1
|
Du J, Kang Z, Zhao Z, Wu H, Chen Y, Zhang C, Chen Y, Liang W, Wang Q, Ma J. Analysis of the effect of Ivor-Lewis esophagectomy and McKeown esophagectomy on perioperative anxiety and depression in patients with esophageal cancer. Eur J Cancer Prev 2024; 33:200-207. [PMID: 37823407 DOI: 10.1097/cej.0000000000000850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
To compare the effects of Ivor-Lewis esophagectomy and McKeown esophagectomy on perioperative anxiety and depression in patients with esophageal cancer. Sixty-three patients with stage I-III middle and lower esophageal carcinoma from June 2021 to December 2022 were randomly divided into observation group (n = 32) treated with laparoscopic Ivor-Lewis esophagectomy and control group (n = 31) treated with laparoscopic McKeown esophagectomy. Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were measured on the second day of admission and the fifth day after surgery to assess the presence of depression and anxiety. The preoperative and postoperative clinical data of both groups were compared, and multivariate analysis was used to identify risk factors associated with depression and anxiety in patients with esophageal cancer. There was no significant difference in SDS and SAS standard scores between the observation group and the control group ( P > 0.05). The postoperative SDS and SAS scores in the control group were significantly higher than those before and after operation in the observation group ( P < 0.01). According to univariate analysis, patients with TNM stage III, tumor diameter greater than 3 cm, postoperative complications, radical McKeown esophagectomy, and C-reactive protein levels above 10 mg/L had a higher incidence of depression and anxiety ( P < 0.05). Multivariate logistic analysis showed that TNM stage III (depression: OR 1.683, 95 CI 1.429-1.861; Anxiety: OR 1.739, 95 CI 1.516-1.902), postoperative complications (depression: OR 2.345, 95 CI 1.435-3.891; Anxiety: OR 1.872, 95 CI 1.372-3.471), surgical approach (depression: OR 1.609, 95 CI 1.502-3.193; Anxiety: OR 1.658, 95 CI 1.469-2.059), and C-reactive protein (depression: OR 2.260, 95 CI 1.157-4.059; Anxiety: OR 0.373, 95 CI 0.253-0.976) were all independent factors for depression and anxiety in patients after esophageal cancer surgery ( P < 0.05). The Ivor-Lewis esophagectomy has the advantages of fewer complications and low inflammatory response, which can help alleviate anxiety and depression and improve patients' quality of life and prognosis.
Collapse
Affiliation(s)
- Jun Du
- Department of Oncological Surgery, The First Affiliated Hospital of Bengbu Medical College, BengBu, AnHui, PR China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Li KK, Wang YJ, Zhang TM, Zhang L, Zhao SL, Chen L, Bao T, Zhao XL, Xie XF, Guo W. Right gastroepiploic artery length determined anastomotic leakage after minimally invasive esophagectomy for esophageal cancer: a prospective cohort study. Int J Surg 2024; 110:2757-2764. [PMID: 38349216 DOI: 10.1097/js9.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/29/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND This prospective cohort study, conducted at a high-volume esophageal cancer center from July 2019 to July 2022, aimed to investigate the link between the right gastroepiploic artery (RGEA) length and anastomotic leakage (AL) rates following minimally invasive esophagectomy (MIE). Real-world data on stomach blood supply in the Chinese population were examined. MATERIALS AND METHODS A total of 516 cases were enrolled, categorized into two groups based on the Youden index-determined optimal cut-off value for the relative length of RGEA (length of RGEA/length of gastric conduit, 64.69%) through ROC analysis: Group SR (short RGEA) and Group LR (long RGEA). The primary observation parameter was the relationship between AL incidence and the ratio of direct blood supply from RGEA. Secondary parameters included the mean length of the right gastroepiploic artery, greater curvature, and the connection type between right and left gastroepiploic vessels. Patient data were prospectively recorded in electronic case report forms. RESULTS The study revealed median lengths of 43.60 cm for greater curvature, 43.16 cm for the gastric conduit, and 26.75 cm for RGEA. AL, the most common postoperative complication, showed a significant difference between groups (16.88 vs. 8.84%, P =0.01). Multivariable binary logistic regression identified Group SR and LR (odds ratio: 2.651, 95% CI: 1.124-6.250, P =0.03) and Neoadjuvant therapy (odds ratio: 2.479, 95% CI: 1.374-4.473, P =0.00) as independent predictors of AL. CONCLUSIONS The study emphasizes the crucial role of RGEA length in determining AL incidence in MIE for esophageal cancer. Preserving RGEA and fostering capillary arches between RGEA and LGEA are recommended strategies to mitigate AL risk.
Collapse
Affiliation(s)
- Kun-Kun Li
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, People's Republic of China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Seo HW, Jeon YJ, Cho JH, Kim HK, Choi YS, Zo JI, Shim YM. Treatment Patterns and Outcomes of Anastomotic Leakage after Esophagectomy for Esophageal Cancer. J Chest Surg 2024; 57:152-159. [PMID: 38228498 DOI: 10.5090/jcs.23.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/22/2023] [Accepted: 11/21/2023] [Indexed: 01/18/2024] Open
Abstract
Background Anastomotic leakage (AL) following esophagectomy represents a serious complication that often results in prolonged hospitalization and necessitates repeated interventions, including nothing-by-mouth (NPO) restriction, endoscopic vacuum therapy (EVT), or surgical repair. In this study, we evaluated the patterns and outcomes of AL treatment. Methods We retrospectively reviewed the medical records of patients who underwent esophagectomy for esophageal cancer at a single center between 2003 and 2020. Of 3,096 examined cases, 181 patients (5.8%) with AL were included in the study: 114 patients (63%) with cervical anastomosis (CA) and 67 (37%) with intrathoracic anastomosis (TA). Results The incidence of AL was 11.9% in the CA and 3.2% in the TA group (p<0.001). Among patients with CA who developed AL, 87 (76.3%) were managed with NPO, 15 (13.2%) with EVT, and 12 (10.5%) with surgical repair. Over 90% of patients with cervical AL resumed an oral diet by the time of discharge, regardless of treatment method. Among patients with TA and AL, 36 (53.7%) received NPO, 25 (37.7%) underwent EVT, and 6 (9%) required surgery. Of these, 34 patients who were managed with NPO and 19 with EVT could resume an oral diet. However, only 2 patients who underwent surgery resumed an oral diet, and 2 patients required additional EVT. Conclusion Although patients with CA displayed a higher incidence of AL, their rate of successful oral intake exceeded that of those with TA, regardless of treatment method. Among patients exhibiting AL with TA, EVT was more commonly employed than in CA cases, and it appears effective.
Collapse
Affiliation(s)
- Hyo Won Seo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeong Jeong Jeon
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Li X, Yu L, Fu M, Yang J, Tan H. Perioperative Risk Factors for Postoperative Pulmonary Complications After Minimally Invasive Esophagectomy. Int J Gen Med 2024; 17:567-577. [PMID: 38374814 PMCID: PMC10876009 DOI: 10.2147/ijgm.s449530] [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: 11/28/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
Background Postoperative pulmonary complications (PPCs) are the most prevalent complication after esophagectomy and are associated with a worse prognosis. This study aimed to investigate the perioperative risk factors for PPCs after minimally invasive esophagectomy (MIE). Methods Seven hundred and sixty-seven consecutive patients who underwent McKeown MIE via thoracoscopy and laparoscopy were retrospectively studied. Patient characteristics, perioperative data, and postoperative complications were analyzed. Results The incidence of PPCs after MIE was 25.2% (193/767). Univariate analysis identified age (odds ratio [OR] 1.022, P = 0.044), male sex (OR 2.955, P < 0.001), pulmonary comorbidities (OR 1.746, P = 0.032), chronic obstructive pulmonary disease (COPD) (OR 2.821, P = 0.003), former smoking status (OR 1.880, P = 0.001), postoperative albumin concentration (OR 0.941, P = 0.007), postoperative creatinine concentration (OR 1.011, P = 0.019), and perioperative transfusion (OR 2.250, P = 0.001) as risk factors for PPCs. In multivariate analysis, the independent risk factors for PPCs were male sex (OR 3.135, P < 0.001), body mass index (BMI) (OR 1.088, P = 0.002), COPD (OR 2.480, P = 0.012), neoadjuvant chemoradiotherapy (OR 2.057, P = 0.035), postoperative albumin concentration (OR 0.929, P = 0.002), and perioperative transfusion (OR 1.939, P = 0.013). The area under the receiver operating characteristic curve for the predictive model generated by multivariate logistic regression analysis was 0.671 (95% confidence interval 0.628-0.713). Conclusions Male sex, BMI, COPD, neoadjuvant chemoradiotherapy, postoperative albumin concentration, and perioperative transfusion were independent predictors of PPCs after MIE.
