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Zheng Z, Peng S, Yang J, Ke W. The relationship between preoperative anemia and length of hospital stay among patients undergoing radical surgery for esophageal carcinoma: a single-centre retrospective study. BMC Anesthesiol 2023; 23:322. [PMID: 37777739 PMCID: PMC10543886 DOI: 10.1186/s12871-023-02235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 08/04/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Although it is unclear if preoperative anemia affects patients undergoing radical resection of esophageal cancer, it does increase the length of stay (LOS) for surgical patients. Accordingly, the purpose of this study was to investigate if, after adjusting for other covariates, anemia was independently associated with LOS in people undergoing radical resection of esophageal cancer. METHODS The retrospective cohort study included 680 patients undergoing radical esophageal cancer surgery between January 2010 and December 2020. Preoperative anemia was the targeted independent variable, while LOS was the target independent variable. Demographics, comorbidities, laboratory tests, surgery and anesthesia, postoperative outcomes, and complications were collected. Multivariate linear analyses were performed for variables that might influence preoperative anemia and LOS selection. Subgroup analysis using hierarchical variables was then used to test the potential relationship. RESULTS The 647 individuals that were randomly chosen had an average age of 61.06 ± 8.16 years, and 77.43% of them were male. The prevalence of anemia was 36.6%. All patients recruited had an average length of stay (LOS) of 26.31 ± 13.19 days, 25.40 ± 11.44 days for patients who had no preoperative anemia, and 27.89 ± 15.66 days for patients who had preoperative anemia, p < 0.05. After adjusting for covariates, the results of fully adjusted linear regression revealed that preoperative anemia was significantly associated with LOS (β = 2.04, 95%CI (0.13, 3.96) ), p < 0.05. The results of the subgroup analysis were basically accurate and steady. Regardless of gender, same outcomes were seen when preoperative anemia was defined as a Hb level < 13 g/dL (β = 2.29, 95%CI (0.33, 4.25) ), p < 0.05. In addition, the LOS was shortened with the increase of preoperative hemoglobin (Hb) (β= -0.81, 95%CI (-1.46, -0.1) ), p < 0.05. CONCLUSION Preoperative anemia is typical in Chinese patients undergoing radical esophageal cancer resection and is independently associated with prolonged LOS.
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Affiliation(s)
- Zonggui Zheng
- Shantou University Medical College, 22 Xinling Road, Shantou, Guangdong, 515041, China
| | - Shixuan Peng
- Department of Oncology, Graduate Collaborative Training Base of The First People's Hospital of Xiangtan City, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Jieping Yang
- Department of Anesthesiology, Royallee Cancer Hospital, No.1, Ciji Road, Huangpu District, Guangzhou, Guangdong, 510555, China
| | - Weiqi Ke
- Department of Anesthesiology, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, Guangdong, 515041, China.
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Li Z, Cheng J, Zhang Y, Wen S, LV H, Xu Y, Zhu Y, Zhang Z, Mu D, Tian Z. Comparison of Up-Front Minimally Invasive Esophagectomy versus Open Esophagectomy on Quality of Life for Esophageal Squamous Cell Cancer. ACTA ACUST UNITED AC 2021; 28:693-701. [PMID: 33503901 PMCID: PMC7924373 DOI: 10.3390/curroncol28010068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/02/2020] [Accepted: 01/18/2021] [Indexed: 11/22/2022]
Abstract
This study investigates whether minimally invasive esophagectomy (MIE) is a safe and effective way for patients with resectable esophageal cancer by comparing the short-term quality of life (QOL) after minimally invasive esophagectomy and open esophagectomy (OE). A total number of 104 patients who underwent esophagectomy from January 2013 to March 2014 were enrolled in this study. These patients were divided into two groups (MIE and OE group). Three scoring scales of quality of life were used to evaluate QOL before the operation and at the first, third, sixth and twelfth months after MIE or OE, which consist of Karnofshy performance scale (KPS), the European Organization for Research and Treatment questionnaire QLQC-30 (EORTC QLQC-30) and esophageal cancer supplement scale (OES-18). The MIE group was higher than the OE group in one-year survival rate (92.54% vs. 72.00%). Significant differences between the two groups were observed in intraoperative bleeding volume (158.53 ± 91.07 mL vs. 228.97 ± 109.33 mL, p = 0.001), and the incidence of postoperative pneumonia (33.33% vs. 58.62%, p = 0.018). The KPS of MIE group was significantly higher than the OE group at the first (80 vs. 70, p = 0.004 < 0.05), third (90 vs. 80, p = 0.006 < 0.05), sixth (90 vs. 80, p = 0.007 < 0.05) and twelfth months (90 vs. 80, p = 0.004 < 0.05) after surgery. The QLQC-30 score of MIE group was better than OE group at first and twelfth months after the operation. The OES-18 score of MIE group was significantly better than OE group at first, sixth and twelfth months after surgery. The short-term quality of life in MIE group was better than OE group.
