1
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Kitagawa Y, Matsuda S, Gotoda T, Kato K, Wijnhoven B, Lordick F, Bhandari P, Kawakubo H, Kodera Y, Terashima M, Muro K, Takeuchi H, Mansfield PF, Kurokawa Y, So J, Mönig SP, Shitara K, Rha SY, Janjigian Y, Takahari D, Chau I, Sharma P, Ji J, de Manzoni G, Nilsson M, Kassab P, Hofstetter WL, Smyth EC, Lorenzen S, Doki Y, Law S, Oh DY, Ho KY, Koike T, Shen L, van Hillegersberg R, Kawakami H, Xu RH, Wainberg Z, Yahagi N, Lee YY, Singh R, Ryu MH, Ishihara R, Xiao Z, Kusano C, Grabsch HI, Hara H, Mukaisho KI, Makino T, Kanda M, Booka E, Suzuki S, Hatta W, Kato M, Maekawa A, Kawazoe A, Yamamoto S, Nakayama I, Narita Y, Yang HK, Yoshida M, Sano T. Clinical practice guidelines for esophagogastric junction cancer: Upper GI Oncology Summit 2023. Gastric Cancer 2024; 27:401-425. [PMID: 38386238 PMCID: PMC11016517 DOI: 10.1007/s10120-023-01457-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/09/2023] [Indexed: 02/23/2024]
Affiliation(s)
- Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Satoru Matsuda
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Takuji Gotoda
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ken Kato
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Florian Lordick
- Department of Oncology and University Cancer Center Leipzig, Leipzig University Medical Center, Comprehensive Cancer Center Central, Leipzig, Jena, Germany
| | - Pradeep Bhandari
- Department of Gastroenterology, Portsmouth University Hospital NHS Trust, Portsmouth, UK
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Paul F Mansfield
- Surgical Oncology, University of Texas, MD Anderson Cancer Center, Houston, USA
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Jimmy So
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Stefan Paul Mönig
- Upper-GI-Surgery University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - Kohei Shitara
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Sun Young Rha
- Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yelena Janjigian
- Department of Medicine, Solid Tumor Gastrointestinal Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Daisuke Takahari
- Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ian Chau
- Department of Medicine, Royal Marsden Hospital, London, UK
| | - Prateek Sharma
- Division of Gastroenterology, School of Medicine and VA Medical Center, University of Kansas, Kansas, USA
| | - Jiafu Ji
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital, Beijing, China
| | - Giovanni de Manzoni
- Department of Surgery, Dentistry, Maternity and Infant, University of Verona, Verona, Italy
| | - Magnus Nilsson
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Paulo Kassab
- Gastroesophageal Surgery, Santa Casa of Sao Paulo Medical School, São Paulo, Brazil
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, USA
| | | | - Sylvie Lorenzen
- Department of Hematology and Oncology, Klinikum Rechts Der Isar Munich, Munich, Germany
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Simon Law
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Do-Youn Oh
- Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Khek Yu Ho
- National University of Singapore, Singapore, Singapore
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Lin Shen
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital, Beijing, China
| | - Richard van Hillegersberg
- Department of Upper Gastrointestinal Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hisato Kawakami
- Department of Medical Oncology, Faculty of Medicine, Kindai University, Higashiosaka, Japan
| | - Rui-Hua Xu
- Department of Medical Oncology, Sun YAT-Sen University Cancer Center, Guangzhou, China
| | - Zev Wainberg
- Gastrointestinal Medical Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Naohisa Yahagi
- Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Ryu Ishihara
- Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Zili Xiao
- Digestive Endoscopic Unit, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Chika Kusano
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Heike Irmgard Grabsch
- Department of Pathology, GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
- Pathology & Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Hiroki Hara
- Gastroenterology, Saitama Cancer Center, Saitama, Japan
| | - Ken-Ichi Mukaisho
