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Zhu Y, Zhang X, Hu Y, Liu L. Optimized thoracoport design for the thoracoscopic procedure during minimally invasive esophagectomy. J Surg Oncol 2018; 117:1246-1250. [PMID: 29355959 DOI: 10.1002/jso.24962] [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: 08/06/2017] [Accepted: 11/28/2017] [Indexed: 02/05/2023]
Abstract
Minimally invasive esophagectomy has several benefits as an effective alternative treatment for esophageal cancer. The three-phase esophageal resection may be the most popular approach to esophagectomy. Numerous thoracoport designs are available for the thoracoscopic procedure. The present study aims to contribute a distinctive three-port technique that is designed to minimize surgical trauma and facilitate operation during the thoracoscopic procedure. In this paper, we describe and demonstrate the details of the port design and each operation step. Based on our practical experience, the rational combination of the port design and instrument usage of the three-port technique makes the thorascopic procedure more convenient.
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Affiliation(s)
- Yunke Zhu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Xiaolong Zhang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Yang Hu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
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Yibulayin W, Abulizi S, Lv H, Sun W. Minimally invasive oesophagectomy versus open esophagectomy for resectable esophageal cancer: a meta-analysis. World J Surg Oncol 2016; 14:304. [PMID: 27927246 PMCID: PMC5143462 DOI: 10.1186/s12957-016-1062-7] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/23/2016] [Indexed: 12/11/2022] Open
Abstract
Background Open esophagectomy (OE) is associated with significant morbidity and mortality. Minimally invasive oesophagectomy (MIO) reduces complications in resectable esophageal cancer. The aim of this study is to explore the superiority of MIO in reducing complications and in-hospital mortality than OE. Methods MEDLINE, Embase, Science Citation Index, Wanfang, and Wiley Online Library were thoroughly searched. Odds ratio (OR)/weighted mean difference (WMD) with a 95% confidence interval (CI) was used to assess the strength of association. Results Fifty-seven studies containing 15,790 cases of resectable esophageal cancer were included. MIO had less intraoperative blood loss, short hospital stay, and high operative time (P < 0.05) than OE. MIO also had reduced incidence of total complications; (OR = 0.700, 95% CI = 0.626 ~ 0.781, PV < 0.05), pulmonary complications (OR = 0.527, 95% CI = 0431 ~ 0.645, PV < 0.05), cardiovascular complications (OR = 0.770, 95% CI = 0.681 ~ 0.872, PV < 0.05), and surgical technology related (STR) complications (OR = 0.639, 95% CI = 0.522 ~ 0.781, PV < 0.05), as well as lower in-hospital mortality (OR = 0.668, 95% CI = 0.539 ~ 0.827, PV < 0.05). However, the number of harvested lymph nodes, intensive care unit (ICU) stay, gastrointestinal complications, anastomotic leak (AL), and recurrent laryngeal nerve palsy (RLNP) had no significant difference. Conclusions MIO is superior to OE in terms of perioperative complications and in-hospital mortality.
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Affiliation(s)
- Waresijiang Yibulayin
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Sikandaer Abulizi
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Hongbo Lv
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Wei Sun
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China.