Collapse
Affiliation(s)
- Xiaoxi Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ling Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Miao Fu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiaonan Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hongyu Tan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| |
Collapse
|
5
|
Ólafsdóttir HS, Dalqvist E, Onjukka E, Klevebro F, Nilsson M, Gagliardi G, Alexandersson von Döbeln G. Postoperative complications after esophagectomy for cancer, neoadjuvant chemoradiotherapy compared to neoadjuvant chemotherapy: A single institutional cohort study. Clin Transl Radiat Oncol 2023; 40:100610. [PMID: 36936472 PMCID: PMC10018434 DOI: 10.1016/j.ctro.2023.100610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/22/2023] [Accepted: 03/03/2023] [Indexed: 03/07/2023] Open
Abstract
Background Complications after esophagectomy are common and the possible increase in postoperative complications associated with neoadjuvant chemoradiotherapy is of concern. The aim of our study was to analyze if the addition of radiotherapy to neoadjuvant chemotherapy increases the incidence and severity of postoperative complications, including evaluation of the relation between radiation doses to the heart and lungs and postoperative complications. Methods The study was based on an institutional surgical database for esophageal cancer. The study period was October 2008 to March 2020. Patients treated with neoadjuvant chemoradiotherapy were compared to patients treated with neoadjuvant chemotherapy and dose/volume parameters for the lungs and heart considered. The primary outcome was 30-day postoperative complications. Results During the study period, 274 patients underwent surgery for esophageal cancer, 93 patients after neoadjuvant chemotherapy and 181 patients after neoadjuvant chemoradiotherapy. The median prescribed radiation dose to the planning target volume was 41.4 Gy, the median of the mean lung dose was 6.2 Gy, and the median of the mean heart dose was 20.3 Gy. The addition of radiotherapy to neoadjuvant chemotherapy did not increase the incidence of postoperative complications. Neither were radiation doses to the lungs and heart associated with postoperative complications. Taxane-based chemotherapy regimens were however associated with an increased incidence of postoperative complications. Conclusions In our cohort, the addition of neoadjuvant radiotherapy to chemotherapy was not associated with postoperative complications. However, taxane-based chemotherapy regimens, with or without concomitant radiotherapy, were associated with postoperative complications.
Collapse
Affiliation(s)
- Halla Sif Ólafsdóttir
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE-141 52 Huddinge, Sweden
- Department of Radiotherapy, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, SE-171 64 Solna, Sweden
- Corresponding author at: Department of Radiotherapy, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Anna Steckséns gata 41, SE-171 76 Stockholm, Sweden.
| | - Emmy Dalqvist
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, SE-171 64 Solna, Sweden
| | - Eva Onjukka
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, SE-171 64 Solna, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, SE-171 64 Solna, Sweden
| | - Fredrik Klevebro
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE-141 52 Huddinge, Sweden
- Department of Upper Abdominal Diseases, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, SE-141 57 Huddinge, Sweden
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE-141 52 Huddinge, Sweden
- Department of Upper Abdominal Diseases, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, SE-141 57 Huddinge, Sweden
| | - Giovanna Gagliardi
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, SE-171 64 Solna, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, SE-171 64 Solna, Sweden
| | - Gabriella Alexandersson von Döbeln
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE-141 52 Huddinge, Sweden
- Medical Unit of Head, Neck, Lung and Skin Cancer, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, SE-171 64 Solna, Sweden
| |
Collapse
|
6
|
Rosianu CG, Hoara P, Achim F, Birla R, Bolocan A, Mohssen A, Copca N, Constantinoiu S. The Use of Esophageal Stents in the Management of Postoperative Fistulas-Current Status, Clinical Outcomes and Perspectives-Review. Life (Basel) 2023; 13:life13040966. [PMID: 37109495 PMCID: PMC10144597 DOI: 10.3390/life13040966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Esophageal fistula remains one of the main postoperative complications, with the treatment often requiring the use of stents. This article reviews the updates on the use of endoscopic stents for the treatment of postoperative esophageal leakage in terms of indications, types of stents used, efficiency, specific complications and perspectives. MATERIALS AND METHODS We searched the PubMed and MEDLINE databases for the keywords postoperative esophageal anastomotic leak and postoperative esophageal anastomotic leak stent, and retrieved relevant papers published until December 2022. RESULTS The endoscopic discovery of the fistula is usually followed by the insertion of a fully covered esophageal stent. It has an efficiency of more than 60% in closing the fistula, and the failure is related to the delayed application of the method, a situation more suitable for endo vac therapy. The most common complication is migration, but life-threatening complications have also been described. The combination of the advantages of endoscopic stents and vacuum therapy is probably found in the emerging VACstent procedure. CONCLUSIONS Although the competing approaches give promising results, this method has a well-defined place in the treatment of esophageal fistulas, and it is probably necessary to refine the indications for each individual procedure.
Collapse
Affiliation(s)
- Cristian Gelu Rosianu
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, "Sfanta Maria" Clinical Hospital, 011172 Bucharest, Romania
| | - Petre Hoara
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Centre of Excelence in Esophageal Surgery, "Sfanta Maria" Clinical Hospital, 011172 Bucharest, Romania
| | - Florin Achim
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Centre of Excelence in Esophageal Surgery, "Sfanta Maria" Clinical Hospital, 011172 Bucharest, Romania
| | - Rodica Birla
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Centre of Excelence in Esophageal Surgery, "Sfanta Maria" Clinical Hospital, 011172 Bucharest, Romania
| | - Alexandra Bolocan
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Ahmed Mohssen
- Gastroenterology Department, "Sfanta Maria" Clinical Hospital, 011172 Bucharest, Romania
| | - Narcis Copca
- Second Department of Surgery, "Sfanta Maria" Clinical Hospital, 011172 Bucharest, Romania
| | - Silviu Constantinoiu
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Centre of Excelence in Esophageal Surgery, "Sfanta Maria" Clinical Hospital, 011172 Bucharest, Romania
| |
Collapse
|
7
|
Luijten JCHBM, Verstegen MHP, van Workum F, Nieuwenhuijzen GAP, van Berge Henegouwen MI, Gisbertz SS, Wijnhoven BPL, Verhoeven RHA, Rosman C. Survival after Ivor Lewis versus McKeown esophagectomy for cancer: propensity score matched analysis. Dis Esophagus 2023:6972913. [PMID: 36617230 DOI: 10.1093/dote/doac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/08/2022] [Accepted: 11/28/2022] [Indexed: 01/09/2023]
Abstract
It is unknown whether Ivor Lewis (IL) or McKeown (McK) esophagectomy is preferred in patients with potentially curable esophageal or gastro-esophageal junction (GEJ) cancer. Patients with mid- and distal esophageal and GEJ cancer without distant metastases who underwent IL or McK esophagectomy in the Netherlands between 2015 and 2017, were selected from the Netherlands Cancer Registry. Patients were propensity score matched for sex, age, American Society of Anesthesiologist classification, comorbidity, tumor type, tumor location, clinical stage, neoadjuvant treatment and year of diagnosis. The primary outcome was a 3-year relative survival (RS). Secondary outcome parameters were number of lymph nodes examined, number of positive lymph nodes, radical resection rate, tumor regression grade, post-operative complications and mortality. A total of 1627 patients who underwent IL (n = 1094) or McK (n = 533) esophagectomy were included. Patient and tumor characteristics were balanced after propensity score matching, leaving 658 patients to be compared. The 3-year RS was 54% after IL and 50% after McK esophagectomy, P = 0.140. The median number of lymph nodes examined, median number of positive lymph nodes, radical resection rate and tumor regression grade were comparable between both groups. Recurrent laryngeal nerve palsy (2 vs. 5%, P = 0.006) occurred less frequently after IL esophagectomy. No differences were observed in post-operative anastomotic leakage rate, pulmonary complication rate and mortality rates. There was no statistically significant difference in the 3-year RS between IL and McK esophagectomy. Based on these results, both IL and McK esophagectomy can be performed in patients with mid to distal esophageal and GEJ cancer.