- Education Center for Medicine and Nursing, Shiga University of Medical Science, Otsu, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eisuke Booka
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Motohiko Kato
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Akira Maekawa
- Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan
| | - Akihito Kawazoe
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shun Yamamoto
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Izuma Nakayama
- Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukiya Narita
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University, Seoul, Republic of Korea
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Otawara, Japan
| | - Takeshi Sano
- Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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2
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Ojha S, Darwish MB, Benzie AL, Logarajah S, McLaren PJ, Osman H, Cho E, Jay J, Jeyarajah DR. Esophagectomy in octogenarians: Is it at a cost? Heliyon 2022; 8:e11945. [DOI: 10.1016/j.heliyon.2022.e11945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/08/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
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Simitian GS, Hall DJ, Leverson G, Lushaj EB, Lewis EE, Musgrove KA, McCarthy DP, Maloney JD. Consequences of anastomotic leaks after minimally invasive esophagectomy: A single-center experience. Surg Open Sci 2022; 11:26-32. [DOI: 10.1016/j.sopen.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/21/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
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Lee AHH, Oo J, Cabalag CS, Link E, Duong CP. Increased risk of diaphragmatic herniation following esophagectomy with a minimally invasive abdominal approach. Dis Esophagus 2022; 35:6373570. [PMID: 34549284 DOI: 10.1093/dote/doab066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/16/2021] [Accepted: 09/04/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Diaphragmatic herniation is a rare complication following esophagectomy, associated with risks of aspiration pneumonia, bowel obstruction, and strangulation. Repair can be challenging due to the presence of the gastric conduit. We performed this systematic review and meta-analysis to determine the incidence and risk factors associated with diaphragmatic herniation following esophagectomy, the timing and mode of presentation, and outcomes of repair. METHODS A systematic search using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was performed using four major databases. A meta-analysis of diaphragmatic herniation incidence following esophagectomies with a minimally invasive abdominal (MIA) approach compared with open esophagectomies was conducted. Qualitative analysis was performed for tumor location, associated symptoms, time to presentation, and outcomes of postdiaphragmatic herniation repair. RESULTS This systematic review consisted of 17,052 patients from 32 studies. The risk of diaphragmatic herniation was 2.74 times higher in MIA esophagectomy compared with open esophagectomy, with pooled incidence of 6.0% versus 3.2%, respectively. Diaphragmatic herniation was more commonly seen following surgery for distal esophageal tumors. Majority of patients (64%) were symptomatic at diagnosis. Presentation within 30 days of operation occurred in 21% of cases and is twice as likely to require emergent repair with increased surgical morbidity. Early diaphragmatic herniation recurrence and cardiorespiratory complications are common sequelae following hernia repair. CONCLUSIONS In the era of MIA esophagectomy, one has to be cognizant of the increased risk of diaphragmatic herniation and its sequelae. Failure to recognize early diaphragmatic herniation can result in catastrophic consequences. Increased vigilance and decreased threshold for imaging during this period is warranted.
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Affiliation(s)
- Adele Hwee Hong Lee
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - June Oo
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Carlos S Cabalag
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Emma Link
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Cuong Phu Duong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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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.