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Zhou C, Ma G, Li X, Li J, Yan Y, Liu P, He J, Ren Y. Is minimally invasive esophagectomy effective for preventing anastomotic leakages after esophagectomy for cancer? A systematic review and meta-analysis. World J Surg Oncol 2015; 13:269. [PMID: 26338060 PMCID: PMC4560054 DOI: 10.1186/s12957-015-0661-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/27/2015] [Indexed: 02/07/2023] Open
Abstract
Background Compared with open esophagectomy (OE), minimally invasive esophagectomy (MIE) proves to have clear benefits in reducing the risk of pulmonary complications for patients with resectable esophageal cancer. The objectives of our study were to explore the superiority of MIE in reducing the occurrence of anastomotic leakages (ALs) when compared to OE. Methods A systematic review and meta-analysis was performed to assess the superiority of MIE on the occurrence of ALs over OE, by searching many sources (through December, 2014) such as Medline, Embase, Wiley Online Library, and Cochrane Library. Fixed-effects model was used to calculate summary odds ratios (ORs) to quantify associations between OE and MIE groups. Cochran’s Q and I2 statistics were used to evaluate heterogeneity among studies. Results Among a total of 43 studies involving 5537 patients included in the meta-analysis, 2527 (45.6 %) cases underwent MIE and 3010 (54.4 %) cases underwent OE. Compared to patients undergoing OE, patients undergoing MIE did not have statistical significance in reduced occurrence of ALs (OR = 0.97, 95 % CI = 0.80–1.17). Insignificant reduced occurrence of ALs was not associated with anastomotic location (OR = 0.90, 95 % CI = 0.71–1.13) or anastomotic procedure (OR = 1.02, 95 % CI = 0.79–1.30). Conclusions More proofs are needed to clarify the strengths or weaknesses of MIE in preventing anastomotic leakages after esophagectomy for cancer. A largely randomized, controlled trial should be undertaken to resolve this contentious issue urgently.
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Affiliation(s)
- Can Zhou
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China.
| | - Gang Ma
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China.
| | - Xiao Li
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China
| | - Juan Li
- Department of Translational Medicine Center, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Yu Yan
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China
| | - Peijun Liu
- Department of Translational Medicine Center, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Jianjun He
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China.
| | - Yu Ren
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China.
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Superiority of Minimally Invasive Oesophagectomy in Reducing In-Hospital Mortality of Patients with Resectable Oesophageal Cancer: A Meta-Analysis. PLoS One 2015. [PMID: 26196135 PMCID: PMC4509855 DOI: 10.1371/journal.pone.0132889] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Compared with open oesophagectomy (OE), minimally invasive oesophagectomy (MIO) proves to have benefits in reducing the risk of pulmonary complications for patients with resectable oesophageal cancer. However, it is unknown whether MIO has superiority in reducing the occurrence of in-hospital mortality (IHM). Objective The objective of this meta-analysis was to explore the effect of MIO vs. OE on the occurrence of in-hospital mortality (IHM). Data Sources Sources such as Medline (through December 31, 2014), Embase (through December 31, 2014), Wiley Online Library (through December 31, 2014), and the Cochrane Library (through December 31, 2014) were searched. Study Selection Data of randomized and non-randomized clinical trials related to MIO versus OE were included. Interventions Eligible studies were those that reported patients who underwent MIO procedure. The control group included patients undergoing conventional OE. Study Appraisal and Synthesis Methods Fixed or random -effects models were used to calculate summary odds ratios (ORs) or relative risks (RRs) for quantification of associations. Heterogeneity among studies was evaluated by using Cochran’s Q and I2 statistics. Results A total of 48 studies involving 14,311 cases of resectable oesophageal cancer were included in the meta-analysis. Compared to patients undergoing OE, patients undergoing MIO had statistically reduced occurrence of IHM (OR=0.69, 95%CI =0.55 -0.86). Patients undergoing MIO also had significantly reduced incidence of pulmonary complications (PCs) (RR=0.73, 95%CI = 0.63-0.86), pulmonary embolism (PE) (OR=0.71, 95%CI= 0.51-0.99) and arrhythmia (OR=0.79, 95%CI = 0.68-0.92). Non-significant reductions were observed among the included studies in the occurrence of anastomotic leak (AL) (OR=0.93, 95%CI =0.78-1.11), or Gastric Tip Necrosis (GTN) (OR=0.89, 95%CI =0.54-1.49). Limitation Most of the included studies were non-randomized case-control studies, with a diversity of study designs, demographics of participants and surgical intervention. Conclusions Minimally invasive oesophagectomy (MIO) has superiority over open oesophagectomy (OE) in terms of the occurrence of in-hospital mortality (IHM) and should be the first-choice surgical procedure in esophageal surgery.