Collapse
Affiliation(s)
- J C H B M Luijten
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht 3501, The Netherlands.,Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen 6525, The Netherlands
| | - M H P Verstegen
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen 6525, The Netherlands.,Imperial College London, London SW7 2AZ, UK
| | - F van Workum
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen 6525, The Netherlands.,Imperial College London, London SW7 2AZ, UK
| | | | - M I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC-Location AMC, University of Amsterdam, Cancer Centre Amsterdam, Amsterdam 1081, The Netherlands
| | - S S Gisbertz
- Department of Surgery, Amsterdam UMC-Location AMC, University of Amsterdam, Cancer Centre Amsterdam, Amsterdam 1081, The Netherlands
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC, Rotterdam 3015, The Netherlands
| | - R H A Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht 3501, The Netherlands.,Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen 6525, The Netherlands
| | - C Rosman
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen 6525, The Netherlands
| |
Collapse
|
8
|
Petric J, Handshin S, Bright T, Watson DI. Planned oesophagectomy after chemoradiotherapy versus salvage oesophagectomy following definitive chemoradiotherapy: a systematic review and meta-analysis. ANZ J Surg 2022; 93:829-839. [PMID: 36582046 DOI: 10.1111/ans.18225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/05/2022] [Accepted: 12/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Oesophageal cancer is the eighth most common cancer and sixth leading cause of cancer-related mortality worldwide. Salvage oesophagectomies are associated with an increased risk of mortality, although recent data suggests that long-term survival rates following salvage oesophagectomy are similar to planned oesophagectomy. The aim was therefore to meta-analyse outcomes for patients undergoing salvage versus planned oesophagectomies to assess the differences in short-term mortality and long-term survival. METHODS A systematic review of Medline, Scopus, Web of Science and PubMed was performed to identify relevant studies. Data were extracted and compared by meta-analysis, using odds ratio and mean differences with 95% confidence intervals. RESULTS Nineteen studies meeting inclusion criteria were included in the meta-analysis, which compared patients in the planned oesophagectomy group (n = 23 555) to patients in the salvage oesophagectomy group (n = 2227). There were significant differences between the groups in terms of rates of postoperative mortality (5.7% salvage oesophagectomy versus 3.1% planned oesophagectomy, P = 0.0004), anastomotic leak (20.6% salvage oesophagectomy versus 14.5% planned oesophagectomy, P < 0.00001), pulmonary complications (37.1% salvage oesophagectomy versus 24.2% planned oesophagectomy, P < 0.0001) and R0 margin (87.6% salvage oesophagectomy versus 91.3% planned oesophagectomy, P < 0.0001). There was no statistical difference between long-term survival rates at 5 years with 39.2% for salvage and 42.6% for planned oesophagectomy (P = 0.28). CONCLUSIONS Salvage oesophagectomies do offer a meaningful chance of long-term survival (at 5 years) for select patients with oesophageal cancer, but the elevated risk of post-operative complications and mortality following salvage oesophagectomy should be recognized.
Collapse
Affiliation(s)
- Josipa Petric
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Samuel Handshin
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tim Bright
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David I Watson
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
9
|
Xing H, Hu M, Wang Z, Jiang Y. Short-term outcomes of Ivor Lewis vs. McKeown esophagectomy: A meta-analysis. Front Surg 2022; 9:950108. [PMID: 36386496 PMCID: PMC9649905 DOI: 10.3389/fsurg.2022.950108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/26/2022] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE The objective of this article is to assess the rate of anastomotic leak and other perioperative outcomes in patients undergoing esophagectomy with either thoracic or cervical anastomosis. METHODS This meta-analysis was conducted by searching relevant literature studies in Web of Science, Cochrane Library, PubMed, and Embase databases. Articles that included patients undergoing esophagectomy and compared perioperative outcomes of McKeown with Ivor Lewis procedures were included. The primary outcome parameter was anastomotic leak, and secondary outcome parameters were grade ≥2 anastomotic leak, chylothorax, recurrent laryngeal nerve injury, hospital length of stay, intensive care unit (ICU) length of stay, postoperative mortality rate, operative time, blood loss, R0 resection rate, and lymph nodes examined. RESULTS A total of eight studies, with 3,291 patients (1,857 Ivor Lewis procedure and 1,434 McKeown procedure) were eligible for analysis. Meta-analysis showed that Ivor Lewis procedure was associated with lower rate of anastomosis leak of all grades [risk ratio (RR), 0.67; 95% confidence interval (CI), 0.55-0.82; P = 0.0001], lower rate of recurrent laryngeal nerve injury (RR, 0.14; 95% CI, 0.08-0.25), and shorter length of hospital stay (weighted mean difference, 0.13; 95% CI, 0.04-0.22). Grade ≥2 anastomotic leak, chylothorax, ICU length of stay, postoperative mortality rate, operative time, blood loss, R0 resection rate, and lymph nodes examined were similar between the two groups. CONCLUSIONS Although all grades of anastomotic leak and recurrent laryngeal nerve injury are higher in the McKeown procedure, this meta-analysis supports similar short-term outcomes and oncological efficacy between Ivor Lewis and McKeown esophagectomy.
Collapse
Affiliation(s)
- Huajie Xing
- Department of Thoracic Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Mengyu Hu
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Zhiqiang Wang
- Department of Thoracic Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yuequan Jiang
- Department of Thoracic Oncology, Chongqing University Cancer Hospital, Chongqing, China
| |
Collapse
|
10
|
Schlottmann F, Angeramo CA, Bras Harriott C, Casas MA, Herbella FAM, Patti MG. Transthoracic Esophagectomy: Hand-sewn Versus Side-to-side Linear-stapled Versus Circular-stapled Anastomosis: A Systematic Review and Meta-analysis. Surg Laparosc Endosc Percutan Tech 2022; 32:380-392. [PMID: 35583556 DOI: 10.1097/sle.0000000000001050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/12/2021] [Indexed: 12/08/2022]
Abstract
BACKGROUND Three anastomotic techniques are mostly used to create an esophagogastric anastomosis in a transthoracic esophagectomy: hand-sewn (HS), side-to-side linear-stapled (SSLS), and circular-stapled (CS). The aim of this study was to compare surgical outcomes after HS, SSLS, and CS intrathoracic esophagogastric anastomosis. MATERIALS AND METHODS A systematic review using the MEDLINE database was performed to identify original articles analyzing outcomes after HS, SSLS, and CS esophagogastric anastomosis. The main outcome was an anastomotic leakage rate. Secondary outcomes included overall morbidity, major morbidity, and mortality. A meta-analysis of proportions and linear regression models were used to assess the effect of each anastomotic technique on the different outcomes. RESULTS A total of 101 studies comprising 12,595 patients were included; 8835 (70.1%) with CS, 2532 (20.1%) with HS, and 1228 (9.8%) with SSLS anastomosis. Anastomotic leak occurred in 10% [95% confidence interval (CI), 6%-15%], 9% (95% CI, 6%-13%), and 6% (95% CI, 5%-7%) of patients after HS, SSLS, and CS anastomosis, respectively. Risk of anastomotic leakage was significantly higher with HS anastomosis (odds ratio=1.73, 95% CI: 1.47-2.03, P<0.0001) and SSLS (odds ratio=1.68, 95% CI: 1.36-2.08, P<0.0001), as compared with CS. Overall morbidity (HS: 52% vs. SLSS: 39% vs. CS: 35%) and major morbidity (HS: 33% vs. CS: 19%) rates were significantly lower with CS anastomosis. Mortality rate was 4% (95% CI, 3%-6%), 2% (95% CI, 2%-3%), and 3% (95% CI, 3%-4%) after HS, SSLS, and CS anastomosis, respectively. CONCLUSION HS and SSLS intrathoracic esophagogastric anastomoses are associated with significantly higher rates of an anastomotic leak than CS anastomosis.
Collapse
Affiliation(s)
- Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
- Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Cristian A Angeramo
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | | | - María A Casas
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | | | - Marco G Patti
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
11
|
Pather K, Mobley EM, Guerrier C, Esma R, Kendall H, Awad ZT. Long-term survival outcomes of esophageal cancer after minimally invasive Ivor Lewis esophagectomy. World J Surg Oncol 2022; 20:50. [PMID: 35209914 PMCID: PMC8876443 DOI: 10.1186/s12957-022-02518-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/10/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives The aim of this study was to determine the long-term overall and disease-free survival and factors associated with overall survival in patients with esophageal cancer undergoing a totally minimally invasive Ivor Lewis esophagectomy (MILE) at a safety-net hospital. Methods This was a single-center retrospective review of consecutive patients who underwent MILE from September 2013 to November 2017. Overall and disease-free survival were analyzed by Kaplan-Meier estimates, and hazard ratios (HR) were derived from multivariable Cox regression models. Results Ninety-six patients underwent MILE during the study period. Overall survival at 1, 3, and 5 years was 83.2%, 61.9%, and 55.9%, respectively. Disease-free survival at 1, 3, and 5 years was 83.2%, 60.6%, and 47.5%, respectively. Overall survival (p < 0.001) and disease-free survival (p < 0.001) differed across pathological stages. By multivariable analysis, increasing age (HR, 1.06; p = 0.02), decreasing Karnofsky performance status score (HR, 0.94; p = 0.002), presence of stage IV disease (HR, 5.62; p = 0.002), locoregional recurrence (HR, 2.94; p = 0.03), and distant recurrence (HR, 4.78; p < 0.001) were negatively associated with overall survival. Overall survival significantly declined within 2 years and was independently associated with stage IV disease (HR, 3.29; p = 0.04) and distant recurrence (HR, 5.78; p < 0.001). Conclusion MILE offers favorable long-term overall and disease-free survival outcomes. Age, Karnofsky performance status score, stage IV, and disease recurrence are shown to be prognostic factors of overall survival. Prospective studies comparing long-term outcomes after different MIE approaches are warranted to validate survival outcomes after MILE. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02518-0.
