorter in the MIE group and was 14 days and 18 days in the MIE and OE groups, respectively (p < 0.001). The OS at 60 months was 58.8% and 41.6% in the MIE and OE groups, respectively (p < 0.001) [hazard ratio 1.783, 95% confidence interval 1.347-2.359]. CONCLUSIONS These results showed that McKeown-MIE was associated with better long-term survival than McKeown-OE for patients with resectable EC.
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Affiliation(s)
- Yan Zheng
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, People's Republic of China
| | - Yin Li
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, People's Republic of China.,Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianben Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, People's Republic of China
| | - Haibo Sun
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, People's Republic of China
| | - Sining Shen
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, People's Republic of China
| | - Yufeng Ba
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, People's Republic of China
| | - Zongfei Wang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, People's Republic of China
| | - Shilei Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, People's Republic of China
| | - Wenqun Xing
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, People's Republic of China.
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Allakhverdyan AS, Anipchenko SN. [Laparothoracoscopic Ivor Lewis esophagectomy with esophageal-gastric intrapleural anastomosis]. Khirurgiia (Mosk) 2020:5-13. [PMID: 33029996 DOI: 10.17116/hirurgia20200915] [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: 11/17/2022]
Abstract
OBJECTIVE To describe the methodology of laparothoracoscopic Ivor Lewis esophagectomy in surgical treatment of esophageal cancer and compare early outcomes of this procedure with conventional Ivor Lewis surgery. MATERIAL AND METHODS There were 30 laparothoracoscopic Ivor Lewis esophagectomies followed by non-hardware esophageal-gastric intrapleural anastomosis for esophageal cancer. All procedures have been performed for the period 2016-2019 at the Moscow Regional Research and Clinical Institute (suturing of anastomosis was based on the method of professor A.S. Allakhverdyan). RESULTS Laparothoracoscopic esophagectomy is characterized by higher surgery time by 136.57 min (p=0.012), less duration of anesthesia and mechanical ventilation by 77.5 min (p=0.042), postoperative ICU-stay by 2.25 hours (p=0.021), blood loss by 550 ml (p=0,000), duration of postoperative fasting by 2 days (p=0.034), hospital-stay by 8 days (p=0.021) compared to open esophagectomy. There were no significant between-group differences in the number of resected lymph nodes (p=0.142). Incidence of esophageal-gastric anastomosis failure is insignificantly higher in the OE group (χ2=1.89; p=0.075). Incidence of pulmonary complications (pneumonia, chylothorax, paresis of the vocal cords, pleural empyema) is less in the LTSE group (p<0.05). Cardiovascular morbidity is significantly lower in the LTSE group (p<0.05). A 30-day mortality rate was similar in both groups (χ2=2.56; p=0.0253). CONCLUSION Early results of laparothoracoscopic Ivor Lewis esophagectomy are superior to the results of conventional Ivor Lewis surgery in surgical treatment of esophageal cancer.
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O'Connell L, Coleman M, Kharyntiuk N, Walsh TN. Quality of life in patients with upper GI malignancies managed by a strategy of chemoradiotherapy alone versus surgery. Surg Oncol 2019; 30:33-39. [PMID: 31500782 DOI: 10.1016/j.suronc.2019.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/09/2019] [Accepted: 05/25/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Neoadjuvant chemoradiotherapy (nCRT) induces a pathological complete response (pCR) in 25-85% of oesophago-gastric cancer. As surgery entails morbidity and mortality risks and quality of life (QL) impairment, its avoidance in patients without residual disease is desirable. This study aimed to compare quality of life of patients with a cCR who chose surveillance with those who chose surgery. METHODS Four groups of patients were studied. Group 1(n = 31) were controls; Group 2 (n = 26) had chemoradiotherapy only; Group 3 (n = 31) had oesophagectomy after nCRT; Group 4 (n = 26) had gastrectomy alone. A 33-point novel questionnaire was administered at two 3 month time points. Participants were also interviewed with a validated questionnaire. RESULTS Mean(±sd) quality of life scores in cCR patients offered surveillance (28.9 ± 4.5) were superior to patients undergoing oesophagectomy (32.3 ± 58. p=0.042) or gastrectomy (33.19 ± 5.9, p=0.004). This result was replicated in the validated questionnaire (p=0.017). There was a trend towards increased reflux-related respiratory symptoms in the oesophagectomy group (7.3 ± 2.2 vs 6.5 ± 1.9; p=0.396) and towards early dumping (8.2 ± 1.4 vs 7.1 ± 1.; p=0.239) and vagotomy-related symptoms (1.82 ± 0.9 vs 1.4 ± 0.6; p=0.438) in the gastrectomy group. CONCLUSIONS Avoidance of surgery in cCR patients is rewarded with a superior quality of life to those undergoing surgery.
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Affiliation(s)
- Lauren O'Connell
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland.
| | - Mary Coleman
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - N Kharyntiuk
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Thomas N Walsh
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland; Royal College of Surgeons in Ireland, Department of Surgery, Beaumont Hospital, Dublin 9, Ireland
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Ely S, Alabaster A, Ashiku SK, Patel A, Velotta JB. Regionalization of thoracic surgery improves short-term cancer esophagectomy outcomes. J Thorac Dis 2019; 11:1867-1878. [PMID: 31285879 DOI: 10.21037/jtd.2019.05.30] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Some studies have found that outcomes from cancer esophagectomy are better at higher-volume centers than at lower-volume centers. Reports on outcomes following systematic centralization have largely demonstrated subsequent improvements, but these originate in nationalized healthcare systems that are not very comparable to the heterogeneous private-payer systems that predominate in the United States. We examined how regionalization of thoracic surgery to Centers of Excellence (CoE) within our American integrated healthcare system changed overall care for our patients, and whether it changed outcomes. Methods We conducted a retrospective chart review of 461 consecutive patients undergoing cancer esophagectomy between 2009-2016, spanning the 2014 shift to regionalization. High-volume was defined as ≥5 esophagectomies per year. We compared characteristics of the surgeon, hospital, and operation pre- and post-regionalization using Chi-square or Fisher's exact test for categorical variables and Kruskal-Wallis test for age. We evaluated their associations with patient outcomes with hierarchical linear and logistic mixed models, which adjusted for clustering within surgeon and facility levels and relevant covariates. Results While there was no difference in their baseline demographics, patients undergoing esophagectomy post-regionalization were much more likely to have their surgery performed at a designated Center of Excellence (78.8% of cases versus 34.2%, P<0.001), at a high-volume hospital (92.1% from 75.7%, P<0.001), by a high-volume surgeon (78.8% from 58.8%, P<0.001), by a board-certified thoracic surgeon (82.5% from 64.0%, P<0.001), and by minimally-invasive, versus open, approach (60.8% from 22.1%, P<0.001). Post-regionalization patients were in higher American Society of Anesthesiologists classes (P=0.03) and trended toward higher-stage disease (P=0.14), indicative of the inclusion of higher-complexity patients. Despite that, regionalization was associated with improved short-term outcomes, most notably: average minimally-invasive esophagectomy (MIE) operative time decreased by 2 hours (-135.9 minutes, 95% CI: -172.2, -99.7 minutes); length of stay (LOS) decreased by 2.3 days (95% CI: -3.4, -1.2 days); and 30-day complication rate decreased significantly, from 50.7% to 30.2% (OR 0.45, 95% CI: 0.25, 0.79). Regionalization was the only variable significantly and independently associated with all three outcomes in our adjusted multivariable models. Mortality, both at 30 and 90 days, decreased modestly but was low pre-regionalization, and the difference did not reach significance. Conclusions Regionalization of thoracic surgery in our hospital system resulted in esophagectomies being performed by more experienced surgeons at higher-volume centers, with a concomitant improvement in short-term outcomes. Patients undergoing esophagectomy, particularly MIE, post-regionalization benefited significantly from decreased LOS and perioperative complication rate. Our results suggest that, in a large integrated healthcare system, regionalization significantly improves overall outcomes for patients undergoing cancer esophagectomy.
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Affiliation(s)
- Sora Ely
- UCSF East Bay Surgery, Oakland, CA, USA.,Oakland Medical Center, Kaiser Permanente, Oakland, CA, USA
| | - Amy Alabaster
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Simon K Ashiku
- Oakland Medical Center, Kaiser Permanente, Oakland, CA, USA
| | - Ashish Patel
- Oakland Medical Center, Kaiser Permanente, Oakland, CA, USA
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Mariette C, Markar SR, Dabakuyo-Yonli TS, Meunier B, Pezet D, Collet D, D'Journo XB, Brigand C, Perniceni T, Carrère N, Mabrut JY, Msika S, Peschaud F, Prudhomme M, Bonnetain F, Piessen G. Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer. N Engl J Med 2019; 380:152-162. [PMID: 30625052 DOI: 10.1056/nejmoa1805101] [Citation(s) in RCA: 422] [Impact Index Per Article: 84.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Postoperative complications, especially pulmonary complications, affect more than half the patients who undergo open esophagectomy for esophageal cancer. Whether hybrid minimally invasive esophagectomy results in lower morbidity than open esophagectomy is unclear. METHODS We performed a multicenter, open-label, randomized, controlled trial involving patients 18 to 75 years of age with resectable cancer of the middle or lower third of the esophagus. Patients were randomly assigned to undergo transthoracic open esophagectomy (open procedure) or hybrid minimally invasive esophagectomy (hybrid procedure). Surgical quality assurance was implemented by the credentialing of surgeons, standardization of technique, and monitoring of performance. Hybrid surgery comprised a two-field abdominal-thoracic operation (also called an Ivor-Lewis procedure) with laparoscopic gastric mobilization and open right thoracotomy. The primary end point was intraoperative or postoperative complication of grade II or higher according to the Clavien-Dindo classification (indicating major complication leading to intervention) within 30 days. Analyses were done according to the intention-to-treat principle. RESULTS From October 2009 through April 2012, we randomly assigned 103 patients to the hybrid-procedure group and 104 to the open-procedure group. A total of 312 serious adverse events were recorded in 110 patients. A total of 37 patients (36%) in the hybrid-procedure group had a major intraoperative or postoperative complication, as compared with 67 (64%) in the open-procedure group (odds ratio, 0.31; 95% confidence interval [CI], 0.18 to 0.55; P<0.001). A total of 18 of 102 patients (18%) in the hybrid-procedure group had a major pulmonary complication, as compared with 31 of 103 (30%) in the open-procedure group. At 3 years, overall survival was 67% (95% CI, 57 to 75) in the hybrid-procedure group, as compared with 55% (95% CI, 45 to 64) in the open-procedure group; disease-free survival was 57% (95% CI, 47 to 66) and 48% (95% CI, 38 to 57), respectively. CONCLUSIONS We found that hybrid minimally invasive esophagectomy resulted in a lower incidence of intraoperative and postoperative major complications, specifically pulmonary complications, than open esophagectomy, without compromising overall and disease-free survival over a period of 3 years. (Funded by the French National Cancer Institute; ClinicalTrials.gov number, NCT00937456 .).