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Abstract
BACKGROUND We have initially published our experience with the robotic transthoracic esophagectomy in 32 patients from a single institute. The present paper is the extension of our experience with robotic system and to best of our knowledge this represents the largest series of robotic transthoracic esophagectomy worldwide. The objective of this study was to investigate the feasibility of the robotic transthoracic esophagectomy for esophageal cancer in a series of patients from a single institute. METHODS A retrospective review of medical records was conducted for 83 esophageal cancer patients who underwent robotic esophagectomy at our institute from December 2009 to December 2012. All patients underwent a thorough clinical examination and pre-operative investigations. All patients underwent robotic esophageal mobilization. En-bloc dissection with lymphadenectomy was performed in all cases with preservation of Azygous vein. Relevant data were gathered from medical records. RESULTS The study population comprised of 50 men and 33 women with mean age of 59.18 years. The mean operative time was 204.94 mins (range 180 to 300). The mean blood loss was 86.75 ml (range 50 to 200). The mean number of lymph node yield was 18. 36 (range 13 to 24). None of the patient required conversion. The mean ICU stay and hospital stay was 1 day (range 1 to 3) and 10.37 days (range 10 to 13), respectively. A total of 16 (19.28%) complication were reported in these patents. Commonly reported complication included dysphagia, pleural effusion and anastomotic leak. No treatment related mortality was observed. After a median follow-up period of 10 months, 66 patients (79.52%) survived with disease free stage. CONCLUSIONS We found robot-assisted thoracoscopic esophagectomy feasible in cases of esophageal cancer. The procedure allowed precise en-bloc dissection with lymphadenectomy in mediastinum with reduced operative time, blood loss and complications.
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Koyanagi K, Ozawa S, Tachimori Y. Minimally invasive esophagectomy performed with the patient in a prone position: a systematic review. Surg Today 2015; 46:275-84. [DOI: 10.1007/s00595-015-1164-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/12/2015] [Indexed: 12/14/2022]
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Honda M, Daiko H, Kinoshita T, Fujita T, Shibasaki H, Nishida T. Minimally invasive resection of synchronous thoracic esophageal and gastric carcinomas followed by reconstruction: a case report. Surg Case Rep 2015; 1:12. [PMID: 26943380 PMCID: PMC4747966 DOI: 10.1186/s40792-015-0018-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 01/09/2015] [Indexed: 12/13/2022] Open
Abstract
We report on a case of synchronous carcinomas of the esophagus and stomach. A 68-year-old man was referred to our hospital for an abnormality found during his medical examination. Further evaluation revealed squamous cell carcinoma in the thoracic lower esophagus and gastric adenocarcinoma located in the middle third of the stomach. Thoracoscopic esophagectomy in the prone position (TSEP), laparoscopic total gastrectomy (LTG) with three-field lymph node dissection, and laparoscopically assisted colon reconstruction (LACR) were performed. The patient did not have any major postoperative complications. His pathological examination revealed no metastases in 56 harvested lymph nodes and no residual tumor. He was followed up for 30 months without recurrence. To our knowledge, this is the first report of esophageal and gastric synchronous carcinomas that were successfully treated with a combination of TSEP, LTG, and LACR. These operations may be a feasible and appropriate treatment for this disease.
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Affiliation(s)
- Masayuki Honda
- Department of Gastrointestinal Oncology, Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, 277-0882, Kashiwa, Chiba, Japan.
| | - Hiroyuki Daiko
- Department of Gastrointestinal Oncology, Esophageal Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, 277-0822, Kashiwa, Chiba, Japan.
| | - Takahiro Kinoshita
- Department of Gastrointestinal Oncology, Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, 277-0882, Kashiwa, Chiba, Japan.
| | - Takeo Fujita
- Department of Gastrointestinal Oncology, Esophageal Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, 277-0822, Kashiwa, Chiba, Japan.
| | - Hidehito Shibasaki
- Department of Gastrointestinal Oncology, Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, 277-0882, Kashiwa, Chiba, Japan.
| | - Toshiro Nishida
- Department of Gastrointestinal Oncology, Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, 277-0882, Kashiwa, Chiba, Japan.