Collapse
Affiliation(s)
- Keouna Pather
- Department of Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA. .,Division of General Surgery, Faculty Clinic, UF College of Medicine - Jacksonville, 653 West 8th Street, FC12, 3rd Floor, Jacksonville, FL, 32209, USA.
| | - Erin M Mobley
- Department of Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Christina Guerrier
- Department of Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Rhemar Esma
- UF Health Jacksonville, Jacksonville, Florida, USA
| | | | - Ziad T Awad
- Department of Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| |
Collapse
|
12
|
Harriott CB, Angeramo CA, Casas MA, Schlottmann F. Open vs. Hybrid vs. Totally Minimally Invasive Ivor Lewis Esophagectomy: Systematic Review and Meta-analysis. J Thorac Cardiovasc Surg 2022; 164:e233-e254. [DOI: 10.1016/j.jtcvs.2021.12.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/03/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023]
|
13
|
Laparoscopic ischaemic conditioning of the gastric conduit prior to a hybrid mckeown oesophagectomy may not decrease the risk of anastomotic leak. Wideochir Inne Tech Maloinwazyjne 2021; 16:669-677. [PMID: 34950261 PMCID: PMC8669984 DOI: 10.5114/wiitm.2021.105529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Morbidity associated with anastomotic leak after oesophagectomy is significant. Techniques to reduce this risk include ischaemic conditioning of the gastric conduit prior to oesophagectomy. Aim To quantify the rate of anastomotic leak after a hybrid minimally invasive McKeown oesophagectomy preceded by laparoscopic gastric devascularization (LGD). Material and methods We identified patients who had undergone neoadjuvant chemoradiotherapy followed by LGD and McKeown oesophagectomy and conducted a retrospective case series. The primary outcome was anastomotic leak, and secondary outcomes included common post-operative complications within 30 days. Results Eleven patients were identified. Seventy-three per cent were male, and 7 of 11 patients were age 70+ years. 91% of tumours were located in the lower oesophagus or gastroesophageal junction (GEJ), and 72% of the series had clinical stage of II–III. The median ischaemic conditioning time was 15 days. Eighteen per cent of patients developed an anastomotic leak, and all were managed non-operatively. One patient developed an anastomotic stricture. Three patients developed pneumonia. Three patients suffered wound infection at the site of the neck incision. One had respiratory failure requiring ventilator support. None required reoperation or readmission. There were no mortalities following either operation. Conclusions Laparoscopic ischaemic conditioning via LGD prior to a hybrid McKeown oesophagectomy for malignancy was associated with a leak rate similar to previously published data for a McKeown oesophagectomy without prior LGD.
Collapse
|
14
|
Angeramo CA, Bras Harriott C, Casas MA, Schlottmann F. Minimally invasive Ivor Lewis esophagectomy: Robot-assisted versus laparoscopic-thoracoscopic technique. Systematic review and meta-analysis. Surgery 2021; 170:1692-1701. [PMID: 34389164 DOI: 10.1016/j.surg.2021.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/06/2021] [Accepted: 07/12/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Evidence comparing conventional minimally invasive esophagectomy (CMIE) via laparoscopy and thoracoscopy with robot-assisted minimally invasive esophagectomy (RAMIE) is scarce. The aim of this meta-analysis was to compare surgical outcomes after CMIE and RAMIE with an intrathoracic anastomosis. METHODS A systematic literature search was performed to identify original articles analyzing outcomes after CMIE and RAMIE. Main surgical outcomes included operative time, intraoperative blood loss, anastomotic leak rates, pneumonia, overall morbidity, length of stay (LOS), and 30-day mortality. Oncologic outcomes included lymph node yield and R0 resections rates. A meta-analysis of proportions and linear regression models were used to assess the effect of each procedure on the different outcomes. RESULTS A total of 6,249 patients were included for analysis; 5,275 (84%) underwent CMIE and 974 (16%) RAMIE. Robotic esophagectomy had longer operative time and less intraoperative blood loss. Anastomotic leakage rates were similar with both approaches. Patients undergoing RAMIE had significantly lower rates of postoperative pneumonia (OR 0.46, 95% CI 0.35-0.61, P < .0001) and overall morbidity (OR 0.67, 95% CI 0.58-0.79, P < .0001). Median LOS was similar in both procedures (RAMIE: 12.1 versus CMIE: 11.9 days, P = .64). Similar mortality rates were found after RAMIE and CMIE (OR 0.69, 95% CI 0.34-1.38, P = .29). Lymph node yield was similar in both procedures, but RAMIE was associated with higher rates of R0 resection (OR 2.84, 95% CI 1.53-5.26, P < .001). CONCLUSION Patients undergoing robotic esophagectomy have less intraoperative blood loss, lower rates of postoperative pneumonia, reduced overall morbidity, and higher rates of R0 resections, as compared with those undergoing a laparoscopic-thoracoscopic esophageal resection.
Collapse
Affiliation(s)
| | | | - María A Casas
- Department of Surgery, Hospital Alemán of Buenos Aires, Argentina
| | | |
Collapse
|
15
|
van Workum F, Verstegen MHP, Klarenbeek BR, Bouwense SAW, van Berge Henegouwen MI, Daams F, Gisbertz SS, Hannink G, Haveman JW, Heisterkamp J, Jansen W, Kouwenhoven EA, van Lanschot JJB, Nieuwenhuijzen GAP, van der Peet DL, Polat F, Ubels S, Wijnhoven BPL, Rovers MM, Rosman C. Intrathoracic vs Cervical Anastomosis After Totally or Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer: A Randomized Clinical Trial. JAMA Surg 2021; 156:601-610. [PMID: 33978698 DOI: 10.1001/jamasurg.2021.1555] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Transthoracic minimally invasive esophagectomy (MIE) is increasingly performed as part of curative multimodality treatment. There appears to be no robust evidence on the preferred location of the anastomosis after transthoracic MIE. Objective To compare an intrathoracic with a cervical anastomosis in a randomized clinical trial. Design, Setting, and Participants This open, multicenter randomized clinical superiority trial was performed at 9 Dutch high-volume hospitals. Patients with midesophageal to distal esophageal or gastroesophageal junction cancer planned for curative resection were included. Data collection occurred from April 2016 through February 2020. Intervention Patients were randomly assigned (1:1) to transthoracic MIE with intrathoracic or cervical anastomosis. Main Outcomes and Measures The primary end point was anastomotic leakage requiring endoscopic, radiologic, or surgical intervention. Secondary outcomes were overall anastomotic leak rate, other postoperative complications, length of stay, mortality, and quality of life. Results Two hundred sixty-two patients were randomized, and 245 were eligible for analysis. Anastomotic leakage necessitating reintervention occurred in 15 of 122 patients with intrathoracic anastomosis (12.3%) and in 39 of 123 patients with cervical anastomosis (31.7%; risk difference, -19.4% [95% CI, -29.5% to -9.3%]). Overall anastomotic leak rate was 12.3% in the intrathoracic anastomosis group and 34.1% in the cervical anastomosis group (risk difference, -21.9% [95% CI, -32.1% to -11.6%]). Intensive care unit length of stay, mortality rates, and overall quality of life were comparable between groups, but intrathoracic anastomosis was associated with fewer severe complications (risk difference, -11.3% [-20.4% to -2.2%]), lower incidence of recurrent laryngeal nerve palsy (risk difference, -7.3% [95% CI, -12.1% to -2.5%]), and better quality of life in 3 subdomains (mean differences: dysphagia, -12.2 [95% CI, -19.6 to -4.7]; problems of choking when swallowing, -10.3 [95% CI, -16.4 to 4.2]; trouble with talking, -15.3 [95% CI, -22.9 to -7.7]). Conclusions and Relevance In this randomized clinical trial, intrathoracic anastomosis resulted in better outcome for patients treated with transthoracic MIE for midesophageal to distal esophageal or gastroesophageal junction cancer. Trial Registration Trialregister.nl Identifier: NL4183 (NTR4333).