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Affiliation(s)
- Zhenhua Li
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Jingge Cheng
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China;
| | - Yuefeng Zhang
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Shiwang Wen
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Huilai LV
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Yanzhao Xu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Yonggang Zhu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Zhen Zhang
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Donghui Mu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Ziqiang Tian
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
- Correspondence: ; Tel.: +86-18531118000
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Gisbertz SS, Hagens ERC, Ruurda JP, Schneider PM, Tan LJ, Domrachev SA, Hoeppner J, van Berge Henegouwen MI. The evolution of surgical approach for esophageal cancer. Ann N Y Acad Sci 2018; 1434:149-155. [PMID: 30191569 DOI: 10.1111/nyas.13957] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/18/2018] [Accepted: 08/02/2018] [Indexed: 12/14/2022]
Abstract
Esophageal surgery for esophageal cancer has been performed for over a century now. Minimally invasive esophagectomy (MIE) was first described in 1992, and it is now a standard approach in many countries. However, MIE is technically difficult and requires a long learning curve. It takes >100 cases to train for MIE with gastric tube reconstruction with an intrathoracic anastomosis. A possible option to overcome several challenges of MIE might be the use of a robotic system. A robot-assisted MIE was first described in 2005, and long-term results have shown its feasibility and safety. Over the years, different approaches for esophagectomy have been established. Our review discusses these developments and recent literature on open, minimally invasive and robotic esophageal surgery.
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Affiliation(s)
- Suzanne S Gisbertz
- Department of Surgery, the Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Eliza R C Hagens
- Department of Surgery, the Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jelle P Ruurda
- Department of Surgical Oncology, the University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paul M Schneider
- The Center for Visceral, Thoracic and Specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland
| | - Li Jie Tan
- Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Jens Hoeppner
- Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany
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Standardizing procedures improves and homogenizes short-term outcomes after minimally invasive esophagectomy. Langenbecks Arch Surg 2018; 403:221-234. [PMID: 29572765 DOI: 10.1007/s00423-018-1661-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 02/21/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Esophageal cancer is one of the deadliest cancers worldwide. Esophagectomy with lymphadenectomy is regarded as the only curative option for resectable esophageal cancer, but it is associated with high morbidity and mortality. Multidisciplinary team (MDT) management was recently associated with improved outcomes after surgery for esophageal cancer. The aim of this study was to investigate the effect of standardizing procedures for minimally invasive esophagectomy (MIE) in the MDT setting. METHODS This was a case-matched control study of 154 patients with esophageal cancer who underwent thoracoscopic esophagectomy in the prone position (TEP) between 2012 and 2016. Surgery was performed by two attending surgeons (surgeons A and B) who began working together in the same MDT in 2015. At that time, the following surgical procedures were standardized between surgeons A and B: mediastinal lymphadenectomy, abdominal procedures, and estimation of the blood supply of the gastric conduit. Short-term outcomes were compared between the following paired groups using propensity scores: surgeon A's pre- and post-standardization groups, surgeon B's pre- and post-standardization groups, and surgeon A's post-standardization group and surgeon B's post-standardization group. RESULTS Concerning surgeon A, the estimated total blood loss in the post-standardization group (142 ± 87 mL) was significantly lower than that in the pre-standardization group (376 ± 215 mL, P = 0.006). The rate of left recurrent laryngeal nerve palsy in the post-standardization group (13%) was significantly lower than that in the pre-standardization group (47%, P = 0.046). Concerning surgeon B, the rate of anastomotic leakage in the post-standardization group (0%) was significantly lower than that in the pre-standardization group (11%, P = 0.039). Comparing the post-standardization groups of surgeons A and B, there were no significant differences in operative outcomes or morbidity. CONCLUSIONS Standardizing procedures for MIE improved and homogenized surgical short-term outcomes.