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Dantoc MM, Cox MR, Eslick GD. The first randomised controlled trial on minimally invasive esophagectomy (MIE) and the ongoing quest for greater evidence. J Thorac Dis 2012; 4:459-61. [PMID: 23050107 DOI: 10.3978/j.issn.2072-1439.2012.08.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 08/14/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Marc M Dantoc
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
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Uttley L, Campbell F, Rhodes M, Cantrell A, Stegenga H, Lloyd-Jones M. Minimally invasive oesophagectomy versus open surgery: is there an advantage? Surg Endosc 2012; 27:724-31. [PMID: 23052523 DOI: 10.1007/s00464-012-2546-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 08/09/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND Oesophageal resection is the main method of curative treatment for cancer of the oesophagus. Despite advances in surgical technology and postoperative care, the survival rate and prognosis of people undergoing oesophagectomy is still poor. The use of minimally invasive techniques in oesophageal surgery offers hope of reduced recovery time due to a reduction in surgical trauma. Although the first reports of thoracoscopy- and laparoscopy-assisted oesophagectomy emerged some 20 years ago, there is still no consensus that the outcomes are clearly superior to outcomes following conventional open surgery. Increasingly, some surgeons promote the use of minimally invasive techniques for oesophagectomy but questions remain over its safety and efficacy compared with open surgery. METHODS We conducted a systematic review of the literature to compare minimally invasive techniques for oesophagectomy to open surgery. The outcomes of interest for efficacy and safety included mortality, operative complications, recurrence, and quality of life. RESULTS There were 28 included comparative studies. No randomised controlled studies (RCTs) were available and therefore the data need to be interpreted with caution. CONCLUSION Recommendations for future research are discussed. We argue that it is difficult to conduct an RCT for this procedure due to ethical considerations and suggest ways that future nonrandomised studies could be improved.
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Affiliation(s)
- Lesley Uttley
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
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Affiliation(s)
- Simon Law
- Department of Surgery, Division of Esophageal and Upper Gastrointestinal Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
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Short-term outcomes following open versus minimally invasive esophagectomy for cancer in England: a population-based national study. Ann Surg 2012; 255:197-203. [PMID: 22173202 DOI: 10.1097/sla.0b013e31823e39fa] [Citation(s) in RCA: 184] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare short-term outcomes of open and minimally invasive esophagectomy (MIE) for cancer. BACKGROUND DATA Numerous studies have demonstrated the safety and possible advantages of MIE in selected cohorts of patients. The increasing use of MIE is not coupled with conclusive evidence of its benefits over "open" esophagectomy, especially in the absence of randomized trials. METHODS Hospital Episode Statistics data were analyzed from April 2005 to March 2010. This is a routinely collected database of all English National Health Service Trusts. Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures, 4th revision (OPCS-4), procedure codes were used to identify index resections and International Statistical Classification of Diseases, 10th Revision (ICD-10), diagnostic codes were used to ascertain comorbidity status and complications. Thirty-day in-hospital mortality, medical complications, and surgical reinterventions were analyzed. Unadjusted and risk-adjusted regression analyses were undertaken. RESULTS Seven thousand five hundred and two esophagectomies were undertaken; of these, 1155 (15.4%) were MIE. In 2009-2010, 24.7% of resections were MIE. There was no difference in 30-day mortality (4.3% vs 4.0%; P = 0.605) and overall medical morbidity (38.0% vs 39.2%; P = 0.457) rates between open and MIE groups, respectively. A higher reintervention rate was associated with the MIE group than with the open group (21% vs 17.6%, P = 0.006; odds ratio, 1.17; 95% confidence interval, 1.00-1.38; P = 0.040). CONCLUSIONS Minimally invasive esophagectomy is increasingly performed in the United Kingdom. Although the study confirmed the safety of MIE in a population-based national data, there are no significant benefits demonstrated in mortality and overall morbidity. Minimally invasive esophagectomy is associated with higher reintervention rate. Further evidence is needed to establish the long-term survival of MIE.