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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
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6
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Casas MA, Angeramo CA, Bras Harriott C, Dreifuss NH, Schlottmann F. Indocyanine green (ICG) fluorescence imaging for prevention of anastomotic leak in totally minimally invasive Ivor Lewis esophagectomy: a systematic review and meta-analysis. Dis Esophagus 2022; 35:6347566. [PMID: 34378016 DOI: 10.1093/dote/doab056] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/07/2021] [Accepted: 07/23/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Indocyanine green (ICG) fluorescence imaging is an emerging technology that might help decreasing anastomotic leakage (AL) rates. The aim of this study was to determine the usefulness of ICG fluorescence imaging for the prevention of AL after minimally invasive esophagectomy with intrathoracic anastomosis. METHODS A systematic literature review of the MEDLINE and Cochrane databases was performed to identify all articles on totally minimally invasive Ivor Lewis esophagectomy. Studies were then divided into two groups based on the use or not of ICG for perfusion assessment. Primary outcome was anastomotic leak. Secondary outcomes included operative time, ICG-related adverse reactions, and mortality rate. A meta-analysis was conducted to estimate the overall weighted proportion and its 95% confidence interval (CI) for main outcomes. RESULTS A total of 3,171 patients were included for analysis: 381 (12%) with intraoperative ICG fluorescence imaging and 2,790 (88%) without ICG. Mean patients' age and proportion of males were similar between groups. Mean operative time was also similar between both groups (ICG: 354.8 vs. No-ICG: 354.1 minutes, P = 0.52). Mean ICG dose was 12 mg (5-21 mg). No ICG-related adverse reactions were reported. AL rate was 9% (95% CI, 5-17%) and 9% (95% CI, 7-12%) in the ICG and No-ICG groups, respectively. The risk of AL was similar between groups (odds ratio 0.85, 95% CI 0.53-1.28, P = 0.45). Mortality was 3% (95% CI, 1-9%) in patients with ICG and 2% (95% CI, 2-3%) in those without ICG. Median length of hospital stay was also similar between groups (ICG: 13.6 vs. No-ICG: 11.2 days, P = 0.29). CONCLUSION The use of ICG fluorescence imaging for perfusion assessment does not seem to reduce AL rates in patients undergoing minimally invasive esophagectomy with intrathoracic anastomosis.
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Affiliation(s)
- María A Casas
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Cristian A Angeramo
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | | | - Nicolás H Dreifuss
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.,Division of Esophageal and Gastric Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
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Ashiku SK, Patel AR, Horton BH, Velotta J, Ely S, Avins AL. A refined procedure for esophageal resection using a full minimally invasive approach. J Cardiothorac Surg 2022; 17:29. [PMID: 35246177 PMCID: PMC8895824 DOI: 10.1186/s13019-022-01765-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/02/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Newer minimally invasive approaches to esophagectomy have brought substantial benefits to esophageal-cancer patients and continue to improve. We report here our experience with a streamlined procedure as part of a comprehensive perioperative-care program that provides additional advances in the continued evolution of this procedure. Methods All patients with primary esophageal cancer referred for resection to the Oakland Medical Center of the Kaiser-Permanente Northern California health plan who underwent this approach between January 2013 and August 2018 were included. Operative and clinical outcome variables were extracted from the electronic medical record, operating-room files, and manual chart review. Results 142 patients underwent the new procedure and care program; 121 (85.2%) were men with mean age of 64.5 years. 127 (89.4%) were adenocarcinoma; 117 (82.4%) were clinical stage III or IVA. 115 (81.0%) required no jejunostomy. Median hospital length-of-stay was 3 days and 8 (5.6%) patients required admission to the intensive care unit. Postoperative complications occurred in 22 (15.5%) patients within 30 days of the procedure. There were no inpatient deaths; one patient (0.7%) died within 30 days following discharge and three additional deaths (2.1%) occurred through 90 days of follow-up. Conclusions This approach resulted in excellent clinical outcomes, including short hospital stays with limited need for the intensive care unit, few perioperative complications, and relatively few patients requiring feeding tubes on discharge. This comprehensive approach to esophagectomy is feasible and provides another clinically meaningful advance in the progress of minimally invasive esophagectomy. Further development and dissemination of this method is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01765-2.
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Affiliation(s)
- Simon K Ashiku
- Department of Thoracic Surgery, Northern California Kaiser-Permanente, 3600 Broadway, Oakland, CA, 94611, USA.