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Mastering minimally invasive esophagectomy requires a mentor; experience of a personal mentorship. Ann Med Surg (Lond) 2017; 13:38-41. [PMID: 28070329 PMCID: PMC5219610 DOI: 10.1016/j.amsu.2016.12.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/23/2016] [Accepted: 12/24/2016] [Indexed: 12/03/2022] Open
Abstract
Since the first laparoscopic procedure, there has been an steady increase in advanced minimally invasive surgery. These procedures include oncological colorectal, hepatobiliary and upper gastrointestinal surgery. Implementation of these procedures requires different and new skills for the surgeons who wish to perform these procedures. To accomplish this surgical teaching program, a mentorship seems the most ideal method to teach the apprentice surgeon these specific skills. At the VU medical center a teaching program for a minimally-invasive esophagectomy for esophageal cancer started in 2009. At first it started in different centers in the Netherlands and later on we also started mentoring other institutes throughout Europe, Latin America and India. In this article we describe our experience and the outcomes of this mentorship in advanced minimally invasive surgery. Not all residency programs include a teaching program with the guidance of dedicated mentors. Teaching minimally invasive surgery requires a mentor. A dedicated team should be set up for learning new minimally invasive techniques.
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Straatman J, van der Wielen N, Nieuwenhuijzen GAP, Rosman C, Roig J, Scheepers JJG, Cuesta MA, Luyer MDP, van Berge Henegouwen MI, van Workum F, Gisbertz SS, van der Peet DL. Techniques and short-term outcomes for total minimally invasive Ivor Lewis esophageal resection in distal esophageal and gastroesophageal junction cancers: pooled data from six European centers. Surg Endosc 2016; 31:119-126. [PMID: 27129563 PMCID: PMC5216077 DOI: 10.1007/s00464-016-4938-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/09/2016] [Indexed: 01/07/2023]
Abstract
Introduction Esophagectomy for cancer can be performed in a two-stage procedure with an intrathoracic anastomosis: the Ivor Lewis esophagectomy. A growing incidence of distal and gastroesophageal junction adenocarcinomas and increasing use of minimally invasive techniques have prompted interest in this procedure. The aim of this study was to assess short-term results of minimally invasive Ivor Lewis esophagectomy (MIE-IL). Methods A retrospective cohort study was performed from June 2007 until September 2014, including patients that underwent MIE-IL for distal esophageal and gastroesophageal junction cancer in six different hospitals in the Netherlands and Spain. Data were collected with regard to operative techniques, pathology and postoperative complications. Results In total, 282 patients underwent MIE-IL, of which 90.2 % received neoadjuvant therapy. Anastomotic leakage was observed in 43 patients (15.2 %), of whom 13 patients (4.6 %) had empyema, necessitating thoracotomy for decortication. With an aggressive treatment of complications, the 30-day and in-hospital mortality rate was 2.1 %. An R0-resection was obtained in 92.5 % of the patients. After neoadjuvant therapy, 20.1 % of patients had a complete response. Conclusions Minimally invasive Ivor Lewis esophagectomy for distal esophageal and gastroesophageal junction adenocarcinomas is an upcoming approach for reducing morbidity caused by laparotomy and thoracotomy. Anastomotic leakage rate is still high possibly due to technical diversity of anastomotic techniques, and a high percentage of patients treated by neoadjuvant chemoradiotherapy. An aggressive approach to complications leads to a low mortality of 2.1 %. Further improvement and standardization in the anastomotic technique are needed in order to perform a safe intrathoracic anastomosis.
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Affiliation(s)
- Jennifer Straatman
- Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands. .,Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Nicole van der Wielen
- Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Camiel Rosman
- Department of Gastrointestinal Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Josep Roig
- Department of Gastrointestinal Surgery, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Joris J G Scheepers
- Department of Gastrointestinal Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Miguel A Cuesta
- Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Misha D P Luyer
- Department of Gastrointestinal Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Frans van Workum
- Department of Gastrointestinal Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Suzanne S Gisbertz