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Affiliation(s)
- Christophe Mariette
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
| | - Sheraz R Markar
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
| | - Tienhan S Dabakuyo-Yonli
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
| | - Bernard Meunier
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
| | - Denis Pezet
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
| | - Denis Collet
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
| | - Xavier B D'Journo
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
| | - Cécile Brigand
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
| | - Thierry Perniceni
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
| | - Nicolas Carrère
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
| | - Jean-Yves Mabrut
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
| | - Simon Msika
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
| | - Frédérique Peschaud
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
| | - Michel Prudhomme
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
| | - Franck Bonnetain
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
| | - Guillaume Piessen
- From the Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, and INSERM, Centre Hospitalier Universitaire (CHU) Lille, Unité Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center, Team "Mucins, epithelial differentiation, and carcinogenesis," Université de Lille, Lille (C.M., G.P.), the Epidemiology and Quality of Life Unit, INSERM Unité 1231, Centre Georges François Leclerc, Dijon (T.S.D.-Y.), the Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes (B.M.), Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand (D.P.), the Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux (D.C.), the Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille (X.B.D.), the Department of Digestive Surgery, Strasbourg University, Strasbourg (C.B.), the Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris (T.P.), the Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse (N.C.), the Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon (J.-Y.M.), the Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, PRES Sorbonne Paris Cité, Colombes (S.M.), the Department of Surgery and Oncology, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt (F.P.), the Department of Digestive Surgery, CHU Nîmes, Nîmes (M.P.), and the Methodology and Quality of Life Unit in Cancer, INSERM Unité Mixte de Recherche 1098, University Hospital of Besançon, Besançon (F.B.) - all in France; and the Department of Surgery and Cancer, Imperial College, London (S.R.M.)
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Huang L, Li TJ. Laparoscopic surgery for gastric cancer: where are we now and where are we going? Expert Rev Anticancer Ther 2018; 18:1145-1157. [PMID: 30187785 DOI: 10.1080/14737140.2018.1520098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Minimally-invasive surgery is gaining increasing popularity for the management of gastric cancer (GC). Areas covered: The authors hereby comprehensively and systematically reviewed the randomized and/or prospective evidence on laparoscopic gastrectomy (LG) for GC. For early GC located in the distal stomach, various randomized trials have demonstrated the superiority/non-inferiority of LG especially in reducing surgical trauma and enhancing postoperative recovery without compromising surgical safety and oncologic efficacy. For advanced GC, while multicenter large-scale randomized evidence has demonstrated the safety and feasibility of LG by experienced hands, the long-term survival which is to be clarified by several ongoing trials are crucial to determine whether a more widespread application is acceptable. Randomized evidence regarding the application of laparoscopic total or proximal gastrectomy, which is technically challenging, is scarce. Various attempts in modification of the traditional laparoscopic approach to further reduce the trauma have been evaluated, such as single-incision and totally LG. LG is becoming increasingly individualized and precise. Expert commentary: The current randomized and/or prospective evidence supports the non-inferiority of laparoscopic surgery especially for the management of early GC located in the distal stomach, while the definitive efficacy of the laparoscopic approach for more surgically challenging situations remains largely explorative and investigative.
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Affiliation(s)
- Lei Huang
- a Department of Gastrointestinal Surgery, Department of General Surgery , First Affiliated Hospital of Anhui Medical University , Hefei , China
| | - Tuan-Jie Li
- b Department of General Surgery , Nanfang Hospital of Southern Medical University , Guangzhou , China
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8
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Metcalfe C, Avery K, Berrisford R, Barham P, Noble SM, Fernandez AM, Hanna G, Goldin R, Elliott J, Wheatley T, Sanders G, Hollowood A, Falk S, Titcomb D, Streets C, Donovan JL, Blazeby JM. Comparing open and minimally invasive surgical procedures for oesophagectomy in the treatment of cancer: the ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) feasibility study and pilot trial. Health Technol Assess 2018; 20:1-68. [PMID: 27373720 DOI: 10.3310/hta20480] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Localised oesophageal cancer can be curatively treated with surgery (oesophagectomy) but the procedure is complex with a risk of complications, negative effects on quality of life and a recovery period of 6-9 months. Minimal-access surgery may accelerate recovery. OBJECTIVES The ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) study aimed to establish the feasibility of, and methodology for, a definitive trial comparing minimally invasive and open surgery for oesophagectomy. Objectives were to quantify the number of eligible patients in a pilot trial; develop surgical manuals as the basis for quality assurance; standardise pathological processing; establish a method to blind patients to their allocation in the first week post surgery; identify measures of postsurgical outcome of importance to patients and clinicians; and establish the main cost differences between the surgical approaches. DESIGN Pilot parallel three-arm randomised controlled trial nested within feasibility work. SETTING Two UK NHS departments of upper gastrointestinal surgery. PARTICIPANTS Patients aged ≥ 18 years with histopathological evidence of oesophageal or oesophagogastric junctional adenocarcinoma, squamous cell cancer or high-grade dysplasia, referred for oesophagectomy or oesophagectomy following neoadjuvant chemo(radio)therapy. INTERVENTIONS Oesophagectomy, with patients randomised to open surgery, a hybrid open chest and minimally invasive abdomen or totally minimally invasive access. MAIN OUTCOME MEASURE The primary outcome measure for the pilot trial was the number of patients recruited per month, with the main trial considered feasible if at least 2.5 patients per month were recruited. RESULTS During 21 months of recruitment, 263 patients were assessed for eligibility; of these, 135 (51%) were found to be eligible and 104 (77%) agreed to participate, an average of five patients per month. In total, 41 patients were allocated to open surgery, 43 to the hybrid procedure and 20 to totally minimally invasive surgery. Recruitment is continuing, allowing a seamless transition into the definitive trial. Consequently, the database is unlocked at the time of writing and data presented here are for patients recruited by 31 August 2014. Random allocation achieved a good balance between the arms of the study, which, as a high proportion of patients underwent their allocated surgery (69/79, 87%), ensured a fair comparison between the interventions. Dressing patients with large bandages, covering all possible incisions, was successful in keeping patients blind while pain was assessed during the first week post surgery. Postsurgical length of stay and risk of adverse events were within the typical range for this group of patients, with one death occurring within 30 days among 76 patients. There were good completion rates for the assessment of pain at 6 days post surgery (88%) and of the patient-reported outcomes at 6 weeks post randomisation (74%). CONCLUSIONS Rapid recruitment to the pilot trial and the successful refinement of methodology indicated the feasibility of a definitive trial comparing different approaches to oesophagectomy. Although we have shown a full trial of open compared with minimally invasive oesophagectomy to be feasible, this is necessarily based on our findings from the two clinical centres that we could include in this small preliminary study. TRIAL REGISTRATION Current Controlled Trials ISRCTN59036820. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 48. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Chris Metcalfe
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kerry Avery
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Richard Berrisford
- Department of Upper Gastrointestinal Surgery, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Paul Barham
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sian M Noble
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - George Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Robert Goldin
- Department of Cellular Pathology, Imperial College London, London, UK
| | - Jackie Elliott
- Gastro-Oesophageal Support and Help Group, Kingswood, Bristol, UK
| | - Timothy Wheatley
- Department of Upper Gastrointestinal Surgery, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Grant Sanders
- Department of Upper Gastrointestinal Surgery, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Andrew Hollowood
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Stephen Falk
- Bristol Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Dan Titcomb
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Christopher Streets
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jane M Blazeby
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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9
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Liu YW, Yan FW, Tsai DL, Li HP, Lee YL, Chiang HH, Hsu HT, Chuang HY, Chou SH. Expedite recovery from esophagectomy and reconstruction for esophageal squamous cell carcinoma after perioperative management protocol reinvention. J Thorac Dis 2017; 9:2029-2037. [PMID: 28840003 DOI: 10.21037/jtd.2017.06.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surgery for esophageal cancer is invasive and challenging, and always to be followed with arduous post-operative care and recovery. This study, maybe one of the first in Asian populations, is to determine whether a reinvented protocol for perioperative management for esophageal cancer surgery which is being implemented in our department, will lead to a faster convalescence and also significantly decrease financial burdens garnered by patients during hospitalization. METHODS Operated on by the same surgeon and team in the same hospital, consecutive patients who had received esophagectomy and reconstruction for esophageal squamous cell carcinoma were retrospectively reviewed. On the basis of two different treatment periods, patients were divided into two groups: A and B. Group A was patients who had received the new reinvented protocol between 2012 and 2016, while group B patients were those having received the previous protocol between 2008 and 2011. Their demographics, post-operative outcome, and hospital charges were collected and compared. RESULTS There were 64 patients in group A, and 69 in group B. Ventilator days (P<0.001), ICU stay (P<0.001), and post-operative stay (P<0.001) were significantly shorter in group A patients. Complication rates were similar between the two groups. No hospital mortality was noted in either group. Hospital charges in group A were found to be perceptively lower, although not statistically significant (P value =0.078). CONCLUSIONS The current protocol of perioperative care effectively ameliorated convalescence after esophagectomy and reconstruction for esophageal squamous cell carcinoma without increasing complication rate or mortality. It is also potentially more practical in future health care policies during this era of financial shortage.
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Affiliation(s)
- Yu-Wei Liu
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fan-Wei Yan
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Dong-Lin Tsai
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsien-Pin Li
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Lung Lee
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Hsing Chiang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Te Hsu
- Department of Anesthesia, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Hung-Yi Chuang
- Department of Environmental and Occupational Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shah-Hwa Chou
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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10
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Yibulayin W, Abulizi S, Lv H, Sun W. Minimally invasive oesophagectomy versus open esophagectomy for resectable esophageal cancer: a meta-analysis. World J Surg Oncol 2016; 14:304. [PMID: 27927246 PMCID: PMC5143462 DOI: 10.1186/s12957-016-1062-7] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/23/2016] [Indexed: 12/11/2022] Open
Abstract
Background Open esophagectomy (OE) is associated with significant morbidity and mortality. Minimally invasive oesophagectomy (MIO) reduces complications in resectable esophageal cancer. The aim of this study is to explore the superiority of MIO in reducing complications and in-hospital mortality than OE. Methods MEDLINE, Embase, Science Citation Index, Wanfang, and Wiley Online Library were thoroughly searched. Odds ratio (OR)/weighted mean difference (WMD) with a 95% confidence interval (CI) was used to assess the strength of association. Results Fifty-seven studies containing 15,790 cases of resectable esophageal cancer were included. MIO had less intraoperative blood loss, short hospital stay, and high operative time (P < 0.05) than OE. MIO also had reduced incidence of total complications; (OR = 0.700, 95% CI = 0.626 ~ 0.781, PV < 0.05), pulmonary complications (OR = 0.527, 95% CI = 0431 ~ 0.645, PV < 0.05), cardiovascular complications (OR = 0.770, 95% CI = 0.681 ~ 0.872, PV < 0.05), and surgical technology related (STR) complications (OR = 0.639, 95% CI = 0.522 ~ 0.781, PV < 0.05), as well as lower in-hospital mortality (OR = 0.668, 95% CI = 0.539 ~ 0.827, PV < 0.05). However, the number of harvested lymph nodes, intensive care unit (ICU) stay, gastrointestinal complications, anastomotic leak (AL), and recurrent laryngeal nerve palsy (RLNP) had no significant difference. Conclusions MIO is superior to OE in terms of perioperative complications and in-hospital mortality.
