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Anoldo P, Vertaldi S, Manigrasso M, D'Amore A, De Palma GD, Milone M. Re-thoracoscopy for the management of gastric conduit dehiscence after minimally invasive McKeown esophagectomy. Int J Surg Case Rep 2023; 103:107876. [PMID: 36640467 PMCID: PMC9845996 DOI: 10.1016/j.ijscr.2023.107876] [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: 12/06/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Gastric conduit dehiscence after esophagectomy represents a severe complication associated with high mortality. Surgical management is achieved through thoracotomy, but often ends up in conduit sacrifice and diversion. CASE PRESENTATION A 59-years-old man underwent minimally invasive McKeown esophagectomy for esophageal adenocarcinoma. After a worsening of the postoperative course and evidence at the CT scan and endoscopy of highly suspect gastric conduit failure, the patient underwent an exploratory thoracoscopy, which revealed a partial dehiscence of the gastric conduit treated with resection of the dehiscent gastric wall by a linear stapler on the guide of a 36-french orogastric tube. Patient had a regular postoperative course without any complications and was discharged on the 6th postoperative day. CLINICAL DISCUSSION The management of conduit necrosis is extremely challenging. There are several interventional options and it is difficult to decide the most appropriate treatment for each individual patient. In our case we decided to perform a reintervention with a thoracoscopic approach, resecting the dehiscent area of the gastric conduit. CONCLUSIONS Minimally invasive surgery is a valid option for the management of post-operative complications, including those in emergency setting. Re-suturing a partial dehiscence of gastric conduit may be feasible if tissue conditions allow.
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Affiliation(s)
- Pietro Anoldo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy.
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Anna D'Amore
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
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Wu W, Zhu Q, Chen L, Liu J. Technical and early outcomes of Ivor Lewis minimally invasive oesophagectomy for gastric tube construction in the thoracic cavity. Interact Cardiovasc Thorac Surg 2014; 18:86-91. [PMID: 24144805 PMCID: PMC3867051 DOI: 10.1093/icvts/ivt448] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/02/2013] [Accepted: 09/05/2013] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Ivor Lewis minimally invasive oesophagectomy (ILMIE) is a complex surgery aiming to remove an oesophageal tumour and to create a new gastric tube in the abdomen. The objective was to assess the technical and early outcomes of ILMIE for gastric tube construction in the thoracic cavity. METHODS A retrospective analysis was conducted in 25 middle or lower oesophageal cancer patients treated with ILMIE between August and December 2012. A gastric tube was constructed in the thoracic cavity in all patients. The gastric tube and the oesophagus were anastomosed using a circular stapler. Clinical data (age, gender, pathological pattern and TNM stage), surgical data (operation time, intraoperative blood loss and intraoperative complications) and follow-up data (postoperative complications, length of stay, thoracic tube drainage time and time before eating) were assessed. RESULTS The mean age was 61 ± 8 years. Sixteen patients were male and 9 were female. Oesophageal cancer was located in the middle oesophagus in 5 cases and in the lower oesophagus in 20. No conversion to open surgery was performed. The mean operative time and intraoperative blood loss were 320 ± 63 min and 137 ± 95 ml, respectively. A mean of 2.4 ± 0.5 linear stapler cartridges was used per patient. A mean of 14.6 ± 5.4 lymph nodes was dissected per patient. Postoperative hospital stay was 13.2 ± 2.4 days. Intraoperative and postoperative complications occurred in 12% (3 of 25) and 20% (5 of 25) of patients, respectively, including 1 case of anastomotic fistula. The patients were followed up for a mean of 3.5 ± 1.2 months, and there was no relapse or death. CONCLUSIONS The construction of a gastric tube through the thoracic cavity using ILMIE is feasible and safe in patients with middle or lower oesophageal cancer. However, longer follow-up and larger sample sizes are needed to evaluate the oncological efficacy.