- Department of Gastrointestinal Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Benedix F, Dalicho S, Stübs P, Schubert D, Bruns C. Evidenzlage zur minimalinvasiven Chirurgie beim Ösophaguskarzinom. Chirurg 2014; 85:668-74. [DOI: 10.1007/s00104-014-2754-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Biere SSAY, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, Gisbertz SS, Klinkenbijl JHG, Hollmann MW, de Lange ESM, Bonjer HJ, van der Peet DL, Cuesta MA. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 2012; 379:1887-92. [PMID: 22552194 DOI: 10.1016/s0140-6736(12)60516-9] [Citation(s) in RCA: 1132] [Impact Index Per Article: 94.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgical resection is regarded as the only curative option for resectable oesophageal cancer, but pulmonary complications occurring in more than half of patients after open oesophagectomy are a great concern. We assessed whether minimally invasive oesophagectomy reduces morbidity compared with open oesophagectomy. METHODS We did a multicentre, open-label, randomised controlled trial at five study centres in three countries between June 1, 2009, and March 31, 2011. Patients aged 18-75 years with resectable cancer of the oesophagus or gastro-oesophageal junction were randomly assigned via a computer-generated randomisation sequence to receive either open transthoracic or minimally invasive transthoracic oesophagectomy. Randomisation was stratified by centre. Patients, and investigators undertaking interventions, assessing outcomes, and analysing data, were not masked to group assignment. The primary outcome was pulmonary infection within the first 2 weeks after surgery and during the whole stay in hospital. Analysis was by intention to treat. This trial is registered with the Netherlands Trial Register, NTR TC 2452. FINDINGS We randomly assigned 56 patients to the open oesophagectomy group and 59 to the minimally invasive oesophagectomy group. 16 (29%) patients in the open oesophagectomy group had pulmonary infection in the first 2 weeks compared with five (9%) in the minimally invasive group (relative risk [RR] 0·30, 95% CI 0·12-0·76; p=0·005). 19 (34%) patients in the open oesophagectomy group had pulmonary infection in-hospital compared with seven (12%) in the minimally invasive group (0·35, 0·16-0·78; p=0·005). For in-hospital mortality, one patient in the open oesophagectomy group died from anastomotic leakage and two in the minimally invasive group from aspiration and mediastinitis after anastomotic leakage. INTERPRETATION These findings provide evidence for the short-term benefits of minimally invasive oesophagectomy for patients with resectable oesophageal cancer. FUNDING Digestive Surgery Foundation of the Unit of Digestive Surgery of the VU University Medical Centre.
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Affiliation(s)
- Surya S A Y Biere
- Department of Surgery, VU University Medical Centre, Amsterdam, Netherlands
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Biere SS, Maas KW, Bonavina L, Garcia JR, van Berge Henegouwen MI, Rosman C, Sosef MN, de Lange ESM, Bonjer HJ, Cuesta MA, van der Peet DL. Traditional invasive vs. minimally invasive esophagectomy: a multi-center, randomized trial (TIME-trial). BMC Surg 2011; 11:2. [PMID: 21226918 PMCID: PMC3031195 DOI: 10.1186/1471-2482-11-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 01/12/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a rise in incidence of esophageal carcinoma due to increasing incidence of adenocarcinoma. Probably the only curative option to date is the use of neoadjuvant therapy followed by surgical resection. Traditional open esophageal resection is associated with a high morbidity and mortality rate. Furthermore, this approach involves long intensive care unit stay, in-hospital stay and long recovery period. Minimally invasive esophagectomy could reduce the morbidity and accelerate the post-operative recovery. METHODS/DESIGN Comparison between traditional open and minimally invasive esophagectomy in a multi-center, randomized trial. Patients with a resectable intrathoracic esophageal carcinoma, including the gastro-esophageal junction tumors (Siewert I) are eligible for inclusion. Prior thoracic surgery and cervical esophageal carcinoma are indications for exclusion. The surgical technique involves a right thoracotomy with lung blockade and laparotomy either with a cervical or thoracic anastomosis for the traditional group. The minimally invasive procedure involves a right thoracoscopy in prone position with a single lumen tube and laparoscopy either with a cervical or thoracic anastomosis. All patients in both groups will undergo identical pre-operative and post-operative protocol. Primary endpoint of this study are post-operative respiratory complications within the first two post-operative weeks confirmed by clinical, radiological and sputum culture data. Secondary endpoints are the operative data, the post-operative data and oncological data such as quality of the specimen and survival. Operative data include duration of the operation, blood loss and conversion to open procedure. Post-operative data include morbidity (major and minor), quality of life tests and hospital stay.Based on current literature and the experience of all participating centers, an incidence of pulmonary complications for 57% in the traditional arm and 29% in the minimally invasive arm, it is estimated that per arm 48 patients are needed. This is based on a two-sided significance level (alpha) of 0.05 and a power of 0.80. Knowing that approximately 20% of the patients will be excluded, we will randomize 60 patients per arm. DISCUSSION The TIME-trial is a prospective, multi-center, randomized study to define the role of minimally invasive esophageal resection in patients with resectable intrathoracic and junction esophageal cancer. TRIAL REGISTRATION (NETHERLANDS TRIAL REGISTER): NTR2452.
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Affiliation(s)
- Surya Say Biere
- Department of Surgery, VU university medical center, Amsterdam, the Netherlands
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Minimally Invasive Subtotal Esophagectomy. POLISH JOURNAL OF SURGERY 2007. [DOI: 10.2478/v10035-007-0105-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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