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Affiliation(s)
- Waresijiang Yibulayin
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Sikandaer Abulizi
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Hongbo Lv
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Wei Sun
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China.
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11
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Noshiro H, Yoda Y, Hiraki M, Kono H, Miyake S, Uchiyama A, Nagai E. Survival outcomes of 220 consecutive patients with three-staged thoracoscopic esophagectomy. Dis Esophagus 2016; 29:1090-1099. [PMID: 26541471 DOI: 10.1111/dote.12426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with thoracic esophageal cancer are often treated by minimally invasive esophagectomy. However, the long-term survival benefits of minimally invasive esophagectomy remain unclear. Two approaches are available for thoracoscopic surgery: one with the patient in the left lateral decubitus position (LLDP), and the other with the patient in the prone position (PP). We investigated the survival benefit of thoracoscopic esophagectomy according to the tumor stage and patient position during the thoracoscopic procedure. We reviewed the records of 220 consecutive patients with esophageal cancer treated from 1998 to 2012. In total, 146 and 74 patients were treated with thoracoscopic esophagectomy in the LLDP and PP, respectively. No patients were initially proposed to be candidates for esophagectomy by thoracotomy during the study period. Data collection was performed with a focus on survival and recurrent disease. Among all the 220 patients, the overall 5-year survival rates were 83.7%, 74.1%, 45.5%, 78.6%, 44.2%, 29.4% and 24.3% in the patients with pStage IA, IB, IIA, IIB, IIIA, IIIB and IIIC disease, respectively. Despite the greater number of dissected mediastinal lymph nodes in the PP procedure, there were no significant differences in the survival curves between the LLDP and PP procedures. The long-term results of thoracoscopic esophagectomy are comparable and acceptable. The PP procedure was not confirmed to offer a superior survival benefit to the LLDP procedure in this retrospective study.
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Affiliation(s)
- H Noshiro
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Y Yoda
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - M Hiraki
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - H Kono
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - S Miyake
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - A Uchiyama
- Department of Surgery, JCHO Kyushu Hospital, Kitakyushu, Japan
| | - E Nagai
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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12
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van der Kaaij RT, van Sandick JW, van der Peet DL, Buma SA, Hartemink KJ. First Experience with Three-Dimensional Thoracolaparoscopy in Esophageal Cancer Surgery. J Laparoendosc Adv Surg Tech A 2016; 26:773-777. [DOI: 10.1089/lap.2016.0078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Rosa T. van der Kaaij
- Department of Surgical Oncology, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Johanna W. van Sandick
- Department of Surgical Oncology, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Sannine A. Buma
- Department of Anesthesiology, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Koen J. Hartemink
- Department of Surgical Oncology, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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13
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Robot-Assisted Mckeown Esophagectomy is Feasible After Neoadjuvant Chemoradiation. Our Initial Experience. Indian J Surg 2016; 80:24-29. [PMID: 29581681 DOI: 10.1007/s12262-016-1533-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022] Open
Abstract
Neoadjuvant chemoradiation has become the standard of care for esophageal cancer, especially for middle third esophageal lesions and those with squamous histology. Although more and more thoracic surgeons and surgical oncologists have now shifted to video-assisted and robot-assisted thoracoscopic esophagectomy; there is still limited experience for the use of minimal-assisted approaches in patients undergoing surgery after neoadjuvant chemoradiation. Most surgeons have concerns of feasibility, safety, and oncological outcomes as well as issues related to difficult learning curve in adopting robotic esophagectomy in patients after chemoradiation. We present our initial experience of Robot-Assisted Mckeown Esophagectomy in 27 patients after neoadjuvant chemoradiation, from May 2013 to October 2014. All patients underwent neoadjuvant chemoradiation to a dose of 50.4 Gy/25Fr with concurrent weekly cisplatin, followed by reassessment with clinical examination and repeat FDG PET/CT 6 weeks after completion of chemoradiation. Patients with progressive disease underwent palliative chemotherapy while patients with either partial or significant response to chemoradiation underwent Robot-Assisted Mckeown Esophagectomy with esophageal replacement by gastric conduit and esophagogastric anastomosis in the left neck. Out of 27 patients, 92.5 % patients had stage cT3/T4 tumours and node-positive disease in 48.1 % on imaging. Most patients were middle thoracic esophageal cancers (23/27), with squamous histology in all except for one. All patients received neoadjuvant chemoradiation and subsequently underwent Robot Assisted Mckeown Esophagectomy. The average time for robot docking, thoracic mobilization and total surgical procedure was 13.2, 108.4 and 342.7 min, respectively. The procedure was well tolerated by all patients with only one case of peri-operative mortality. Average ICU stay was 6.35 days (range 3-9 days). R0 resection rate of 96.3 % and average lymph node yield of 18 could be achieved. Pathological node negativity rate (pN0) and complete response (pCR) were 66.6 and 44.4 %, respectively. In the initial cases, four patients had to be converted to open due technical reasons or intraoperative complications. The present study, with shorter operative times, similar ICU stay, overall low morbidity, and mortality and optimal oncological outcomes suggest that robot-assisted thoracic mobilization of esophagus in patients with prior chemoradiation is feasible and safe with acceptable oncological outcomes. It has a shorter learning curve and hence allows for a transthoracic minimally invasive transthoracic esophagectomy to more and more patients, otherwise unfit for conventional approach.
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14
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Giugliano DN, Berger AC, Rosato EL, Palazzo F. Total minimally invasive esophagectomy for esophageal cancer: approaches and outcomes. Langenbecks Arch Surg 2016; 401:747-56. [PMID: 27401326 DOI: 10.1007/s00423-016-1469-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/16/2016] [Indexed: 12/23/2022]
Abstract
Since the introduction of minimally invasive esophagectomy 25 years ago, its use has been reported in several high volume centers. With only one published randomized control trial and five meta-analyses comparing its outcomes to open esophagectomy, available level I evidence is very limited. Available technical approaches include total minimally invasive transthoracic (Ivor Lewis or McKeown) or transhiatal esophagectomy; several hybrid options are available with one portion of the procedure completed via an open approach. A review of available level I evidence with focus on total minimally invasive esophagectomy is presented. The old debate regarding the superiority of a transthoracic versus transhiatal approach to esophagectomy may have been settled by minimally invasive esophagectomy as only few centers are reporting on the latter being utilized. The studies with the highest level of evidence available currently show that minimally invasive techniques via a transthoracic approach are associated with less overall morbidity, fewer pulmonary complications, and shorter hospital stays than open esophagectomy. There appears to be no detrimental effect on oncologic outcomes and possibly an added benefit derived by improved lymph node retrieval. Quality of life improvements may also translate into improved survival, but no conclusive evidence exists to support this claim. Robotic and hybrid techniques have also been implemented, but there currently is no evidence showing that these are superior to other minimally invasive techniques.
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Affiliation(s)
- Danica N Giugliano
- Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA
| | - Adam C Berger
- Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA
| | - Ernest L Rosato
- Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA
| | - Francesco Palazzo
- Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA.
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15
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Singh M, Uppal R, Chaudhary K, Javed A, Aggarwal A. Use of single-lumen tube for minimally invasive and hybrid esophagectomies with prone thoracoscopic dissection: case series. J Clin Anesth 2016; 33:450-5. [PMID: 27555209 DOI: 10.1016/j.jclinane.2016.04.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 04/03/2016] [Accepted: 04/24/2016] [Indexed: 01/17/2023]
Abstract
Minimally invasive and hybrid minimally invasive esophagectomy (MIE) is a technically challenging procedure. Anesthesia for the same is equally challenging due to special requirements of the video-assisted thoracoscopic technique used and shared operative and respiratory fields. Standard ventilatory strategy for this kind of surgery has been 1-lung ventilation with the help of a double-lumen tube. Prone positioning for thoracoscopic dissection facilitates gravity-dependant collapse of the operative side lung induced by a unilateral capnothorax, thus making the use of single-lumen endotracheal tube a feasible option for this surgery. We report our experience of 10 consecutive cases of minimally invasive esophagectomy conducted in prone position at our center and the use of single-lumen endotracheal tube for ventilation.
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Affiliation(s)
- Manila Singh
- Department of Anaesthesia and Intensive Care, G.B. Pant Hospital, New Delhi, India.
| | - Rajeev Uppal
- Department of Anaesthesia and Intensive Care, G.B. Pant Hospital, New Delhi, India.
| | - Kapil Chaudhary
- Department of Anaesthesia and Intensive Care, G.B. Pant Hospital, New Delhi, India.
| | - Amit Javed
- Department of G.I. Surgery, G.B. Pant Hospital, New Delhi, India.
| | - Anil Aggarwal
- Department of G.I. Surgery, G.B. Pant Hospital, New Delhi, India.
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16
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Wee JO, Bravo-Iñiguez CE, Jaklitsch MT. Early Experience of Robot-Assisted Esophagectomy With Circular End-to-End Stapled Anastomosis. Ann Thorac Surg 2016; 102:253-9. [PMID: 27154153 DOI: 10.1016/j.athoracsur.2016.02.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/23/2016] [Accepted: 02/16/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Surgical resection is a critical element in the treatment of esophageal cancer. Esophagectomy is technically challenging and is associated with high morbidity and mortality rates. Efforts to reduce these rates have spurred the adoption of minimally invasive techniques. This study describes a single-institution experience of robot-assisted esophagectomy with circular end-to-end stapled anastomosis. METHODS Between December 2013 and April 2015, a series of consecutive patients underwent robot-assisted Ivor Lewis esophagectomy with circular end-to-end anastomosis (RAILE-EEA) at a tertiary care center with curative intent. We retrospectively reviewed their electronic medical records using real-time prospectively collected data. The operative and postoperative outcomes were recorded. RESULTS Twenty patients underwent RAILE-EEA during the study period. The abdominal mobilization was performed laparoscopically, and the thoracic portion was robotic. The median total operative time was 455 minutes (range, 318-765 minutes), the 90-day operative mortality was 0%, and morbidity was present in 11 of 20 patients (55%). Atrial fibrillation was the most common event and was observed in 3 patients (15%). There were no anastomotic leaks. The median estimated blood loss was 275 mL, and the conversion rate was 0%. Complete (R0) resection was achieved in all cases. The mean number of lymph nodes was 23.2 (± 2.26). The median follow-up time was 330 days (range, 108-600 days), and the overall 1-year survival was 84%. CONCLUSIONS RAILE-EEA in our institution suggests a safe, effective, and reproducible alternative with satisfactory postoperative outcomes for the treatment of esophageal cancer. It provided good local control, adequate lymphadenectomy, low morbidity, and low 90-day operative mortality.