Collapse
Affiliation(s)
- Frans van Workum
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Moniek H P Verstegen
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan R Klarenbeek
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefan A W Bouwense
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jan Willem Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Walther Jansen
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Ewout A Kouwenhoven
- Department of Surgery, Ziekenhuisgroep (Hospital Group) Twente, Almelo, the Netherlands
| | - Jan J B van Lanschot
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | - Fatih Polat
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Sander Ubels
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | |
Collapse
|
16
|
Li H, Lin J, Zhang H, Wu B, Chen Y, He H, Zhou L, Gong L, Chen G, Wang M, Lin W. A propensity score matching study of the short-term efficacy of azygos arch-sparing McKeown minimally invasive esophagectomy. J Gastrointest Oncol 2021; 12:28-37. [PMID: 33708422 DOI: 10.21037/jgo-21-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background To evaluate the short-term efficacy of azygos arch-sparing McKeown minimally invasive esophagectomy (McKeown-MIE). Methods We retrospectively analyzed the clinical data of 221 patients with thoracic esophageal squamous cell carcinoma who underwent McKeown-MIE at the Department of Thoracic Surgery of Gaozhou People's Hospital from August 1, 2017 to September 30, 2019. According to whether the azygos arch was preserved or not, the patients were assigned to one of two groups: the preservation group (40 cases) and the ligation group (181 cases). Within 3 months of the operation, the perioperative outcomes and the postoperative short-term efficacy of the two groups were compared. Results After propensity score (PS) matching, 40 pairs of patients were matched successfully. Between the two groups, there were no statistical difference in intraoperative blood loss, the number of lymph nodes dissected, thoracic drainage duration, fasting time, postoperative hospital stay time, and major postoperative complications (P>0.05). Compared with the ligation group, patients in the preservation group had a shorter intensive care unit (ICU) stay time, a shorter operative time, a lower volume of postoperative thoracic drainage (both the first 3 days and overall) following surgery, a tubular stomach that had a smaller caliber, and a lower incidence of tubular gastric malpositioning (P<0.05). Conclusions Preserving the azygos arch during a McKeown-MIE is safe and feasible. Doing so, not only effectively restricts the expansion of the gastric conduit, leading to a lower incidence of malpositioning, but also dramatically reduces postoperative thoracic drainage, and ICU stay time.
Collapse
Affiliation(s)
- Hui Li
- Department of Thoracic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jiongzhen Lin
- Department of Thoracic Surgery, Gaozhou People's Hospital, Guangdong Esophageal Cancer Institute Gaozhou Branch, Gaozhou, China
| | - Hai Zhang
- Department of Thoracic Surgery, Gaozhou People's Hospital, Guangdong Esophageal Cancer Institute Gaozhou Branch, Gaozhou, China
| | - Bomeng Wu
- Department of Thoracic Surgery, Gaozhou People's Hospital, Guangdong Esophageal Cancer Institute Gaozhou Branch, Gaozhou, China
| | - Ying Chen
- Department of Thoracic Surgery, Gaozhou People's Hospital, Guangdong Esophageal Cancer Institute Gaozhou Branch, Gaozhou, China
| | - Haiquan He
- Department of Thoracic Surgery, Gaozhou People's Hospital, Guangdong Esophageal Cancer Institute Gaozhou Branch, Gaozhou, China
| | - Linrong Zhou
- Department of Thoracic Surgery, Gaozhou People's Hospital, Guangdong Esophageal Cancer Institute Gaozhou Branch, Gaozhou, China
| | - Lanjuan Gong
- Department of Thoracic Surgery, Gaozhou People's Hospital, Guangdong Esophageal Cancer Institute Gaozhou Branch, Gaozhou, China
| | - Gang Chen
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Maosheng Wang
- Department of Thoracic Surgery, Gaozhou People's Hospital, Guangdong Esophageal Cancer Institute Gaozhou Branch, Gaozhou, China
| | - Wanli Lin
- Department of Thoracic Surgery, Gaozhou People's Hospital, Guangdong Esophageal Cancer Institute Gaozhou Branch, Gaozhou, China
| |
Collapse
|
17
|
A 10-year ACS-NSQIP Analysis of Trends in Esophagectomy Practices. J Surg Res 2020; 256:103-111. [DOI: 10.1016/j.jss.2020.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 02/06/2023]
|
18
|
Li Y, Liu Z, Liu G, Fang Q, Zhao L, Zhao P, Wang J, Yang M. Impact on Short-Term Complications of Early Oral Feeding in Patients with Esophageal Cancer After Esophagectomy. Nutr Cancer 2020; 73:609-616. [PMID: 32482102 DOI: 10.1080/01635581.2020.1769690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
To evaluate early oral feeding (EOF) in short-term outcomes of patients with esophageal cancer after esophagectomy. 179 patients with esophageal cancer who underwent esophagectomy between January 2016 and February 2018 were enrolled for this study. 87 patients with EOF without nasogastric tube or nasogastric tube was removed within 24 h, were selected as the experimental group, whereas 92 patients who received nasojejunal tube feeding were set as the control group. All laboratory testing, clinical features, and hospitalization expenses were compared between the two groups. No statistical significance was observed between the two groups in hemoglobin, albumin, and prealbumin levels after esophagectomy. Notably, there was no significant difference in the incidence of severe pneumonia and anastomotic leakage between the two groups. Admittance period, postoperative defecation time, and medical expenses were significantly decreased among patients with EOF (P < 0.001). Multivariate Cox multiple-factor regression analysis revealed that there was no correlation between EOF and the risk of anastomotic leakage. EOF might not be a risk factor for increasing the incidence of severe pneumonia and anastomotic leakage in patients with esophageal cancer after esophagectomy, and it could reduce the hospitalization period as well as control medical expenses.
Collapse
Affiliation(s)
- Yi Li
- Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
| | - Zhenjun Liu
- Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
| | - Guangyuan Liu
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
| | - Qiang Fang
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
| | - Lili Zhao
- Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
| | - Pei Zhao
- Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
| | - Jiuhui Wang
- Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
| | - Mu Yang
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center. School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.,Translational Centre for Oncoimmunology, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
| |
Collapse
|
19
|
Zhang T, Hou X, Li Y, Fu X, Liu L, Xu L, Liu Y. Effectiveness and safety of minimally invasive Ivor Lewis and McKeown oesophagectomy in Chinese patients with stage IA–IIIB oesophageal squamous cell cancer: a multicentre, non-interventional and observational study. Interact Cardiovasc Thorac Surg 2020; 30:812-819. [PMID: 32285107 DOI: 10.1093/icvts/ivaa038] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 02/05/2023] Open
Abstract
Abstract
OBJECTIVES
To compare the long-term overall survival and outcomes of patients with oesophageal squamous cell cancer treated with minimally invasive McKeown or Ivor Lewis oesophagectomy.
METHODS
A multicentre, non-interventional, retrospective, observational study was performed in oesophageal squamous cell cancer patients pathologically confirmed with stage IA–IIIB middle or lower thoracic tumours who underwent minimally invasive oesophagectomy between 1 January 2010 and 30 June 2017 in 7 hospitals in China. Cox proportional hazards models assessed factors associated with overall survival and disease recurrence. The primary outcome was overall survival and cancer recurrence; the secondary outcomes included number of lymph nodes resected, 30-day mortality and postoperative complications.
RESULTS
A total of 1540 patients were included (950 McKeown, 590 Ivor Lewis). The mean age was 61.6 years, and 1204 were male. The mean number of lymph nodes removed during the McKeown procedure was 21.2 ± 11.4 compared with 14.8 ± 8.9 in Ivor Lewis patients (P < 0.001). The 5-year overall survival rates were 67.9% (McKeown) and 55.0% (Ivor Lewis). McKeown oesophagectomy was associated with improved overall survival (Ivor Lewis versus McKeown hazard ratio 1.36, 95% confidence interval 1.11–1.66; P = 0.003), particularly in patients with stage T3 tumours (middle thoracic oesophagus). However, postoperative complications occurred more frequently following McKeown oesophagectomy (42.2% vs 17.6% Ivor Lewis; P < 0.001).
CONCLUSIONS
Minimally invasive McKeown oesophagectomy was associated with improved overall survival and a decreased risk of disease recurrence, while Ivor Lewis patients had fewer postoperative complications. McKeown oesophagectomy may represent the optimal technique for patients with stage T3 tumours.