| | - Ashish R Patel
- Department of Thoracic Surgery, Northern California Kaiser-Permanente, 3600 Broadway, Oakland, CA, 94611, USA
| | - Brandon H Horton
- Division of Research, Northern California Kaiser-Permanente, Oakland, CA, USA
| | - Jeffrey Velotta
- Department of Thoracic Surgery, Northern California Kaiser-Permanente, 3600 Broadway, Oakland, CA, 94611, USA
| | - Sora Ely
- Department of Thoracic Surgery, Northern California Kaiser-Permanente, 3600 Broadway, Oakland, CA, 94611, USA
| | - Andrew L Avins
- Division of Research, Northern California Kaiser-Permanente, Oakland, CA, USA
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Xie J, Zhang L, Liu Z, Lu CL, Xu GH, Guo M, Lian X, Liu JQ, Zhang HW, Zheng SY. Advantages of McKeown minimally invasive oesophagectomy for the treatment of oesophageal cancer: propensity score matching analysis of 169 cases. World J Surg Oncol 2022; 20:52. [PMID: 35216598 PMCID: PMC8881864 DOI: 10.1186/s12957-022-02527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Oesophagectomy, the gold standard for oesophageal cancer treatment, causes significantly high morbidity and mortality. McKeown minimally invasive oesophagectomy (MIE) is preferred for treating oesophageal malignancies; however, limited studies with large sample sizes focusing on the surgical and oncological outcomes of this procedure have been reported. We aimed to compare the clinical safety and efficacy of McKeown MIE with those of open oesophagectomy (OE). PATIENTS AND METHODS Overall, 338 oesophageal cancer patients matched by gender, age, location, size, and T and N stages (McKeown MIE: 169 vs OE: 169) were analysed. The clinicopathologic features, operational factors, postoperative complications, and prognoses were compared between the groups. RESULTS McKeown MIE resulted in less bleeding (200 mL vs 300 mL, p<0.01), longer operation time (335.0 h vs 240.0 h, p<0.01), and higher number of harvested lymph nodes (22 vs 9, p<0.01) than OE did. Although the rate of recurrent laryngeal nerve injury in the two groups was not significantly different, incidence of anastomotic leakage (8 vs 24, p=0.003) was significantly lower in the McKeown MIE group. In addition, patients who underwent McKeown MIE had higher 5-year overall survival than those who underwent OE (69.9% vs 40.4%, p<0.001). CONCLUSION McKeown MIE is proved to be feasible and safe to achieve better surgical and oncological outcomes for oesophageal cancer compared with OE.
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Affiliation(s)
- Jun Xie
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Shizi Street No. 188, Suzhou, 215006, Jiangsu, China
| | - Lei Zhang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shanxi Province, China
| | - Zhen Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Chun-Lei Lu
- Digestive Diseases Center of Wuxi Mingci Hospital, No. 599 Zhongnan Road, Jinxing Street, Wuxi City, 214000, Jiangsu Province, China
| | - Guang-Hui Xu
- Department of General Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, 710033, Shan Xi Province, China
| | - Man Guo
- Department of General Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, 710033, Shan Xi Province, China
| | - Xiao Lian
- Department of General Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, 710033, Shan Xi Province, China
| | - Jin-Qiang Liu
- Department of General Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, 710033, Shan Xi Province, China
| | - Hong-Wei Zhang
- Digestive Diseases Center of Wuxi Mingci Hospital, No. 599 Zhongnan Road, Jinxing Street, Wuxi City, 214000, Jiangsu Province, China.
| | - Shi-Ying Zheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Shizi Street No. 188, Suzhou, 215006, Jiangsu, China.
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9
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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]
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10
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Casas MA, Angeramo CA, Bras Harriott C, Schlottmann F. Surgical outcomes after totally minimally invasive Ivor Lewis esophagectomy. A systematic review and meta-analysis. Eur J Surg Oncol 2021; 48:473-481. [PMID: 34955315 DOI: 10.1016/j.ejso.2021.11.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/20/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A transthoracic esophagectomy is associated with high rates of morbidity. Minimally invasive esophagectomy has emerged to decrease such morbidity. The aim of this study was to accurately determine surgical outcomes after totally minimally invasive Ivor-Lewis Esophagectomy (TMIE). METHODS A systematic literature search was performed to identify original articles analyzing patients who underwent TMIE. Main outcomes included overall morbidity, major morbidity, pneumonia, arrhythmia, anastomotic leak, chyle leak, and mortality. A meta-analysis was conducted to estimate the overall weighted proportion and its 95% confidence interval (CI) for each analyzed outcome. RESULTS A total of 5619 patients were included for analysis; 4781 (85.1%) underwent a laparoscopic/thoracoscopic esophagectomy and 838 (14.9%) a robotic-assisted esophagectomy. Mean age of patients was 63.5 (55-67) years and 75.8% were male. Overall morbidity and major morbidity rates were 39% (95% CI, 33%-45%) and 20% (95% CI, 13%-28%), respectively. Postoperative pneumonia and arrhythmia rates were 10% (95% CI, 8%-13%) and 12% (95% CI, 8%-17%), respectively. Anastomotic leak rate across studies was 8% (95% CI, 6%-10%). Chyle leak rate was 3% (95% CI, 2%-5%). Mortality rate was 2% (95% CI, 2%-2%). Median ICU stay and length of hospital stay were 2 (1-4) and 11.2 (7-20) days, respectively. CONCLUSIONS Totally minimally invasive Ivor-Lewis esophagectomy is a challenging procedure with high morbidity rates. Strategies to enhance postoperative outcomes after this operation are still needed.