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Affiliation(s)
- Jon O Wee
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Carlos E Bravo-Iñiguez
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael T Jaklitsch
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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17
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Cuesta MA, van der Wielen N, Straatman J, van der Peet DL. Video-assisted thoracoscopic esophagectomy: keynote lecture. Gen Thorac Cardiovasc Surg 2016; 64:380-5. [PMID: 27130186 PMCID: PMC4916188 DOI: 10.1007/s11748-016-0650-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/06/2016] [Indexed: 12/30/2022]
Abstract
Minimally invasive esophagectomy (MIE) by thoracoscopy after neoadjuvant therapy results in significant short-term advantages such as a lower incidence of pulmonary infections and a better quality of life (QoL) with the same completeness of resection. After 1 year, a better QoL is still observed for MIE in comparison with the open approach, while having the same survival. Seven issues about implementation of MIE for cancer require discussion: (1) choice of the extension of esophageal resection and use of neoadjuvant therapy; (2) reasons to approach the esophageal cancer by MIE; (3) determining the best minimally invasive approach for gastro-esophageal junction cancers; (4) implementation of evidence-based MIE; (5) standardization of the surgical anatomy of the esophagus based on MIE; (6) future lines of research of MIE; and (7) learning process. In the time of imaging-integrated surgery it is clear that the MIE approach should be increasingly implemented in all centers worldwide having an adequate volume of patients and expertise.
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Affiliation(s)
- Miguel A Cuesta
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1018 HV, Amsterdam, The Netherlands.
| | - Nicole van der Wielen
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1018 HV, Amsterdam, The Netherlands
| | - Jennifer Straatman
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1018 HV, Amsterdam, The Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1018 HV, Amsterdam, The Netherlands
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Chrungoo R, Mala T, Gupta R. Role of laparoscopic surgery in cancer of stomach: Our early experience. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2015. [DOI: 10.14319/ijcto.33.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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19
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Superiority of Minimally Invasive Oesophagectomy in Reducing In-Hospital Mortality of Patients with Resectable Oesophageal Cancer: A Meta-Analysis. PLoS One 2015. [PMID: 26196135 PMCID: PMC4509855 DOI: 10.1371/journal.pone.0132889] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Compared with open oesophagectomy (OE), minimally invasive oesophagectomy (MIO) proves to have benefits in reducing the risk of pulmonary complications for patients with resectable oesophageal cancer. However, it is unknown whether MIO has superiority in reducing the occurrence of in-hospital mortality (IHM). Objective The objective of this meta-analysis was to explore the effect of MIO vs. OE on the occurrence of in-hospital mortality (IHM). Data Sources Sources such as Medline (through December 31, 2014), Embase (through December 31, 2014), Wiley Online Library (through December 31, 2014), and the Cochrane Library (through December 31, 2014) were searched. Study Selection Data of randomized and non-randomized clinical trials related to MIO versus OE were included. Interventions Eligible studies were those that reported patients who underwent MIO procedure. The control group included patients undergoing conventional OE. Study Appraisal and Synthesis Methods Fixed or random -effects models were used to calculate summary odds ratios (ORs) or relative risks (RRs) for quantification of associations. Heterogeneity among studies was evaluated by using Cochran’s Q and I2 statistics. Results A total of 48 studies involving 14,311 cases of resectable oesophageal cancer were included in the meta-analysis. Compared to patients undergoing OE, patients undergoing MIO had statistically reduced occurrence of IHM (OR=0.69, 95%CI =0.55 -0.86). Patients undergoing MIO also had significantly reduced incidence of pulmonary complications (PCs) (RR=0.73, 95%CI = 0.63-0.86), pulmonary embolism (PE) (OR=0.71, 95%CI= 0.51-0.99) and arrhythmia (OR=0.79, 95%CI = 0.68-0.92). Non-significant reductions were observed among the included studies in the occurrence of anastomotic leak (AL) (OR=0.93, 95%CI =0.78-1.11), or Gastric Tip Necrosis (GTN) (OR=0.89, 95%CI =0.54-1.49). Limitation Most of the included studies were non-randomized case-control studies, with a diversity of study designs, demographics of participants and surgical intervention. Conclusions Minimally invasive oesophagectomy (MIO) has superiority over open oesophagectomy (OE) in terms of the occurrence of in-hospital mortality (IHM) and should be the first-choice surgical procedure in esophageal surgery.
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Straughan DM, Azoury SC, Bennett RD, Pimiento JM, Fontaine JP, Toloza EM. Robotic-Assisted Esophageal Surgery. Cancer Control 2015; 22:335-9. [DOI: 10.1177/107327481502200312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- David M. Straughan
- Departments of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Saïd C. Azoury
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Robert D. Bennett
- Departments of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Jose M. Pimiento
- Departments of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
- Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
- Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Jacques P. Fontaine
- Departments of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
- Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
- Departments of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Eric M. Toloza
- Departments of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
- Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
- Departments of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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21
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Levchenko EV, Dvoretskiĭ SI, Karachun AM, Shcherbakov AM, Komarov IV, Pelipas' IV, Avanesian AA. [Mini-invasive technologies in complex treatment of esophagus cancer]. Khirurgiia (Mosk) 2015:30-36. [PMID: 26031817 DOI: 10.17116/hirurgia2015230-36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It was evaluated mini-invasive endovideosurgical technologies using in complex treatment of esophagus cancer. The investigation included 28 patients with thoracic esophagus cancer. Age of patients operated in terms from April 2012 to December 2013 was from 42 to 74 years (mean 61.7 ± 8.7 years). Only surgical treatment was used in 10 patients. Neoadjuvant chemotherapy and radiotherapy were performed in 18 patients. Hybrid mini-invasive esophagectomy (laparoscopic stomach mobilization and right-side thoracotomy) were used in 14 cases. The frequency of postoperative complications was 35.5%. Mini-invasive endovideosurgical esophagectomy was done in 14 patients. The frequency of postoperative complications was 57.1%. There were not deaths. Our experience demonstrates good results of mini-invasive technologies using in treatment of patients with esophagus cancer. Endovideosurgical methods permit to perform adequate volume of surgery in case of oncological diseases.
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Affiliation(s)
- E V Levchenko
- Nauchno-issledovatel'skiĭ institut onkologii im. N.N. Petrova Minzdrava RF, Sankt-Peterburg
| | - S Iu Dvoretskiĭ
- Nauchno-issledovatel'skiĭ institut onkologii im. N.N. Petrova Minzdrava RF, Sankt-Peterburg; Pervyĭ Sankt-Peterburgskiĭ gosudarstvennyĭ meditsinskiĭ universitet im. I.P. Pavlova
| | - A M Karachun
- Nauchno-issledovatel'skiĭ institut onkologii im. N.N. Petrova Minzdrava RF, Sankt-Peterburg
| | - A M Shcherbakov
- Nauchno-issledovatel'skiĭ institut onkologii im. N.N. Petrova Minzdrava RF, Sankt-Peterburg
| | - I V Komarov
- Nauchno-issledovatel'skiĭ institut onkologii im. N.N. Petrova Minzdrava RF, Sankt-Peterburg
| | - Iu V Pelipas'
- Nauchno-issledovatel'skiĭ institut onkologii im. N.N. Petrova Minzdrava RF, Sankt-Peterburg
| | - A A Avanesian
- Nauchno-issledovatel'skiĭ institut onkologii im. N.N. Petrova Minzdrava RF, Sankt-Peterburg
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22
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Shewale JB, Correa AM, Baker CM, Villafane-Ferriol N, Hofstetter WL, Jordan VS, Kehlet H, Lewis KM, Mehran RJ, Summers BL, Schaub D, Wilks SA, Swisher SG. Impact of a Fast-track Esophagectomy Protocol on Esophageal Cancer Patient Outcomes and Hospital Charges. Ann Surg 2015; 261:1114-23. [PMID: 25243545 PMCID: PMC4838458 DOI: 10.1097/sla.0000000000000971] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the effects of a fast-track esophagectomy protocol (FTEP) on esophageal cancer patients' safety, length of hospital stay (LOS), and hospital charges. BACKGROUND FTEP involved transferring patients to the telemetry unit instead of the surgical intensive care unit (SICU) after esophagectomy. METHODS We retrospectively reviewed 708 consecutive patients who underwent esophagectomy for primary esophageal cancer during the 4 years before (group A; 322 patients) or 4 years after (group B; 386 patients) the institution of an FTEP. Postoperative morbidity and mortality, LOS, and hospital charges were reviewed. RESULTS Compared with group A, group B had significantly shorter median LOS (12 days vs 8 days; P < 0.001); lower mean numbers of SICU days (4.5 days vs 1.2 days; P < 0.001) and telemetry days (12.7 days vs 9.7 days; P < 0.001); and lower rates of atrial arrhythmia (27% vs 19%; P = 0.013) and pulmonary complications (27% vs 20%; P = 0.016). Multivariable analysis revealed FTEP to be associated with shorter LOS (P < 0.001) even after adjustment for predictors like tumor histology and location. FTEP was also associated with a lower rate of pulmonary complications (odds ratio = 0.655; 95% confidence interval = 0.456, 0.942; P = 0.022). In addition, the median hospital charges associated with primary admission and readmission within 90 days for group B ($65,649) were lower than that for group A ($79,117; P < 0.001). CONCLUSIONS These findings suggest that an FTEP reduces patients' LOS, perioperative morbidity, and hospital charges.
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Affiliation(s)
- Jitesh B. Shewale
- Department of Thoracic and Cardiovascular Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arlene M. Correa
- Department of Thoracic and Cardiovascular Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carla M. Baker
- Department of Thoracic and Cardiovascular Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Wayne L. Hofstetter
- Department of Thoracic and Cardiovascular Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Victoria S. Jordan
- Department of Thoracic and Cardiovascular Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Henrik Kehlet
- Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Katie M. Lewis
- Department of Thoracic and Cardiovascular Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Reza J. Mehran
- Department of Thoracic and Cardiovascular Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Barbara L. Summers
- Department of Thoracic and Cardiovascular Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane Schaub
- Department of Thoracic and Cardiovascular Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sonia A. Wilks
- Department of Thoracic and Cardiovascular Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen G. Swisher
- Department of Thoracic and Cardiovascular Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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23
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van der Sluis PC, Ruurda JP, Verhage RJJ, van der Horst S, Haverkamp L, Siersema PD, Borel Rinkes IHM, Ten Kate FJW, van Hillegersberg R. Oncologic Long-Term Results of Robot-Assisted Minimally Invasive Thoraco-Laparoscopic Esophagectomy with Two-Field Lymphadenectomy for Esophageal Cancer. Ann Surg Oncol 2015; 22 Suppl 3:S1350-6. [PMID: 26023036 PMCID: PMC4686562 DOI: 10.1245/s10434-015-4544-x] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Open transthoracic esophagectomy is the worldwide gold standard in the treatment of resectable esophageal cancer. Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RAMIE) for esophageal cancer may be associated with reduced blood loss, shorter intensive care unit (ICU) stay, and less cardiopulmonary morbidity; however, long-term oncologic results have not been reported to date. METHODS Between June 2007 and September 2011, a total of 108 patients with potentially resectable esophageal cancer underwent RAMIE at the University Medical Centre Utrecht, with curative intent. All data were recorded prospectively. RESULTS Median duration of the surgical procedure was 381 min (range 264-636). Pulmonary complications were most common and were observed in 36 patients (33 %). Median ICU stay was 1 day, and median overall postoperative hospital stay was 16 days. In-hospital mortality was 5 %. The majority of patients (78 %) presented with T3 and T4 disease, and 68 % of patients had nodal-positive disease (cN1-3). In 65 % of patients, neoadjuvant treatment (chemotherapy 57 %, chemoradiotherapy 7 %, radiotherapy 1 %) was administered, and in 103 (95 %) patients, a radical resection (R0) was achieved. The median number of lymph nodes was 26, median follow-up was 58 months, 5-year overall survival was 42 %, median disease-free survival was 21 months, and median overall survival was 29 months. Tumor recurrence occurred in 51 patients and was locoregional only in 6 (6 %) patients, systemic only in 31 (30 %) patients, and combined in 14 (14 %) patients. CONCLUSION RAMIE was shown to be oncologically effective, with a high percentage of R0 radical resections and adequate lymphadenectomy. RAMIE provided good local control with a low percentage of local recurrence at long-term follow up.