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Jarral OA, Purkayastha S, Athanasiou T, Darzi A, Hanna GB, Zacharakis E. Thoracoscopic esophagectomy in the prone position. Surg Endosc 2012; 26:2095-103. [PMID: 22395952 DOI: 10.1007/s00464-012-2172-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 01/13/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Minimally invasive esophageal surgery has arisen in an attempt to reduce the significant complications associated with esophagectomy. Despite proposed technical and physiological advantages, the prone position technique has not been widely adopted. This article reviews the current status of prone thoracoscopic esophagectomy. METHODS A systematic literature search was performed to identify all published clinical studies related to prone esophagectomy. Medline, EMBASE and Google Scholar were searched using the keywords "prone," "thoracoscopic," and "esophagectomy" to identify articles published between January 1994 and September 2010. A critical review of these studies is given, and where appropriate the technique is compared to the more traditional minimally invasive technique utilising the left lateral decubitus position. RESULTS Twelve articles reporting the outcomes following prone thoracoscopic oesophagectomy were tabulated. These studies were all non-randomised single-centre prospective or retrospective studies of which four compared the technique to traditional minimally invasive surgery. Although prone esophagectomy is demonstrated as being both feasible and safe, there is no convincing evidence that it is superior to other forms of esophageal surgery. Most authors comment that the prone position is associated with superior surgical ergonomics and theoretically offers a number of physiological benefits. CONCLUSION The ideal approach within minimally invasive esophageal surgery continues to be a subject of debate since no single method has produced outstanding results. Further clinical studies are required to see whether ergonomic advantages of the prone position can be translated into improved patient outcomes.
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Affiliation(s)
- Omar A Jarral
- Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College London, Praed Street, London, W2 1NY, UK
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Dantoc MM, Cox MR, Eslick GD. Does minimally invasive esophagectomy (MIE) provide for comparable oncologic outcomes to open techniques? A systematic review. J Gastrointest Surg 2012; 16:486-94. [PMID: 22183862 DOI: 10.1007/s11605-011-1792-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 11/23/2011] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of this study is to compare minimally invasive esophagectomy (MIE) and open techniques with respect to oncologic outcomes through analysis of the extent of lymph node clearance, number of lymph nodes retrieved, oncologic stage, and 5-year mortality. METHODOLOGY A systematic review of the literature review was conducted using MEDLINE, PubMed, EMBASE, and the Cochrane databases (1950-2011), and evaluated all comparative studies. Comparison between the open and MIE/hybrid MIE (HMIE) groups was possible with data being available for direct comparison. RESULTS After careful review, 17 case-control studies with 1,586 patients having an esophagectomy were included in this systematic review. The median (range) number of lymph nodes found in the MIE, open and HMIE groups were 16 (5.7-33.90), 10 (3-32.80) and 17 (17-17.15), of which there was significance between the MIE and open groups (p=0.03) but not significant between MIE versus HMIE (p=0.25). There was no statistical significance in pathologic stage between open, MIE and HMIE groups. Generally, there were good short-term (30 day) survival rates between all three groups. The open group had 5-year survival rates between 16% and 57% compared to the MIE group 12.5%-63% (p=0.33). Overall 5-year survival was found to be not significant between open group and MIE (p=0.93). MIE does not appear on statistical evidence to present any survival advantage. CONCLUSION The evidence of this study suggests that MIE is equivalent to standard open esophagectomy in achieving similar oncological outcomes. Further randomised controlled trials are required to provide for a higher level of evidence.