Clinical trial registration: clinicaltrial.gov
NCT03428074
Collapse
Affiliation(s)
- Tong Zhang
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xiaobin Hou
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Xu
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing, China
| | - Yang Liu
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
20
|
Ozawa S, Koyanagi K, Ninomiya Y, Yatabe K, Higuchi T. Postoperative complications of minimally invasive esophagectomy for esophageal cancer. Ann Gastroenterol Surg 2020; 4:126-134. [PMID: 32258977 PMCID: PMC7105848 DOI: 10.1002/ags3.12315] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 12/11/2022] Open
Abstract
Minimally invasive esophagectomy (MIE) has been performed increasingly more frequently for the treatment of esophageal cancer, ever since it was first described in 1992. However, the incidence of postoperative complications of MIE has not yet been well-characterized, because (a) there are few reports of studies with a sufficient sample size, (b) a variety of minimally invasive surgical techniques are used, and (c) there are few reports in which an established system for classifying the severity of complications is examined. According to an analysis performed by the Esophageal Complications Consensus Group, the most common complications of MIE are pneumonia, arrhythmia, anastomotic leakage, conduit necrosis, chylothorax, and recurrent laryngeal nerve palsy. Therefore, we decided to focus on these complications. We selected 48 out of 1245 reports of studies (a) that included more than 50 patients each, (b) in which the esophagectomy technique used was clearly described, and (c) in which the complications were adequately described. The overall incidences of the postoperative complications of MIE for esophageal cancer were analyzed according to the MIE technique adopted, that is, McKeown MIE, Ivor Lewis MIE, robotic-assisted McKeown MIE, robotic-assisted Ivor Lewis MIE, or mediastinoscopic transmediastinal esophagectomy. Pneumonia, arrhythmia, anastomotic leakage, and recurrent laryngeal nerve palsy occurred at an incidence rate of about 10% each; Ivor Lewis MIE was associated with a relatively low incidence of recurrent laryngeal nerve palsy. It is important to recognize that the incidences of complications of MIE are influenced by the MIE technique adopted and the extent of lymph node dissection.
Collapse
Affiliation(s)
- Soji Ozawa
- Department of Gastroenterological SurgeryTokai University School of MedicineKanagawaJapan
| | - Kazuo Koyanagi
- Department of Gastroenterological SurgeryTokai University School of MedicineKanagawaJapan
| | - Yamato Ninomiya
- Department of Gastroenterological SurgeryTokai University School of MedicineKanagawaJapan
| | - Kentaro Yatabe
- Department of Gastroenterological SurgeryTokai University School of MedicineKanagawaJapan
| | - Tadashi Higuchi
- Department of Gastroenterological SurgeryTokai University School of MedicineKanagawaJapan
| |
Collapse
|
21
|
Luo R, He Z, Xu Y, Zhu Z. Comparison of the surgical outcomes of McKeown minimally invasive esophagectomy and Ivor-Lewis esophagectomy for the treatment of middle esophageal cancer: A single-center retrospective study. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2020. [DOI: 10.1016/j.lers.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
|
22
|
Wang J, Hu J, Zhu D, Wang K, Gao C, Shan T, Yang Y. McKeown or Ivor Lewis minimally invasive esophagectomy: a systematic review and meta-analysis. Transl Cancer Res 2020; 9:1518-1527. [PMID: 35117499 PMCID: PMC8798823 DOI: 10.21037/tcr.2020.01.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/06/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Minimally invasive esophagectomy (MIE) is increasingly accepted in many countries. McKeown esophagectomy and Ivor Lewis esophagectomy are two protocols commonly used for MIE, but which one provides more benefit to the patients remains matter of controversy. METHODS All records in PubMed, Embase, Medline, The Cochrane Library, Wanfang Database, China National Knowledge Infrastructure (CNKI) and Chinese VIP Information till May 2019 were systematically retrieved to compare the cohort studies of McKeown esophagectomy and Ivor Lewis esophagectomy. A meta-analysis of the extracted data was performed using the Review Manager 5.3 and Stata 15 software. RESULTS The meta-analysis included 23 cohort studies in which a total of 4,933 patients were enrolled. The results revealed that minimally invasive McKeown esophagectomy (MIME) was superior to minimally invasive Ivor Lewis esophagectomy (MILE) in hospital cost, but inferior to it in operating time, length of hospital stay, in-hospital mortality, 30-day mortality, 90-day mortality, anastomotic leakage, anastomotic leakage requiring surgery, anastomotic stenosis, recurrent laryngeal nerve (RLN) injury, chylothorax, pulmonary complications and total complications. There were no statistical differences between MIME and MILE in blood loss, detected number of lymph nodes, blood transfusion rate, R0 resection rate, re-operation rate, drainage duration, length of the stay in intensive care unit (ICU), 1-year mortality, lung infection, cardiac arrhythmia and delayed gastric emptying. CONCLUSIONS Except for the cost, MILE is superior to MIME in several aspects, and may represent a better choice for MIE. The results of the present study should be interpreted with caution since the meta-analysis is based on nonrandom cohort studies which may have a selection bias.
Collapse
Affiliation(s)
- Jingpu Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Jingfeng Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Dengyan Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Kankan Wang
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Chunzhi Gao
- Department of Spinal Orthopedics, General Hospital of Pingmei Shenma Medical Group, Pingdingshan 467000, China
| | - Tingting Shan
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Yang Yang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| |
Collapse
|
23
|
Famiglietti A, Lazar JF, Henderson H, Hamm M, Malouf S, Margolis M, Watson TJ, Khaitan PG. Management of anastomotic leaks after esophagectomy and gastric pull-up. J Thorac Dis 2020; 12:1022-1030. [PMID: 32274171 PMCID: PMC7139088 DOI: 10.21037/jtd.2020.01.15] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Anastomotic leak is one of the most feared complications of esophagectomy, leading to prolonged hospital stay, increased postoperative mortality, and additional cost both to the patient and the hospital. Historically, anastomotic leaks have been treated with several techniques including conservative measures, percutaneous or operative drainage, primary surgical repair with buttressing, T-tube drainage, or excision of the esophageal replacement conduit with end esophagostomy. With advances in treatment modalities, including endoscopic stenting, clips and suturing, endoluminal vacuum-assisted closure (EVAC), such leaks increasingly are being managed without operative re-intervention and with salvage of the esophageal replacement conduit. For the purposes of this review, we identified studies analyzing the management of postoperative leak after esophagectomy. We then compared the efficacy of the various newer modalities for closure of anastomotic leaks and gastric conduit defects. We found both esophageal stent and EVAC sponges are effective treatments for closure of anastomotic leak. The chosen treatment modality for salvage of the esophageal replacement conduit is entirely dependent on the patient’s clinical status and the surgeon’s preference and experience. Emerging endoscopic and endoluminal therapies have increased the armamentarium of tools the esophageal surgeon has to facilitate successful resolution of anastomotic leaks following esophagectomy with reconstruction. While some literature suggests that EVACs have a slightly superior result in conduit success, we question this endorsement as EVACs mostly are utilized for contained leaks, many of which may have healed with conservative measures. This poses a challenge as there is clearly a bias given patient selection.
Collapse
Affiliation(s)
- Amber Famiglietti
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - John F. Lazar
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hayley Henderson
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Margaret Hamm
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Stefanie Malouf
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Marc Margolis
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Thomas J. Watson
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Puja Gaur Khaitan
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| |
Collapse
|
24
|
Sabra MJ, Alwatari YA, Wolfe LG, Xu A, Kaplan BJ, Cassano AD, Shah RD. Ivor Lewis vs Mckeown esophagectomy: analysis of operative outcomes from the ACS NSQIP database. Gen Thorac Cardiovasc Surg 2020; 68:370-379. [DOI: 10.1007/s11748-020-01290-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/04/2020] [Indexed: 01/08/2023]
|
25
|
Kaufmann KB, Baar W, Glatz T, Hoeppner J, Buerkle H, Goebel U, Heinrich S. Epidural analgesia and avoidance of blood transfusion are associated with reduced mortality in patients with postoperative pulmonary complications following thoracotomic esophagectomy: a retrospective cohort study of 335 patients. BMC Anesthesiol 2019; 19:162. [PMID: 31438866 PMCID: PMC6706927 DOI: 10.1186/s12871-019-0832-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/18/2019] [Indexed: 02/07/2023] Open
Abstract
Background Postoperative pulmonary complications (PPCs) represent the most frequent complications after esophagectomy. The aim of this study was to identify modifiable risk factors for PPCs and 90-days mortality related to PPCs after esophagectomy in esophageal cancer patients. Methods This is a single center retrospective cohort study of 335 patients suffering from esophageal cancer who underwent esophagectomy between 1996 and 2014 at a university hospital center. Statistical processing was conducted using univariate and multivariate stepwise logistic regression analysis of patient-specific and procedural risk factors for PPCs and mortality. Results The incidence of PPCs was 52% (175/335) and the 90-days mortality rate of patients with PPCs was 8% (26/335) in this study cohort. The univariate and multivariate analysis revealed the following independent risk factors for PPCs and its associated mortality. ASA score ≥ 3 was the only independent patient-specific risk factor for the incidence of PPCs and 90-days mortality of patients with an odds ratio for PPCs being 1.7 (1.1–2.6 95% CI) and an odds ratio of 2.6 (1.1–6.2 95% CI) for 90-days mortality. The multivariate approach depicted two independent procedural risk factors including transfusion of packed red blood cells (PRBCs) odds ratio of 1.9 (1.2–3 95% CI) for PPCs and an odds ratio of 5.0 (2.0–12.6 95% CI) for 90-days mortality; absence of thoracic epidural anesthesia (TEA) revealed the highest odds ratio 2.0 (1.01–3.8 95% CI) for PPCs and an odds ratio of 3.9 (1.6–9.7 95% CI) for 90-days mortality. Conclusion In esophageal cancer patients undergoing esophagectomy via thoracotomy, epidural analgesia and the avoidance of intraoperative blood transfusion are significantly associated with a reduced 90-days mortality related to PPCs.