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Affiliation(s)
- P C van der Sluis
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Surgery, G04.228, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R J J Verhage
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S van der Horst
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Haverkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I H M Borel Rinkes
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F J W Ten Kate
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Surgery, G04.228, University Medical Center Utrecht, Utrecht, The Netherlands.
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24
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Koyanagi K, Ozawa S, Tachimori Y. Minimally invasive esophagectomy performed with the patient in a prone position: a systematic review. Surg Today 2015; 46:275-84. [DOI: 10.1007/s00595-015-1164-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/12/2015] [Indexed: 12/14/2022]
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25
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Trugeda Carrera MS, Fernández-Díaz MJ, Rodríguez-Sanjuán JC, Manuel-Palazuelos JC, de Diego García EM, Gómez-Fleitas M. [Initial results of robotic esophagectomy for esophageal cancer]. Cir Esp 2015; 93:396-402. [PMID: 25794776 DOI: 10.1016/j.ciresp.2015.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 12/28/2014] [Accepted: 01/05/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION There is scant experience with robot-assisted esophagectomy in cases of esophageal and gastro-esophageal junction cancer. Our aim is to report our current experience. PATIENTS AND METHODS Observational cohort study of the first 32 patients who underwent minimally invasive esophagectomy for esophageal cancer from September 2011 to June 2014. The gastric tube was created laparoscopically. In the thoracic field, a robot-assisted thoracoscopic approach was performed in the prone position with intrathoracic robotic hand-sewn anastomosis. Patient and tumour characteristics, surgical technique, short-term outcomes (morbidity and mortality) and oncological results (radicality and number of removed nodes) were evaluated. RESULTS Thirty-two patients, with a mean age of 58 years (34-74) were treated by a totally minimally invasive esophagectomy: robotic laparoscopy and thoracoscopy (11 McKeown and 21 Ivor-Lewis). Twenty-nine received neoadjuvant chemoradiotherapy. There were no conversions to open surgery. Console time was 218minutes (190-285). Blood loss was 170ml (40-255). One patient died from cardiac disease. Nine patients had a major complication (Dindo-Clavien grade II or higher). There was no case of respiratory complication or recurrent laryngeal nerve palsy. Five patients had intrathoracic fistula, 4 radiological and one clinical. Three had chylothorax, 2 cervical fistula and one gastric tube necrosis. The median hospital stay was 12 days (8-50). All the resections were R0 and the median of removed lymph nodes was 16 (2-23). CONCLUSIONS Our results suggest that minimally invasive esophagectomy with robot-assisted thoracoscopy is safe and achieves oncological standards.
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Affiliation(s)
- M Soledad Trugeda Carrera
- Unidad de Cirugía Esófago-Gástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España.
| | - M José Fernández-Díaz
- Unidad de Cirugía Esófago-Gástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España
| | - Juan Carlos Rodríguez-Sanjuán
- Unidad de Cirugía Esófago-Gástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España
| | - José Carlos Manuel-Palazuelos
- Unidad de Cirugía Esófago-Gástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España
| | - Ernesto Matias de Diego García
- Unidad de Cirugía Esófago-Gástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España
| | - Manuel Gómez-Fleitas
- Unidad de Cirugía Esófago-Gástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España
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26
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Honda M, Daiko H, Kinoshita T, Fujita T, Shibasaki H, Nishida T. Minimally invasive resection of synchronous thoracic esophageal and gastric carcinomas followed by reconstruction: a case report. Surg Case Rep 2015; 1:12. [PMID: 26943380 PMCID: PMC4747966 DOI: 10.1186/s40792-015-0018-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 01/09/2015] [Indexed: 12/13/2022] Open
Abstract
We report on a case of synchronous carcinomas of the esophagus and stomach. A 68-year-old man was referred to our hospital for an abnormality found during his medical examination. Further evaluation revealed squamous cell carcinoma in the thoracic lower esophagus and gastric adenocarcinoma located in the middle third of the stomach. Thoracoscopic esophagectomy in the prone position (TSEP), laparoscopic total gastrectomy (LTG) with three-field lymph node dissection, and laparoscopically assisted colon reconstruction (LACR) were performed. The patient did not have any major postoperative complications. His pathological examination revealed no metastases in 56 harvested lymph nodes and no residual tumor. He was followed up for 30 months without recurrence. To our knowledge, this is the first report of esophageal and gastric synchronous carcinomas that were successfully treated with a combination of TSEP, LTG, and LACR. These operations may be a feasible and appropriate treatment for this disease.
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Affiliation(s)
- Masayuki Honda
- Department of Gastrointestinal Oncology, Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, 277-0882, Kashiwa, Chiba, Japan.
| | - Hiroyuki Daiko
- Department of Gastrointestinal Oncology, Esophageal Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, 277-0822, Kashiwa, Chiba, Japan.
| | - Takahiro Kinoshita
- Department of Gastrointestinal Oncology, Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, 277-0882, Kashiwa, Chiba, Japan.
| | - Takeo Fujita
- Department of Gastrointestinal Oncology, Esophageal Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, 277-0822, Kashiwa, Chiba, Japan.
| | - Hidehito Shibasaki
- Department of Gastrointestinal Oncology, Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, 277-0882, Kashiwa, Chiba, Japan.
| | - Toshiro Nishida
- Department of Gastrointestinal Oncology, Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, 277-0882, Kashiwa, Chiba, Japan.
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Manson JM, Beasley WD. A personal perspective on controversies in the surgical management of oesophageal cancer. Ann R Coll Surg Engl 2014; 96:575-8. [PMID: 25350177 PMCID: PMC4474096 DOI: 10.1308/003588414x13946184901605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2013] [Indexed: 11/22/2022] Open
Abstract
Significant disagreement and debate persist regarding several aspects of the optimal surgical management of oesophageal cancer. We address some of these issues based on our consecutive series of 165 patients undergoing oesophageal resection (reported in full elsewhere) and the available literature. The areas considered are controversial but we argue in favour of a 'traditional' two-stage open approach (Ivor-Lewis), leaving the pylorus alone, making no attempt to perform a radical lymphadenectomy and fashioning a hand sewn anastomosis.
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Affiliation(s)
- J McK Manson
- Abertawe Bro Morgannwg University Health Board, UK
| | - WD Beasley
- Abertawe Bro Morgannwg University Health Board, UK
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28
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Huang L, Onaitis M. Minimally invasive and robotic Ivor Lewis esophagectomy. J Thorac Dis 2014; 6 Suppl 3:S314-21. [PMID: 24876936 DOI: 10.3978/j.issn.2072-1439.2014.04.32] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/21/2014] [Indexed: 12/12/2022]
Abstract
Esophageal cancer is the eighth most common malignancy and the sixth most common cause of cancer-related death worldwide. Esophagectomy provides a curative treatment but carries significant morbidity and mortality. Ivor Lewis esophagectomy (ILE) is one of the most commonly employed open techniques of esophagectomy. Minimally invasive approaches have been explored in ILE in an effort to reduce operative morbidity. This article reviews recent literature of minimally invasive Ivor Lewis esophagectomy (MI-ILE), discusses its clinical outcomes, and introduces the robotic approach in MI-ILE. MI-ILE has demonstrated comparable postoperative outcomes to open ILE, and it has shown potential to reduce blood loss and length of hospitalization. Due to limited studies, no significant improvement of long-term survival has been reported in MI-ILE. Robotic ILE is safe and feasible, but more studies are needed to prove identifiable benefits. Randomized controlled trials comparing MI-ILE or robotic ILE with conventional open ILE are warranted to determine the optimal surgical procedure for the treatment of esophageal cancer.
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Affiliation(s)
| | - Mark Onaitis
- Department of Surgery, Duke University, Durham, NC, USA
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29
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Avery KNL, Metcalfe C, Berrisford R, Barham CP, Donovan JL, Elliott J, Falk SJ, Goldin R, Hanna G, Hollowood AA, Krysztopik R, Noble S, Sanders G, Streets CG, Titcomb DR, Wheatley T, Blazeby JM. The feasibility of a randomized controlled trial of esophagectomy for esophageal cancer--the ROMIO (Randomized Oesophagectomy: Minimally Invasive or Open) study: protocol for a randomized controlled trial. Trials 2014; 15:200. [PMID: 24888266 PMCID: PMC4084574 DOI: 10.1186/1745-6215-15-200] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/22/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There is a need for evidence of the clinical effectiveness of minimally invasive surgery for the treatment of esophageal cancer, but randomized controlled trials in surgery are often difficult to conduct. The ROMIO (Randomized Open or Minimally Invasive Oesophagectomy) study will establish the feasibility of a main trial which will examine the clinical and cost-effectiveness of minimally invasive and open surgical procedures for the treatment of esophageal cancer. METHODS/DESIGN A pilot randomized controlled trial (RCT), in two centers (University Hospitals Bristol NHS Foundation Trust and Plymouth Hospitals NHS Trust) will examine numbers of incident and eligible patients who consent to participate in the ROMIO study. Interventions will include esophagectomy by: (1) open gastric mobilization and right thoracotomy, (2) laparoscopic gastric mobilization and right thoracotomy, and (3) totally minimally invasive surgery (in the Bristol center only). The primary outcomes of the feasibility study will be measures of recruitment, successful development of methods to monitor quality of surgery and fidelity to a surgical protocol, and development of a core outcome set to evaluate esophageal cancer surgery. The study will test patient-reported outcomes measures to assess recovery, methods to blind participants, assessments of surgical morbidity, and methods to capture cost and resource use. ROMIO will integrate methods to monitor and improve recruitment using audio recordings of consultations between recruiting surgeons, nurses, and patients to provide feedback for recruiting staff. DISCUSSION The ROMIO study aims to establish efficient methods to undertake a main trial of minimally invasive surgery versus open surgery for esophageal cancer. TRIAL REGISTRATION The pilot trial has Current Controlled Trials registration number ISRCTN59036820(25/02/2013) at http://www.controlled-trials.com; the ROMIO trial record at that site gives a link to the original version of the study protocol.