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Affiliation(s)
- Marc M Dantoc
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Sydney Medical School, Nepean Hospital, Penrith, NSW, 2751, Australia
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14
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An Early Experience Using the Technique of Transoral OrVil EEA Stapler for Minimally Invasive Transthoracic Esophagectomy. Ann Thorac Surg 2011; 92:1862-9. [DOI: 10.1016/j.athoracsur.2011.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 07/07/2011] [Accepted: 07/12/2011] [Indexed: 12/29/2022]
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Najarian S, Fallahnezhad M, Afshari E. Advances in medical robotic systems with specific applications in surgery--a review. J Med Eng Technol 2011; 35:19-33. [PMID: 21142589 DOI: 10.3109/03091902.2010.535593] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Although robotics was started as a form of entertainment, it gradually became used in different branches of science. Medicine, particularly in the operating room, has been influenced significantly by this field. Robotic technologies have offered valuable enhancements to medical or surgical processes through improved precision, stability and dexterity. In this paper we review different robotics and computer-assisted systems developed with medical and surgical applications. We cover early and recently developed systems in different branches of surgery. In addition to the united operational systems, we provide a review of miniature robotic, diagnostic and sensory systems developed to assist or collaborate with a main operator system. At the end of the paper, a discussion is given with the aim of summarizing the proposed points and predicting the future of robotics in medicine.
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Affiliation(s)
- S Najarian
- Biomechanics Department, Laboratory of Artificial Tactile Sensing and Robotic Surgery, Faculty of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Hafez Avenue, Tehran, Iran.
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Quality indicators of surgery for adenocarcinoma of the esophagus and gastroesophageal junction. Recent Results Cancer Res 2010; 182:127-42. [PMID: 20676877 DOI: 10.1007/978-3-540-70579-6_11] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Surgical treatment of adenocarcinoma of the esophagus and gastroesophageal junction is complex and challenging. Huge variation exist in the immediate and long term outcomes of such interventions and it is generally accepted that this is a direct consequence of the experience of the surgical team. However beside surgical quality many other indicators of quality management may influence outcome. Definition of the gastroesophageal junction remains controversial and the performance of staging procedures i.e. CT scan, endoscopy and fine needle aspiration, PET scan still suboptimal. As a result there is disagreement on the selection of patients for surgery, type of surgical approach in particular in relation to the extent of lymph node dissection as well as the extent of esophageal and/or gastric resection. In the design of randomized controlled trials comparing primary surgery versus multimodality treatment surgical quality criteria are notoriously lacking. It therefore remains a matter of debate which patients eventually will benefit from primary surgery versus those who will benefit from induction therapy. A lack of surgical quality indicators is also very prominent when assessing the value of new surgical technologies such as minimally invasive surgery or robotic surgery. Improvements in this wide spectrum of aspects is mandatory and will certainly be of great value to further improve both short and long term outcome after surgery for these complex cancers.
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Feeney C, Hussey J, Carey M, Reynolds JV. Assessment of physical fitness for esophageal surgery, and targeting interventions to optimize outcomes. Dis Esophagus 2010; 23:529-39. [PMID: 20459443 DOI: 10.1111/j.1442-2050.2010.01058.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review examines how higher levels of physiological reserve and fitness can help the patient endure the demands of esophageal surgery. Lung function, body composition, cardiac function, inflammatory mediators and exercise performance are all determinants of fitness. Physical fitness, both as an independent risk factor and through its effect on other risk factors, has been found to be significantly associated with the risk of developing postoperative pulmonary complications (PPCs) in patients following esophagectomy. Respiratory dysfunction preoperatively poses the dominant risk of developing complications, and PPCs are the most common causes of morbidity and mortality. The incidence of PPCs is between 15 and 40% with an associated 4.5-fold increase in operative mortality leading to approximately 45% of all deaths post-esophagectomy. Cardiac complications are the other principal postoperative complications, and pulmonary and cardiac complications are reported to account for up to 70% of postoperative deaths after esophagectomy. Risk reduction in patients planned for surgery is key in attaining optimal outcomes. The goal of this review was to discuss the risk factors associated with the development of postoperative pulmonary complications and how these may be modified prior to surgery with a specific focus on the pulmonary complications associated with esophageal resection. There are few studies that have examined the effect of modifying physical fitness pre-esophageal surgery. The data to date would indicate a need to develop targeted interventions preoperatively to increase physical function with the aim of decreasing postoperative complications.