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Affiliation(s)
| | | | - Liang Chen
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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van der Sluis PC, Ruurda JP, van der Horst S, Verhage RJJ, Besselink MGH, Prins MJD, Haverkamp L, Schippers C, Rinkes IHMB, Joore HCA, ten Kate FJW, Koffijberg H, Kroese CC, van Leeuwen MS, Lolkema MPJK, Reerink O, Schipper MEI, Steenhagen E, Vleggaar FP, Voest EE, Siersema PD, van Hillegersberg R. Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer, a randomized controlled trial (ROBOT trial). Trials 2012; 13:230. [PMID: 23199187 PMCID: PMC3564860 DOI: 10.1186/1745-6215-13-230] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 10/26/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND For esophageal cancer patients, radical esophagolymphadenectomy is the cornerstone of multimodality treatment with curative intent. Transthoracic esophagectomy is the preferred surgical approach worldwide allowing for en-bloc resection of the tumor with the surrounding lymph nodes. However, the percentage of cardiopulmonary complications associated with the transthoracic approach is high (50 to 70%).Recent studies have shown that robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RATE) is at least equivalent to the open transthoracic approach for esophageal cancer in terms of short-term oncological outcomes. RATE was accompanied with reduced blood loss, shorter ICU stay and improved lymph node retrieval compared with open esophagectomy, and the pulmonary complication rate, hospital stay and perioperative mortality were comparable. The objective is to evaluate the efficacy, risks, quality of life and cost-effectiveness of RATE as an alternative to open transthoracic esophagectomy for treatment of esophageal cancer. METHODS/DESIGN This is an investigator-initiated and investigator-driven monocenter randomized controlled parallel-group, superiority trial. All adult patients (age ≥ 18 and ≤ 80 years) with histologically proven, surgically resectable (cT1-4a, N0-3, M0) esophageal carcinoma of the intrathoracic esophagus and with European Clinical Oncology Group performance status 0, 1 or 2 will be assessed for eligibility and included after obtaining informed consent. Patients (n = 112) with resectable esophageal cancer are randomized in the outpatient department to either RATE (n = 56) or open three-stage transthoracic esophageal resection (n = 56). The primary outcome of this study is the percentage of overall complications (grade 2 and higher) as stated by the modified Clavien-Dindo classification of surgical complications. DISCUSSION This is the first randomized controlled trial designed to compare RATE with open transthoracic esophagectomy as surgical treatment for resectable esophageal cancer. If our hypothesis is proven correct, RATE will result in a lower percentage of postoperative complications, lower blood loss, and shorter hospital stay, but with at least similar oncologic outcomes and better postoperative quality of life compared with open transthoracic esophagectomy. The study started in January 2012. Follow-up will be 5 years. Short-term results will be analyzed and published after discharge of the last randomized patient. TRIAL REGISTRATION Dutch trial register: NTR3291 ClinicalTrial.gov: NCT01544790.
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Affiliation(s)
- Pieter C van der Sluis
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Sylvia van der Horst
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Roy JJ Verhage
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Marc GH Besselink
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Margriet JD Prins
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Leonie Haverkamp
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Carlo Schippers
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Inne HM Borel Rinkes
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Hans CA Joore
- Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Fiebo JW ten Kate
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Hendrik Koffijberg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Christiaan C Kroese
- Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Maarten S van Leeuwen
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Martijn PJK Lolkema
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Onne Reerink
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Marguerite EI Schipper
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Elles Steenhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Emile E Voest
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, the Netherlands
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Boone J, Schipper MEI, Moojen WA, Borel Rinkes IHM, Cromheecke GJE, van Hillegersberg R. Robot-assisted thoracoscopic oesophagectomy for cancer. Br J Surg 2009; 96:878-86. [PMID: 19591168 DOI: 10.1002/bjs.6647] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Thoracoscopic oesophagectomy was introduced to reduce the morbidity of transthoracic oesophagectomy. The aim was to assess the short- and mid-term results of robot-assisted thoracoscopic oesophagectomy for oesophageal cancer. METHODS Between October 2003 and May 2007, 47 patients with resectable oesophageal cancer underwent robot-assisted thoracoscopic oesophagectomy. Clinical data were collected prospectively. RESULTS Conversion to thoracotomy was necessary in seven patients. Median operating time was 450 min and median blood loss 625 ml. Median postoperative ventilation time was 1 day, intensive care stay 3 days and hospital stay 18 days. Twenty-one of 47 patients had pulmonary complications. Three patients died in hospital. A median of 29 (range 8-68) lymph nodes was dissected and R0 resection was achieved in 36 patients. Twenty-three patients had stage IVa disease. After a median follow-up of 35 months, median disease-free survival was 15 (95 per cent confidence interval 12 to 18) months. CONCLUSION Robot-assisted thoracoscopic oesophagectomy was oncologically acceptable. Operating time, blood loss and pulmonary complications might decrease with further experience.
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Affiliation(s)
- J Boone
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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