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Affiliation(s)
- Kerry NL Avery
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, BS8 2PS, Clifton Bristol, UK
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, BS8 2PS, Clifton Bristol, UK
| | - Richard Berrisford
- Department of Upper Gastrointestinal Surgery, Derriford Hospital, Derriford Road, PL6 8DH Plymouth, UK
| | - C Paul Barham
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Marlborough Street, BS1 3NU Bristol, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, BS8 2PS, Clifton Bristol, UK
| | - Jackie Elliott
- Gastro-Oesophageal Support and Help Group, 15 Honey Hill Road, BS15 4HG Kingswood, South Gloucestershire, UK
| | - Stephen J Falk
- Bristol Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Horfield Road, BS2 8ED Bristol, UK
| | - Rob Goldin
- Centre for Pathology, 4th Floor Clarence Wing, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
| | - George Hanna
- Department of Bio-Surgery & Surgical Technology, Imperial College NHS Trust, Academic Surgical Unit, 10th Floor, QEQM Building, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
| | - Andrew A Hollowood
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Marlborough Street, BS1 3NU Bristol, UK
| | - Richard Krysztopik
- Gastroenterology & Surgical Department B57, Royal United Hospital Bath NHS Trust, Combe Park, BA1 3NG Bath, UK
| | - Sian Noble
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, BS8 2PS, Clifton Bristol, UK
| | - Grant Sanders
- Department of Upper Gastrointestinal Surgery, Derriford Hospital, Derriford Road, PL6 8DH Plymouth, UK
| | - Christopher G Streets
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Marlborough Street, BS1 3NU Bristol, UK
| | - Dan R Titcomb
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Marlborough Street, BS1 3NU Bristol, UK
| | - Tim Wheatley
- Department of Upper Gastrointestinal Surgery, Derriford Hospital, Derriford Road, PL6 8DH Plymouth, UK
| | - Jane M Blazeby
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, BS8 2PS, Clifton Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Marlborough Street, BS1 3NU Bristol, UK
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30
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Trugeda S, Fernández-Díaz MJ, Rodríguez-Sanjuán JC, Palazuelos CM, Fernández-Escalante C, Gómez-Fleitas M. Initial results of robot-assisted Ivor-Lewis oesophagectomy with intrathoracic hand-sewn anastomosis in the prone position. Int J Med Robot 2014; 10:397-403. [PMID: 24782293 DOI: 10.1002/rcs.1587] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/27/2014] [Accepted: 02/24/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is scanty experience concerning robot-assisted Ivor-Lewis oesophagectomy, so every new experience is helpful. METHODS We describe the techniques and short-term results of Ivor-Lewis oesophagectomy using a laparoscopic approach and robot-assisted thoracoscopy, and an observational study of prospective surveillance of the first 14 patients treated for oesophageal cancer. A gastric tube was created laparoscopically. Oesophagectomy was performed through a robot-assisted thoracoscopy followed by hand-sewn intrathoracic anastomosis. RESULTS There were no conversion cases. Mortality was zero. Six patients had a major complication. There were no cases of respiratory complication or recurrent laryngeal nerve palsy. Three patients had a radiological fistula (21.4%), successfully treated by endoscopic stenting, and one (7.1%) had an anastomosis leak needing reoperation. There were two cases of chylothorax (14.3%). CONCLUSIONS Our initial results suggest that the reported technique is safe and satisfies the oncological principles. It provides the advantages of minimally invasive surgery by overcoming some limitations of conventional thoracoscopy.
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Affiliation(s)
- S Trugeda
- Department of General Surgery, University Hospital 'Marqués de Valdecilla', University of Cantabria, Santander, Spain
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31
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Falkenback D, Lehane CW, Lord RVN. Robot-assisted gastrectomy and oesophagectomy for cancer. ANZ J Surg 2014; 84:712-21. [PMID: 24730691 DOI: 10.1111/ans.12591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Robot-assisted surgery is a technically feasible alternative to open and laparoscopic surgery, which is being more frequently used in general surgery. We undertook this review to investigate whether robotic assistance provides a significant benefit for oesophagogastric cancer surgery. METHODS Electronic databases were searched for original English-language publications for robotic-assisted gastrectomy and oesophagectomy between January 1990 and October 2013. RESULTS Sixty-one publications were included. Thirty-five included gastrectomy, 31 included oesophagectomy and five included both operations. Several publications suggest that robot-assisted subtotal gastrectomy can be as safe and effective as an open or laparoscopic procedure, with equal outcomes with regard to the number of lymph nodes resected, overall morbidity and perioperative mortality, and length of hospital stay. Robotic assistance is associated with longer operation times but also with less blood loss in some reports. A significant benefit for robotic assistance has not been shown for the more extensive operations of oesophagectomy or total gastrectomy with D2-lymphadenectomy. There are very few oncologic data regarding local recurrence or long-term survival for any of the robotic operations. CONCLUSIONS No significant differences in morbidity, mortality or number of lymph node harvested have been shown between robot-assisted and laparoscopic gastrectomy or oesophagectomy. Robotic surgery, with its relatively short learning curve, may facilitate reproducible minimally invasive surgery in this field but operation times are reportedly longer and cost differences remain unclear. Randomized trials with oncologic outcomes and cost comparisons are needed.
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Affiliation(s)
- Dan Falkenback
- Department of Surgery, St. Vincent's Hospital and University of Notre Dame School of Medicine, Sydney, New South Wales, Australia; Department of Surgery, Lund University and Lund University Hospital (Skane University Hospital), Lund, Sweden
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Enhanced recovery for esophagectomy: a systematic review and evidence-based guidelines. Ann Surg 2014; 259:413-31. [PMID: 24253135 DOI: 10.1097/sla.0000000000000349] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This article aims to provide the first systematic review of enhanced recovery after surgery (ERAS) programs for esophagectomy and generate guidelines. BACKGROUND ERAS programs use multimodal approaches to reduce complications and accelerate recovery. Although ERAS is well established in colorectal surgery, experience after esophagectomy has been minimal. However, esophagectomy remains an extremely high-risk operation, commonly performed in patients with significant comorbidities. Consequently, ERAS may have a significant role to play in improving outcomes. No guidelines or reviews have been published in esophagectomy. METHODS We undertook a systematic review of the PubMed, EMBASE, and the Cochrane databases in July 2012. The literature was searched for descriptions of ERAS in esophagectomy. Components of successful ERAS programs were determined, and when not directly available for esophagectomy, extrapolation from related evidence was made. Graded recommendations for each component were then generated. RESULTS Six retrospective studies have assessed ERAS for esophagectomy, demonstrating favorable morbidity, mortality, and length of stay. Methodological quality is, however, low. Overall, there is little direct evidence for components of ERAS, with much derived from nonesophageal thoracoabdominal surgery. CONCLUSIONS ERAS in principle seems logical and safe for esophagectomy. However, the underlying evidence is poor and lacking. Despite this, a number of recommendations for practice and research can be made.
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Mallipeddi MK, Onaitis MW. The Contemporary Role of Minimally Invasive Esophagectomy in Esophageal Cancer. Curr Oncol Rep 2014; 16:374. [DOI: 10.1007/s11912-013-0374-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Gibson MK, Dhaliwal AS, Clemons NJ, Phillips WA, Dvorak K, Tong D, Law S, Pirchi ED, Räsänen J, Krasna MJ, Parikh K, Krishnadath KK, Chen Y, Griffiths L, Colleypriest BJ, Farrant JM, Tosh D, Das KM, Bajpai M. Barrett's esophagus: cancer and molecular biology. Ann N Y Acad Sci 2013; 1300:296-314. [PMID: 24117650 DOI: 10.1111/nyas.12252] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The following paper on the molecular biology of Barrett's esophagus (BE) includes commentaries on signaling pathways central to the development of BE including Hh, NF-κB, and IL-6/STAT3; surgical approaches for esophagectomy and classification of lesions by appropriate therapy; the debate over the merits of minimally invasive esophagectomy versus open surgery; outcomes for patients with pharyngolaryngoesophagectomy; the applications of neoadjuvant chemotherapy and chemoradiotherapy; animal models examining the surgical models of BE and esophageal adenocarcinoma; the roles of various morphogens and Cdx2 in BE; and the use of in vitro BE models for chemoprevention studies.
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Affiliation(s)
- Michael K Gibson
- Department of Medicine and Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Arashinder S Dhaliwal
- Department of Medicine and Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nicholas J Clemons
- Surgical Oncology Research Laboratory, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.,Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Wayne A Phillips
- Surgical Oncology Research Laboratory, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.,Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Katerina Dvorak
- Department of Cellular and Molecular Medicine, Arizona Cancer Center, University of Arizona Cancer Center, Tucson, Arizona
| | - Daniel Tong
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Hong Kong
| | - Simon Law
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Hong Kong
| | - E Daniel Pirchi
- Servicio de Cirugía, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
| | - Jari Räsänen
- Division of General Thoracic and Esophageal Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Mark J Krasna
- Jersey Shore University Medical Center, Neptune, New Jersey
| | - Kaushal Parikh
- Department of Gastroenterology & Hepatology, and Centre for Experimental & Molecular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Kausilia K Krishnadath
- Department of Gastroenterology & Hepatology, and Centre for Experimental & Molecular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Yu Chen
- Department of Biology & Biochemistry, University of Bath, Bath, UK
| | | | | | - J Mark Farrant
- Department of Biology & Biochemistry, University of Bath, Bath, UK
| | - David Tosh
- Department of Biology & Biochemistry, University of Bath, Bath, UK
| | - Kiron M Das
- Department of Medicine, UMDNJ-RWJMS, New Brunswick, New Jersey
| | - Manisha Bajpai
- Department of Medicine, UMDNJ-RWJMS, New Brunswick, New Jersey
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Noshiro H, Miyake S. Thoracoscopic esophagectomy using prone positioning. Ann Thorac Cardiovasc Surg 2013; 19:399-408. [PMID: 24284506 DOI: 10.5761/atcs.ra.13-00262] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Thoracotomic esophagectomy followed by cervical and abdominal procedures has been conventionally performed as the best curable operative procedure for treating invasive thoracic esophageal carcinoma. Despite improvements in the survival rate, the procedure is associated with significant operative morbidity and mortality rates due to the extreme invasiveness of an extensive dissection of the lymph nodes. Minimally invasive esophagectomy (MIE) was developed to reduce surgical invasiveness. Recently, the use of thoracoscopic esophagectomy performed in the prone position has stimulated new interest in minimally invasive approaches. However, the advantages and disadvantages of this technique are not well known. In this review, the literature to date, including series and comparative studies of minimally invasive esophagectomy performed in the prone position, is summarized, and the various lessons learned and controversies surrounding this technique are addressed.