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Affiliation(s)
- C Feeney
- Department of Physiotherapy, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
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Abstract
Minimally invasive approaches to esophageal resection have been shown to be feasible and safe, with outcomes similar to open esophagectomy. There are no controlled trials comparing the outcomes of minimally invasive esophagectomy (MIE) with open techniques, just a few comparative studies and many single institution series from which assessment of MIE and its present role have been made. The reported improvements from MIE approaches include reduced blood loss, time in intensive care and time in hospital. In comparative studies there is no clear reduction in respiratory complications, although larger series suggest there may be a benefit from MIE. Although MIE approaches report less lymph node retrieval compared with open extended lymphadenectomy, MIE cancer outcomes are comparable with open surgery. MIE will be a major component of the future esophageal surgeons' armamentarium, but should continue to be carefully assessed. There is a role for multicentered studies to prospectively audit outcomes. Large numbers of patients would be required to perform randomized trials of MIE versus open resection.
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Affiliation(s)
- B Mark Smithers
- Upper Gastrointestinal and Soft Tissue Unit, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Queensland, Australia.
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19
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Esophagectomy without mortality: what can surgeons do? J Gastrointest Surg 2010; 14 Suppl 1:S101-7. [PMID: 19774427 DOI: 10.1007/s11605-009-1028-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 08/25/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Surgical resection remains the mainstay treatment for patients with localized esophageal cancer. It is, however, a complex procedure. Mortality rate used to be high, but in recent years, death rate has been reduced to below 5% in specialized centers. METHODS Outcome of esophagectomy can be improved by paying attention to (1) appropriate patient section, (2) choice of surgical techniques and their execution, and (3) optimizing perioperative care. A volume-outcome relationship is also evident. Surgeons can perform esophagectomy without mortality, but a multi-disciplinary team management is essential to achieve this goal.
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Gil-Bona J, Sabaté A, Pi A, Adroer R, Jaurrieta E. [Mortality risk factors in surgical patients in a tertiary hospital: a study of patient records in the period 2004-2006]. Cir Esp 2009; 85:229-37. [PMID: 19303588 DOI: 10.1016/j.ciresp.2008.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 10/27/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine mortality risk factors in surgical patients. MATERIAL AND METHOD A cross-sectional study was carried out on all surgical patients who died while in hospital, over a period of three years (2004-2006). Pre, intra and postoperative variables were analysed. Comparisons were made between patients operated on as emergencies and elective surgery patients. Multivariate analysis was performed on the pre, intra and postoperative variables, using chi(2) of Pearson correlation with a confidence interval of 95%. RESULTS Surgery was performed on a total of 38 815 patients, of which 6 326 were emergency procedures and 32 489 as elective. There were 479 deaths registered: 36 occurred in the operating theatre and 443 died after the operation. Arterial hypertension, diabetes mellitus and cancer were significant causes of death. Intraoperative complications were associated with mortality during the surgical procedure. Emergency surgery was an independent risk factor (mortality, 5.5% vs. 0.4% for elective surgery). Sepsis, cardiac and respiratory related deaths were the main risk factors for postoperative death. CONCLUSIONS Prevention and adequate treatment of perioperative risk factors should significantly reduce morbidity and mortality rates, mainly in those patient operated as emergencies.
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Affiliation(s)
- Jesús Gil-Bona
- Servicio de Anestesiología Reanimación y Terapéutica del Dolor, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
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21
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Tomaszek S, Cassivi SD. Esophagectomy for the treatment of esophageal cancer. Gastroenterol Clin North Am 2009; 38:169-81, x. [PMID: 19327574 DOI: 10.1016/j.gtc.2009.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Esophageal cancer is an aggressive disease with an overall poor prognosis. Esophagectomy remains a key therapeutic option in treating patients who have this disease. Tailoring the surgical approach to the patient and the nature of his or her malignancy is essential. Over time, advances in staging, preoperative assessment, operative techniques, and postoperative care have resulted in decreased operative mortality and better long-term outcomes.