Collapse
Affiliation(s)
- Kai B Kaufmann
- Department of Anesthesiology and Critical Care Medicine, University of Freiburg, - University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
| | - Wolfgang Baar
- Department of Anesthesiology and Critical Care Medicine, University of Freiburg, - University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Torben Glatz
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Jens Hoeppner
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Hartmut Buerkle
- Department of Anesthesiology and Critical Care Medicine, University of Freiburg, - University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Ulrich Goebel
- Department of Anesthesiology and Critical Care Medicine, University of Freiburg, - University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Sebastian Heinrich
- Department of Anesthesiology and Critical Care Medicine, University of Freiburg, - University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| |
Collapse
|
26
|
Ding Q, Zhou W, Xue Y, Han X, Yin D, Xue L, Luo J. Comparison of postoperative complications between different operation methods for esophageal cancer. Thorac Cancer 2019; 10:1669-1672. [PMID: 31245903 PMCID: PMC6669799 DOI: 10.1111/1759-7714.13092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 11/26/2022] Open
Abstract
Background We explored the selection of surgical method and differences in postoperative complications in patients with esophageal cancer (EC). Methods The data of 434 patients with EC who underwent thoracic surgery at the Jiangsu Provincial People's Hospital between January 2011 and December 2016 were collected. Patients were divided into three groups: Sweet surgery (143 cases), Ivor–Lewis surgery (232 cases), and minimally invasive esophagectomy (MIE, 59 cases). The number of postoperative days, number of lymph nodes dissected, and incidence of pulmonary infection, serous membrane fluid, arrhythmia, chylous fistula, gastric emptying dysfunction, and anastomotic leakage were recorded. Results A statistically significant number of female stage I patients with upper EC underwent MIE (P < 0.05). Postoperative complications were observed in all three groups but were not statistically significant (P > 0.05). A greater number of lymph nodes were dissected in the Ivor–Lewis group compared to the other groups (P < 0.05). Conclusion Clinically, MIE is often selectively used for women with upper and mid‐early EC, especially in stage I. In our sample, more lymph nodes were dissected in the Ivor–Lewis than in the MIE group, which can reduce recurrence and improve the survival rate. Ivor–Lewis surgery is often used in mid‐lower and terminal EC, while MIE is often used in upper and mid‐early EC. Compared to the other surgical methods, MIE does not increase the risk of postoperative complications. The gradual maturation of MIE technology will further expand indications and increase the number of lymph nodes dissected.
Collapse
Affiliation(s)
- Qingqing Ding
- Department of Geriatric Oncology, People's Hospital of Jiangsu Province, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Wenyin Zhou
- Department of Pathophysiology, School of Basic Medical Science, Nanjing Medical University, Nanjing, China
| | - Yibo Xue
- Department of Thoracic Surgery, People's Hospital of Jiangsu Province, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao Han
- Department of Geriatric Oncology, People's Hospital of Jiangsu Province, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Dandan Yin
- Department of Geriatric Oncology, People's Hospital of Jiangsu Province, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Lei Xue
- Department of Thoracic Surgery, People's Hospital of Jiangsu Province, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Jinhua Luo
- Department of Thoracic Surgery, People's Hospital of Jiangsu Province, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| |
Collapse
|
27
|
Gao C, Xu G, Wang C, Wang D. Evaluation of preoperative risk factors and postoperative indicators for anastomotic leak of minimally invasive McKeown esophagectomy: a single-center retrospective analysis. J Cardiothorac Surg 2019; 14:46. [PMID: 30819240 PMCID: PMC6394086 DOI: 10.1186/s13019-019-0864-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Minimally invasive McKeown esophagectomy is an important surgical approach for esophageal cancer. Anastomotic leak is one of its common and serious complications. We assumed that the preoperative risk factors and postoperative indicators would predict or detect anastomotic leak. METHODS Between December 2016 and July 2017, patients underwent minimally invasive McKeown esophagectomy were identified and their preoperative variables and postoperative test indicators were recorded. Fisher's exact test, 2-tailed unpaired t test, nonparametric test and logistic regression were used to compare these datum between patients with or without anastomotic leak (AL). Receiver Operator Characteristic (ROC) curve was used to identify the best cut-off value of drainage amylase concentration for distinguishing anastomotic leak. RESULTS In all the 96 patients included, 12 patients were diagnosed as anastomotic leak by the esophagram. No differences in preoperative variables were observed between patients with and without AL. Patients in AL group appeared to have a lower prealbumin concentration in AL group on POD (postoperative day) 4(P = 0.05), POD 5(P = 0.04), POD 6 (P = 0.06). Prealbumin concentration cutoff value of 128 g/L on postoperative day 5 is 100.00% sensitive and 50.00% specific for predicting esophageal leaks. Drain amylases levels were higher in patients with anastomotic leak than those without anastomotic leak on POD 3(P = 0.03), POD 4(P = 0.01), POD 5(P < 0.001), POD 6(P < 0.001). The drain amylase cutoff value of 85 IU/L on postoperative day 4 was 75.00% sensitive and 84.00% specific for detecting esophageal leaks; the cutoff value of 65 IU/L on postoperative day 5 was 91.67% sensitive and 80.77% specific. The cutoff of 55/L on POD 6 is 100% sensitive and 86.96% specific. CONCLUSION Drainage amylase concentration on postoperative days may help to discover anastomotic leak in early stage after minimally invasive McKeown esophagectomy. Prealbumin concentration below 128 g/L on POD 5 might be potential risk factor for anastomotic leak.
Collapse
Affiliation(s)
- Chuan Gao
- Department of Thoracic Surgery, Jinling Hospital, No.34 Yanggongjing, Qinhuai District, Nanjing, 210002, China
| | - Gang Xu
- Department of Thoracic Surgery, Jinling Hospital, No.34 Yanggongjing, Qinhuai District, Nanjing, 210002, China
| | - Changyong Wang
- Department of Thoracic Surgery, Jinling Hospital, No.34 Yanggongjing, Qinhuai District, Nanjing, 210002, China
| | - Dong Wang
- Department of Thoracic Surgery, Jinling Hospital, No.34 Yanggongjing, Qinhuai District, Nanjing, 210002, China.
| |
Collapse
|
28
|
Baranov NS, van Workum F, van der Maas J, Kouwenhoven E, van Det M, van den Wildenberg FJH, Polat F, Nieuwenhuijzen GAP, Luyer MDP, Rosman C. The Influence of Age on Complications and Overall Survival After Ivor Lewis Totally Minimally Invasive Esophagectomy. J Gastrointest Surg 2019; 23:1293-1300. [PMID: 30565069 PMCID: PMC6591183 DOI: 10.1007/s11605-018-4062-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 11/15/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The number of elderly patients suffering from esophageal cancer is increasing, due to an increasing incidence of esophageal cancer and increasing life expectancy. However, the effect of age on morbidity, mortality, and survival after Ivor Lewis total minimally invasive esophagectomy (TMIE) is not well known. METHODS A prospectively documented database from December 2010 to June 2017 was analyzed, including all patients who underwent Ivor Lewis TMIE for esophageal cancer in three Dutch high-volume esophageal cancer centers. Patients younger than 75 years (younger group) were compared to patients aged 75 years or older (elderly group). Baseline patient characteristics and perioperative data were included. Surgical complications were graded using the Clavien-Dindo scale. The primary outcome was postoperative complications Clavien-Dindo ≥ 3. Secondary outcome parameters were postoperative complications, in-hospital mortality, 30- and 90-day mortality and survival. RESULTS Four hundred and forty-six patients were included, 357 in the younger and 89 in the elderly group. No significant differences were recorded regarding baseline patient characteristics. There was no significant difference in complications graded Clavien-Dindo ≥ 3 and overall complications, short-term mortality, and survival. Delirium occurred in 27.0% in the elderly and 11.8% in the younger group (p < 0.001). After correction for baseline comorbidity this difference remained significant (p = 0.001). Median hospital length of stay was 13 days in the elderly and 11 days in the younger group (p = 0.010). CONCLUSIONS Ivor Lewis TMIE can be safely performed in selected elderly patients without increasing postoperative morbidity and mortality.