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Affiliation(s)
- Hirokazu Noshiro
- Department of Surgery, Faculty of Medicine, Saga University, Saga, Saga, Japan
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Cash JC, Zehetner J, Hedayati B, Bildzukewicz NA, Katkhouda N, Mason RJ, Lipham JC. Outcomes following laparoscopic transhiatal esophagectomy for esophageal cancer. Surg Endosc 2013; 28:492-9. [PMID: 24100862 DOI: 10.1007/s00464-013-3230-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 09/17/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Most published minimally invasive esophagectomy techniques involve a multiple field approach, including laparoscopic and thoracoscopic esophageal mobilization. Laparoscopic transhiatal esophagectomy (LTE) should potentially reduce the complications associated with thoracotomy. This study aims to compare outcomes of LTE with open transhiatal esophagectomy (OTE) and en-bloc esophagectomy (EBE). METHODS Retrospective chart review was performed on all patients who had an LTE for cancer between July 2008 and July 2012 at our institution. Data was compared with an historic cohort of patients who underwent OTE and EBE at the same institution from July 2002 to July 2008. RESULTS There were 33 patients with LTE, compared with 60 patients with OTE and 139 with EBE. The presence of minor operative complications was similar (p = 0.36), but major complications were significantly less common in the LTE group (12, 23 and 33 %, respectively; p = 0.04). The median number of blood transfusions during hospitalization was significantly lower in the LTE group (0, 2.5 and 3, respectively; p = 0.005). Median tumor size was significantly smaller (1.5, 2.2, and 3 cm, respectively; p = 0.03), but the LTE group had a significantly higher percentage of patients with neoadjuvant treatment (39, 14 and 29 %, respectively; p = 0.008). Median lymph node yield for LTE was lower (24, 36 and 48, respectively; p < 0.0001), but the percentage of patients with positive nodes was similar (33, 33 and 39 %, respectively; p = 0.69). Mortality was equivalent among the groups (0, 2 and 4 %, respectively; p = 0.38). The median LOS for the LTE group was significantly lower (10, 13 and 15 days, respectively; p < 0.0001). Overall survival was not different between the three groups (p = 0.65), with median survival at 24 months of 70, 65 and 65 %, respectively. CONCLUSION LTE can be performed safely with less major complications and shorter hospital stay than open esophagectomy. The reduced lymph-node harvest did not impact overall survival.
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Affiliation(s)
- J Christian Cash
- Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St, Suite 514, Los Angeles, CA, 90033, USA
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Ramage L, Deguara J, Davies A, Hamouda A, Tsigritis K, Forshaw M, Botha AJ. Gastric tube necrosis following minimally invasive oesophagectomy is a learning curve issue. Ann R Coll Surg Engl 2013; 95:329-34. [PMID: 23838494 DOI: 10.1308/003588413x13629960045751] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Gastric tube necrosis following oesophagectomy is thought to have an increased association with a minimally invasive technique. Some suggest gastric ischaemic preconditioning may reduce ischaemic complications. We discuss our series of 155 consecutive minimally invasive oesophagectomies (MIOs), including a number of cases of gastric tube ischaemia, of which 4 (2.6%) developed conduit necrosis. METHODS Data were collected prospectively of MIOs carried out by a single surgeon between 2005 and 2011. Cases of gastric tube necrosis were identified. RESULTS Overall, 155 patients were identified. The inpatient mortality rate was 2.6%. Gastric tube necrosis occurred in four patients (2.6%). An ultrasonic dissector injury to the gastroepiploic arcade had occurred in two cases. In another case, the gastric tube was strangulated in the hiatus. In the remaining case, no clear mechanical cause was identified. All 4 cases occurred within the first 73 cases. The gastric tube necrosis rate of the first 50 cases versus cases 51-155 was 4% and 2% respectively (p=0.5948). The anastomotic leak rate in these two cohorts was 18% and 7% respectively (p=0.0457). There was a significant reduction in overall gastric tube complications from 22% to 10% following the learning curve of the initial 50 cases (p=0.0447). CONCLUSIONS In our series, gastric tube necrosis appears to be a learning curve issue. Prophylactic measures such as ischaemic preconditioning become less relevant as the operating surgeon's experience increases. Instead, meticulous attention to preserving the gastroepiploic arcade, avoidance of tension in the tube and careful positioning of the gastric conduit through an adequately sized hiatus are key factors.
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Affiliation(s)
- L Ramage
- Guy's and St Thomas' NHS Foundation Trust, UK
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Puntambekar S, Kenawadekar R, Pandit A, Nadkarni A, Joshi S, Agarwal G, Bhat NA, Malik J, Reddy S. Minimally invasive esophagectomy in the elderly. Indian J Surg Oncol 2013; 4:326-31. [PMID: 24426751 DOI: 10.1007/s13193-013-0263-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 08/14/2013] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE A retrospective analysis of a prospectively maintained database to evaluate our experience in elderly patients (>70 years) undergoing Thoracolaparoscopic esophagectomy for cancer oesophagus. To ascertain whether age, is a limiting factor for patients undergoing minimally invasive esophagectomy. METHODS All Patients above 70 years of age, referred to the Gastro-esophageal clinic were included in the study. Tumours were staged as per AJCC 6th ed. 2002. Patients diagnosed with T1/2/3, N0/1 lesion of the mid/lower oesophagus (Infra Azygous) and type I and II Gastro esophageal junction tumours were included in the study. Patients with ASA grade IV were excluded. All patients who underwent Thoracolaparoscopic esophagectomy from January 2009 till January 2012 were evaluated for their perioperative outcomes. RESULTS Sixty eight patients underwent Minimal Invasive esophagectomy from January 2009 to January 2012. There were 45 males and 23 females. The average age in elderly group was 75.76 ± 5.96 years (range 70 to 91). Mean operative time was 178.84 ± 65.26 min, mean blood loss 143.84 ml(range 32-450 ml), mean ICU stay 3.84 days(range 2-11 days) and mean hospital stay was 12.76 days(range 8-21 days). Pneumonia and Cardiac related complications occurred in 10.30 % and 1.47 % patients respectively. None of the procedures required conversion to open thoracotomy. CONCLUSIONS Thoracolaparoscopic esophagectomy is feasible and surgically safe in elderly patients with low morbidity and mortality. Thus age of a patient should not be considered a limiting factor. ULTRAMINI ABSTRACT This is an original article about our experience of thoracolaparoscopic esophagectomy for cancer esophagus in elderly patients. After analyzing the data we feel that age of the patient cannot be a truly limiting factor for patient diagnosed of esophageal cancer to undergo minimally invasive esophagectomy.
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Affiliation(s)
- Shailesh Puntambekar
- Department of Minimal Access Surgery, Galaxy Care Laparoscopic Institute, Karve Road, Pune, India
| | - Rahul Kenawadekar
- Department of Minimal Access Surgery, Galaxy Care Laparoscopic Institute, Karve Road, Pune, India
| | - Archit Pandit
- Department of Minimal Access Surgery, Galaxy Care Laparoscopic Institute, Karve Road, Pune, India
| | - Akshay Nadkarni
- Department of Minimal Access Surgery, Galaxy Care Laparoscopic Institute, Karve Road, Pune, India
| | - Saurabh Joshi
- Department of Minimal Access Surgery, Galaxy Care Laparoscopic Institute, Karve Road, Pune, India
| | - Geetanjali Agarwal
- Department of Minimal Access Surgery, Galaxy Care Laparoscopic Institute, Karve Road, Pune, India
| | - Nasir Ahmad Bhat
- Department of Minimal Access Surgery, Galaxy Care Laparoscopic Institute, Karve Road, Pune, India
| | - Jainul Malik
- Department of Minimal Access Surgery, Galaxy Care Laparoscopic Institute, Karve Road, Pune, India
| | - Sunil Reddy
- Department of Minimal Access Surgery, Galaxy Care Laparoscopic Institute, Karve Road, Pune, India
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Abstract
Answer questions and earn CME/CNE Esophageal adenocarcinoma (EAC) is characterized by 6 striking features: increasing incidence, male predominance, lack of preventive measures, opportunities for early detection, demanding surgical therapy and care, and poor prognosis. Reasons for its rapidly increasing incidence include the rising prevalence of gastroesophageal reflux and obesity, combined with the decreasing prevalence of Helicobacter pylori infection. The strong male predominance remains unexplained, but hormonal influence might play an important role. Future prevention might include the treatment of reflux or obesity or chemoprevention with nonsteroidal antiinflammatory drugs or statins, but no evidence-based preventive measures are currently available. Likely future developments include endoscopic screening of better defined high-risk groups for EAC. Individuals with Barrett esophagus might benefit from surveillance, at least those with dysplasia, but screening and surveillance strategies need careful evaluation to be feasible and cost-effective. The surgery for EAC is more extensive than virtually any other standard procedure, and postoperative survival, health-related quality of life, and nutrition need to be improved (eg, by improved treatment, better decision-making, and more individually tailored follow-up). Promising clinical developments include increased survival after preoperative chemoradiotherapy, the potentially reduced impact on health-related quality of life after minimally invasive surgery, and the new endoscopic therapies for dysplastic Barrett esophagus or early EAC. The overall survival rates are improving slightly, but poor prognosis remains a challenge.
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Affiliation(s)
- Jesper Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Kitagawa H, Namikawa T, Iwabu J, Akimori T, Okabayashi T, Sugimoto T, Mimura T, Kobayashi M, Hanazaki K. Efficacy of Laparoscopic Gastric Mobilization for Esophagectomy: Comparison with Open Thoraco-abdominal Approach. J Laparoendosc Adv Surg Tech A 2013; 23:452-5. [DOI: 10.1089/lap.2012.0377] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Japan
| | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Japan
| | - Toyokazu Akimori
- Department of Surgery, Kochi Prefectural Hospital, Sukumo, Kochi, Japan
| | | | - Takeki Sugimoto
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Japan
| | - Toshiki Mimura
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Nankoku, Kochi, Japan
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Negative lymph-node count is associated with survival in patients with resected esophageal squamous cell carcinoma. Surgery 2013; 153:234-41. [DOI: 10.1016/j.surg.2012.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 08/03/2012] [Indexed: 12/13/2022]
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Contribution of robotics to minimally invasive esophagectomy. J Robot Surg 2013; 7:325-32. [DOI: 10.1007/s11701-012-0391-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 12/27/2012] [Indexed: 10/27/2022]
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Briez N, Piessen G, Torres F, Lebuffe G, Triboulet JP, Mariette C. Effects of hybrid minimally invasive oesophagectomy on major postoperative pulmonary complications. Br J Surg 2012; 99:1547-53. [PMID: 23027071 DOI: 10.1002/bjs.8931] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Morbidity after oesophageal cancer surgery remains high, mainly due to major postoperative pulmonary complications (MPPCs). The aim of this study was to test the hypothesis that hybrid minimally invasive oesophagectomy (HMIO) decreases the 30-day MPPC rate without compromising oncological outcomes. METHODS Consecutive patients undergoing curative oesophagectomy for cancer by laparoscopic gastric mobilization and open thoracotomy (HMIO) between January 2004 and December 2009 were matched to randomly selected patients undergoing a totally open approach during the same study interval. Matching variables were age, sex, cancer stage, location of the primary tumour, histological subtype, American Society of Anesthesiologists grade, malnutrition, neoadjuvant chemoradiation and epidural analgesia. RESULTS MPPCs at 30 days were significantly less frequent after HMIO compared with open surgery (15·7 versus 42·9 per cent; P < 0·001). Postoperative in-hospital mortality and overall morbidity rates were 4·3 and 47·5 per cent respectively, again significantly lower in the HMIO group: 1·4 versus 7·1 per cent (P = 0·018) and 35·7 versus 59·3 per cent (P < 0·001). In multivariable analysis, HMIO, adenocarcinoma subtype, epidural analgesia and surgery after 2006 were independent protective factors against MPPCs, and HMIO was independently protective against acute respiratory distress syndrome (ARDS). Lymph node yields and survival were similar in the two groups. CONCLUSION HMIO for oesophageal cancer, using laparoscopic gastric mobilization and open right thoracotomy, offered a substantial and independent protective effect against MPPCs, including ARDS, without compromising oncological outcomes.