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Affiliation(s)
- Sandra Tomaszek
- Division of General Thoracic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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Boone J, Livestro DP, Elias SG, Borel Rinkes IHM, van Hillegersberg R. International survey on esophageal cancer: part I surgical techniques. Dis Esophagus 2009; 22:195-202. [PMID: 19191856 DOI: 10.1111/j.1442-2050.2008.00929.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In patients with esophageal cancer, radical surgical resection of the esophagus and surrounding lymph nodes is the only curative treatment option. Nevertheless, no standard surgical procedure exists. The aims of the present study were to gain insight into the frequencies of the various surgical techniques in esophageal cancer surgery as applied by surgeons throughout the world and to identify intercontinental differences regarding surgical techniques. Surgeons with particular interest in esophageal surgery, including members of the International Society for Diseases of the Esophagus, the European Society of Esophagology Group d'Etude Européen des Maladies de l'Oesophage and the OESO, were invited to participate in an online questionnaire. Questions were asked regarding approach to esophagectomy, extent of lymphadenectomy (LND), type of reconstruction, and anastomotic techniques. Subanalyses were performed for the surgeons' case volume per year, years of experience in esophageal cancer surgery, and continent. Of 567 invited surgeons, 269 participated, resulting in an overall response rate of 47%. The responders currently performing esophagectomies (n= 250; 44%), represented 41 countries across the six continents. Fifty-two percent of responders favor open transthoracic esophagectomy (TTE) over transhiatal esophagectomy (THE) or minimally invasive esophagectomy (MIE). THE is preferred by 26%, whereas MIE is favored by 14%. Eight percent have no preference for one approach to esophagectomy over the other. The extent of LND is most frequently the 2-field, routinely performed by 73% of surgeons. The continuity of the digestive tract is most frequently restored with a gastric conduit (85%). In open TTE, the anastomosis is routinely created in the neck by 56% of responders and in the chest by 40%. Cervical anastomoses are routinely fashioned by means of a handsewn technique by 65% of responders, while 35% favor the stapled technique. The cervical incision is predominantly performed vertically on the left side of the neck (routinely by 66%). A horizontal neck incision is routinely carried out by 19% of responders and a vertical right-sided incision by 11%. Significant differences in surgical techniques could be detected between low- and high-volume surgeons, between surgeons with <or=10 versus >or=21 years of experience, and between surgeons from different continents. In conclusion, currently the most commonly applied surgical procedure is the open right-sided transthoracic approach with a two-field lymphadenectomy, using a gastric tube anastomosed at the left side of the neck by means of a handsewn, end-to-side technique. The results of this survey provide baseline data for future research and for the development of international guidelines.
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Affiliation(s)
- Judith Boone
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
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Abstract
Esophageal resection is a formidable operation associated with high morbidity and mortality. Anesthetic management may contribute to the containment of respiratory failure and anastomotic leakage by the use of thoracic epidural analgesia, protective ventilation strategies, prevention of tracheal aspiration, and judicious fluid management.
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Affiliation(s)
- Ju-Mei Ng
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
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24
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Abstract
The divergence in epidemiology between the East and West has made interpretation of data in the literature more difficult and has affected the choice of the most appropriate surgical technique and treatment strategies. The management of esophageal cancer certainly has evolved, and many more options are available. Stage-directed strategies and individualization of treatment are important considerations. Surgeons play a central role in directing management of this disease by advising how best to integrate surgical therapy with nonoperative programs. Surgeons should aim at improving their results further, so that the best results of surgery are compared with seemingly "safer" nonsurgical therapies. Low death rates have been achieved in specialized centers, but there still is much room for improvement in morbidity rates. Even with the best surgical resection and chemoradiation therapy, distant failure remains a barrier to improved survival rates. Therapeutic improvements will require more effective systemic drugs and a better ability to predict responders with precision. Management strategies will evolve further, with improvements in molecular techniques, imaging methods, and introduction of more novel tumoricidal agents. The challenge for the future is to test strategies critically in a scientific, unbiased manner and to explore other innovative treatments.
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Affiliation(s)
- Simon Law
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
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