Collapse
Affiliation(s)
- Nikolaj S. Baranov
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Marc van Det
- Department of Surgery, ZGT Hospital, Almelo, The Netherlands
| | | | - Fatih Polat
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Misha D. P. Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
29
|
Deng J, Su Q, Ren Z, Wen J, Xue Z, Zhang L, Chu X. Comparison of short-term outcomes between minimally invasive McKeown and Ivor Lewis esophagectomy for esophageal or junctional cancer: a systematic review and meta-analysis. Onco Targets Ther 2018; 11:6057-6069. [PMID: 30275710 PMCID: PMC6157998 DOI: 10.2147/ott.s169488] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose Minimally invasive esophagectomy is increasingly performed for esophageal or gastroesophageal junctional cancer, with advantages of improved perioperative outcomes in comparison with open esophagectomy. McKeown and Ivor Lewis are widely used procedures of minimally invasive esophagectomy, and there have been controversies on which one is preferred for patients with resectable esophageal or junctional cancer. Patients and methods This review was registered at the International Prospective Register of Systematic Reviews (number CRD42017075989). Studies in PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov were thoroughly investigated. Eligible studies included prospective and retrospective studies evaluating short-term outcomes of minimally invasive McKeown esophagectomy (MIME) vs minimally invasive Ivor Lewis esophagectomy (MILE) in patients with resectable esophageal or junctional tumors. Main parameters included anastomotic leak and 30-day/in-hospital mortality. Overall incidence rates (ORs)/weighted mean difference (WMD) with 95% confidence intervals (CIs) were calculated by employing random-effects models. Results Fourteen studies containing 3,468 cases were included in this meta-analysis. Age, male sex, and American Joint Committee on Cancer (AJCC) stage between the 2 groups were not statistically different. MIME led to more blood loss, longer operating time, and longer hospital stay than MILE. MIME was associated with higher incidence of pulmonary complications (OR =1.96, 95% CI =1.28–3.00) as well as total anastomotic leak (OR =2.55, 95% CI =1.40–4.63), stricture (OR =2.07, 95% CI =1.05–4.07), and vocal cord injury/palsy (OR =5.62, 95% CI =3.46–9.14). In addition, the differences of R0 resection rate, number of lymph modes retrieved, blood transfusion rate, length of intensive care unit stay, incidence of cardiac arrhythmia, and Chyle leak between MIME and MILE were not statistically significant. Notably, incidence of severe anastomotic leak (OR =1.28, 95% CI =0.73–2.24) and 30-day/in-hospital mortality (OR =1.76, 95% CI =0.92–3.36) as well as 90-day mortality (OR =2.22, 95% CI =0.71–6.98) between the 2 procedures were also not significantly different. Conclusion This study suggests that MIME and MILE are comparable with respect to clinical safety. MILE may be a better option when oncologically and clinically suitable. MIME is still a safe alternative procedure when clinically indicated. However, this evidence is at risk for bias; randomized controlled trials are needed to validate or correct our results.
Collapse
Affiliation(s)
- Jianqing Deng
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Qingqing Su
- Department of Nursing Department, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhipeng Ren
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Jiaxin Wen
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Zhiqiang Xue
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Lianbin Zhang
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Xiangyang Chu
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| |
Collapse
|
30
|
Jelvehgaran P, Alderliesten T, Georgiou G, Meijer SL, Bloemen PR, Kodach LL, van Laarhoven HWM, van Berge Henegouwen MI, Hulshof MCCM, Rasch CRN, van Leeuwen TG, de Boer JF, de Bruin M, van Herk M. Feasibility of using optical coherence tomography to detect radiation-induced fibrosis and residual cancer extent after neoadjuvant chemo-radiation therapy: an ex vivo study. BIOMEDICAL OPTICS EXPRESS 2018; 9:4196-4216. [PMID: 30615728 PMCID: PMC6157785 DOI: 10.1364/boe.9.004196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/03/2018] [Accepted: 08/02/2018] [Indexed: 05/11/2023]
Abstract
Treatment of resectable esophageal cancer includes neoadjuvant chemo-radiation therapy (nCRT) followed by esophagectomy in operable patients. High-risk surgery may have been avoided in patients with a pathological complete response (pCR). We investigated the feasibility of optical coherence tomography (OCT) to detect residual cancer and radiation-induced fibrosis in 10 esophageal cancer patients that underwent nCRT followed by esophagectomy. We compared our OCT findings with histopathology. Overall, OCT was able to differentiate between healthy tissue, fibrotic tissue, and residual cancer with a sensitivity and specificity of 79% and 67%, respectively. Hence, OCT has the potential to add to the assessment of a pCR.
Collapse
Affiliation(s)
- Pouya Jelvehgaran
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
- Institute for Laser Life and Biophotonics Amsterdam, Department of Physics and Astronomy, VU University Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Tanja Alderliesten
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Giota Georgiou
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Sybren L. Meijer
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Paul R. Bloemen
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Liudmila L. Kodach
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Hanneke W. M. van Laarhoven
- Department of Medical Oncology, Amsterdam UMC and Cancer Center Amsterdam, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Mark I. van Berge Henegouwen
- Department of Surgery, Amsterdam UMC and Cancer Center Amsterdam, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Maarten C. C. M. Hulshof
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Coen R. N. Rasch
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Ton G. van Leeuwen
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Johannes F. de Boer
- Institute for Laser Life and Biophotonics Amsterdam, Department of Physics and Astronomy, VU University Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Martijn de Bruin
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Marcel van Herk
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
- Manchester Cancer Research Centre, Division of Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK
| |
Collapse
|
31
|
Masabni K, Kandagatla P, Popoff AM, Rubinfeld I, Hammoud Z. Is Esophagectomy for Benign Conditions Benign? Ann Thorac Surg 2018; 106:368-374. [PMID: 29689236 DOI: 10.1016/j.athoracsur.2018.03.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/05/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Outcomes data on esophagectomy performed for benign conditions is scarce. Using the National Surgical Quality Improvement Program database, we sought to analyze outcomes of esophagectomy performed for benign conditions. METHODS The National Surgical Quality Improvement Program database was queried for all esophagectomies performed from 2005 to 2015. Outcomes for benign conditions were analyzed and compared with outcomes for malignant conditions. RESULTS Esophagectomy was performed in 7,477 patients during the study period. Of those, 6,762 underwent esophagectomy for malignant conditions and 715 for benign conditions. For patients with benign conditions, reconstruction was performed using gastric conduit in 631 and colon/intestine in 84. The anastomosis was intrathoracic in 420 and cervical in 295. Benign esophagectomies were more likely to be emergent (10.1% vs 0.4%, p < 0.001). In addition, these patients had a longer hospital length of stay (17.2 days vs 14.5 days, p < 0.001) and higher occurrence of Clavien-Dindo grade IV complications (25% vs 20%, p = 0.003). Mortality was similar at 4%. In patients with benign conditions, reconstruction with colon/intestine had higher occurrence of Clavien-Dindo Grade IV complications (37% vs 23%, p = 0.006), surgical wound infections (33% vs 16%, p < 0.001), and death (10% vs 4%, p = 0.017) compared with gastric reconstruction. Site of anastomosis did not affect outcomes. CONCLUSIONS Benign esophagectomies are associated with significant morbidity. Although the site of the anastomosis does not alter outcomes, use of colon/intestine conduit should be pursued with caution.
Collapse
Affiliation(s)
- Khalil Masabni
- Department of Surgery, Henry Ford Health System/Wayne State University, Detroit, Michigan
| | - Pridvi Kandagatla
- Department of Surgery, Henry Ford Health System/Wayne State University, Detroit, Michigan
| | - Andrew M Popoff
- Division of Thoracic Surgery, Henry Ford Health System/Wayne State University, Detroit, Michigan
| | - Ilan Rubinfeld
- Department of Surgery, Henry Ford Health System/Wayne State University, Detroit, Michigan
| | - Zane Hammoud
- Division of Thoracic Surgery, Henry Ford Health System/Wayne State University, Detroit, Michigan.
| |
Collapse
|