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Affiliation(s)
- N Briez
- Departments of Digestive and Oncological Surgery, University Hospital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, France
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Abstract
Surgical resection remains a standard treatment option for localized esophageal cancer. Surgical approaches to esophagectomy include transhiatal and transthoracic techniques as well as minimally invasive techniques that have been developed to reduce the morbidities associated with laparotomy and thoracotomy incisions. The perioperative mortality for esophagectomy remains high with cardiopulmonary and anastomotic complications as the most frequent and serious morbidities. This article reviews the management of patients presenting for esophagectomy, with a focus on evidence-based anesthetic and perioperative approaches for improving outcomes.
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Affiliation(s)
- J Michael Jaeger
- TCV Surgical ICU, University of Virginia Health System, Charlottesville, VA 22908-0710, USA
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van der Sluis PC, Ruurda JP, van der Horst S, Verhage RJJ, Besselink MGH, Prins MJD, Haverkamp L, Schippers C, Rinkes IHMB, Joore HCA, ten Kate FJW, Koffijberg H, Kroese CC, van Leeuwen MS, Lolkema MPJK, Reerink O, Schipper MEI, Steenhagen E, Vleggaar FP, Voest EE, Siersema PD, van Hillegersberg R. Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer, a randomized controlled trial (ROBOT trial). Trials 2012; 13:230. [PMID: 23199187 PMCID: PMC3564860 DOI: 10.1186/1745-6215-13-230] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 10/26/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND For esophageal cancer patients, radical esophagolymphadenectomy is the cornerstone of multimodality treatment with curative intent. Transthoracic esophagectomy is the preferred surgical approach worldwide allowing for en-bloc resection of the tumor with the surrounding lymph nodes. However, the percentage of cardiopulmonary complications associated with the transthoracic approach is high (50 to 70%).Recent studies have shown that robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RATE) is at least equivalent to the open transthoracic approach for esophageal cancer in terms of short-term oncological outcomes. RATE was accompanied with reduced blood loss, shorter ICU stay and improved lymph node retrieval compared with open esophagectomy, and the pulmonary complication rate, hospital stay and perioperative mortality were comparable. The objective is to evaluate the efficacy, risks, quality of life and cost-effectiveness of RATE as an alternative to open transthoracic esophagectomy for treatment of esophageal cancer. METHODS/DESIGN This is an investigator-initiated and investigator-driven monocenter randomized controlled parallel-group, superiority trial. All adult patients (age ≥ 18 and ≤ 80 years) with histologically proven, surgically resectable (cT1-4a, N0-3, M0) esophageal carcinoma of the intrathoracic esophagus and with European Clinical Oncology Group performance status 0, 1 or 2 will be assessed for eligibility and included after obtaining informed consent. Patients (n = 112) with resectable esophageal cancer are randomized in the outpatient department to either RATE (n = 56) or open three-stage transthoracic esophageal resection (n = 56). The primary outcome of this study is the percentage of overall complications (grade 2 and higher) as stated by the modified Clavien-Dindo classification of surgical complications. DISCUSSION This is the first randomized controlled trial designed to compare RATE with open transthoracic esophagectomy as surgical treatment for resectable esophageal cancer. If our hypothesis is proven correct, RATE will result in a lower percentage of postoperative complications, lower blood loss, and shorter hospital stay, but with at least similar oncologic outcomes and better postoperative quality of life compared with open transthoracic esophagectomy. The study started in January 2012. Follow-up will be 5 years. Short-term results will be analyzed and published after discharge of the last randomized patient. TRIAL REGISTRATION Dutch trial register: NTR3291 ClinicalTrial.gov: NCT01544790.
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Affiliation(s)
- Pieter C van der Sluis
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Sylvia van der Horst
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Roy JJ Verhage
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Marc GH Besselink
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Margriet JD Prins
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Leonie Haverkamp
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Carlo Schippers
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Inne HM Borel Rinkes
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Hans CA Joore
- Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Fiebo JW ten Kate
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Hendrik Koffijberg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Christiaan C Kroese
- Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Maarten S van Leeuwen
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Martijn PJK Lolkema
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Onne Reerink
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Marguerite EI Schipper
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Elles Steenhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Emile E Voest
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
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46
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Dantoc MM, Cox MR, Eslick GD. The first randomised controlled trial on minimally invasive esophagectomy (MIE) and the ongoing quest for greater evidence. J Thorac Dis 2012; 4:459-61. [PMID: 23050107 DOI: 10.3978/j.issn.2072-1439.2012.08.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 08/14/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Marc M Dantoc
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
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Uttley L, Campbell F, Rhodes M, Cantrell A, Stegenga H, Lloyd-Jones M. Minimally invasive oesophagectomy versus open surgery: is there an advantage? Surg Endosc 2012; 27:724-31. [PMID: 23052523 DOI: 10.1007/s00464-012-2546-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 08/09/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND Oesophageal resection is the main method of curative treatment for cancer of the oesophagus. Despite advances in surgical technology and postoperative care, the survival rate and prognosis of people undergoing oesophagectomy is still poor. The use of minimally invasive techniques in oesophageal surgery offers hope of reduced recovery time due to a reduction in surgical trauma. Although the first reports of thoracoscopy- and laparoscopy-assisted oesophagectomy emerged some 20 years ago, there is still no consensus that the outcomes are clearly superior to outcomes following conventional open surgery. Increasingly, some surgeons promote the use of minimally invasive techniques for oesophagectomy but questions remain over its safety and efficacy compared with open surgery. METHODS We conducted a systematic review of the literature to compare minimally invasive techniques for oesophagectomy to open surgery. The outcomes of interest for efficacy and safety included mortality, operative complications, recurrence, and quality of life. RESULTS There were 28 included comparative studies. No randomised controlled studies (RCTs) were available and therefore the data need to be interpreted with caution. CONCLUSION Recommendations for future research are discussed. We argue that it is difficult to conduct an RCT for this procedure due to ethical considerations and suggest ways that future nonrandomised studies could be improved.
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Affiliation(s)
- Lesley Uttley
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
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48
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Kim T, Hochwald SN, Sarosi GA, Caban AM, Rossidis G, Ben-David K. Review of minimally invasive esophagectomy and current controversies. Gastroenterol Res Pract 2012; 2012:683213. [PMID: 22919374 PMCID: PMC3419416 DOI: 10.1155/2012/683213] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 06/01/2012] [Accepted: 06/08/2012] [Indexed: 01/09/2023] Open
Abstract
Esophagectomy is a complex operation with significant morbidity and mortality. Minimally invasive esophagectomy (MIE) was described in the 1990s in an effort to reduce operative morbidity. Since then many institutions have adopted and described their series with this technique. This paper reviews the literature on the variety of MIE techniques, clinical and quality of life outcomes with open versus MIE, and controversies surrounding MIE-such as prone positioning, stapling techniques, size of the gastric conduit, and robotic techniques.
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Affiliation(s)
- T. Kim
- Department of Surgery, College of Medicine, University of Florida, P.O. Box 100109, Gainesville, FL 32610-0109, USA
| | - S. N. Hochwald
- Department of Surgery, College of Medicine, University of Florida, P.O. Box 100109, Gainesville, FL 32610-0109, USA
| | - G. A. Sarosi
- Department of Surgery, College of Medicine, University of Florida, P.O. Box 100109, Gainesville, FL 32610-0109, USA
| | - A. M. Caban
- Department of Surgery, College of Medicine, University of Florida, P.O. Box 100109, Gainesville, FL 32610-0109, USA
| | - G. Rossidis
- Department of Surgery, College of Medicine, University of Florida, P.O. Box 100109, Gainesville, FL 32610-0109, USA
| | - K. Ben-David
- Department of Surgery, College of Medicine, University of Florida, P.O. Box 100109, Gainesville, FL 32610-0109, USA
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49
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Bailey L, Khan O, Willows E, Somers S, Mercer S, Toh S. Open and laparoscopically assisted oesophagectomy: a prospective comparative study†. Eur J Cardiothorac Surg 2012; 43:268-73. [DOI: 10.1093/ejcts/ezs314] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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50
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Short-term outcomes following open versus minimally invasive esophagectomy for cancer in England: a population-based national study. Ann Surg 2012; 255:197-203. [PMID: 22173202 DOI: 10.1097/sla.0b013e31823e39fa] [Citation(s) in RCA: 184] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare short-term outcomes of open and minimally invasive esophagectomy (MIE) for cancer. BACKGROUND DATA Numerous studies have demonstrated the safety and possible advantages of MIE in selected cohorts of patients. The increasing use of MIE is not coupled with conclusive evidence of its benefits over "open" esophagectomy, especially in the absence of randomized trials. METHODS Hospital Episode Statistics data were analyzed from April 2005 to March 2010. This is a routinely collected database of all English National Health Service Trusts. Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures, 4th revision (OPCS-4), procedure codes were used to identify index resections and International Statistical Classification of Diseases, 10th Revision (ICD-10), diagnostic codes were used to ascertain comorbidity status and complications. Thirty-day in-hospital mortality, medical complications, and surgical reinterventions were analyzed. Unadjusted and risk-adjusted regression analyses were undertaken. RESULTS Seven thousand five hundred and two esophagectomies were undertaken; of these, 1155 (15.4%) were MIE. In 2009-2010, 24.7% of resections were MIE. There was no difference in 30-day mortality (4.3% vs 4.0%; P = 0.605) and overall medical morbidity (38.0% vs 39.2%; P = 0.457) rates between open and MIE groups, respectively. A higher reintervention rate was associated with the MIE group than with the open group (21% vs 17.6%, P = 0.006; odds ratio, 1.17; 95% confidence interval, 1.00-1.38; P = 0.040). CONCLUSIONS Minimally invasive esophagectomy is increasingly performed in the United Kingdom. Although the study confirmed the safety of MIE in a population-based national data, there are no significant benefits demonstrated in mortality and overall morbidity. Minimally invasive esophagectomy is associated with higher reintervention rate. Further evidence is needed to establish the long-term survival of MIE.
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