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Affiliation(s)
- María A Casas
- Department of Surgery, Hospital Alemán of Buenos Aires, Argentina
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Murakami K, Yoshida M, Uesato M, Toyozumi T, Isozaki T, Urahama R, Kano M, Matsumoto Y, Matsubara H. Does thoracoscopic esophagectomy really reduce post-operative pneumonia in all cases? Esophagus 2021; 18:724-733. [PMID: 34247287 DOI: 10.1007/s10388-021-00855-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 05/31/2021] [Indexed: 02/03/2023]
Abstract
It has been said that "thoracoscopy suppresses the occurrence of pneumonia in comparison to thoracotomy", but does it reflect real clinical practice? To resolve this clinical question, we compared the results of randomized controlled trials (RCTs) and retrospective cohort studies from limited institutes (CLIs) in which a large number of high-volume centers were the main participants to those of retrospective cohort studies based on nationwide databases (CNDs) in which both high-volume centers and low-volume hospitals participated. A systematic review and meta-analysis were conducted to compare the short-term outcomes of thoracoscopic to open esophagectomy for esophageal cancer in the three above-mentioned research formats. In total, 43 studies with 21,057 patients, which included 1 RCT with 115 patients, 38 CLIs with 6,126 patients and 4 CNDs with 14,816 patients, were selected. Pneumonia was one of the most important complications. Although significant superiority in thoracoscopic esophagectomy was observed in RCTs (p = 0.005) and CLIs (p = 0.003), no such difference was seen in findings using nationwide databases (p = 0.69). In conclusion, unlike RCTs and CLIs, CNDs did not show the superiority of thoracoscopic surgery in terms of post-operative pneumonia. RCTs and CLIs were predominantly performed by high-volume hospitals, while CNDs were often performed by low-volume hospitals. In actual clinical practice including various types of hospitals, the superiority of thoracoscopic over open esophagectomy regarding the incidence of pneumonia may, therefore, decrease.
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Affiliation(s)
- Kentaro Murakami
- Department of Frontier Surgery Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, Japan.
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, 6-1-14 Konodai, Ichikawa City, Chiba, Japan
| | - Masaya Uesato
- Department of Frontier Surgery Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Takeshi Toyozumi
- Department of Frontier Surgery Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Tetsuro Isozaki
- Department of Frontier Surgery Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Ryuma Urahama
- Department of Frontier Surgery Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Masayuki Kano
- Department of Frontier Surgery Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Yasunori Matsumoto
- Department of Frontier Surgery Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, Japan
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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.
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Affiliation(s)
| | | | - María A Casas
- Department of Surgery, Hospital Alemán of Buenos Aires, Argentina
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13
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Fabbi M, De Pascale S, Ascari F, Petz WL, Fumagalli Romario U. Side-to-side esophagogastric anastomosis for minimally invasive Ivor-Lewis esophagectomy: operative technique and short-term outcomes. Updates Surg 2021; 73:1837-1847. [PMID: 33900550 PMCID: PMC8500894 DOI: 10.1007/s13304-021-01054-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/07/2021] [Indexed: 12/05/2022]
Abstract
Totally minimally invasive Ivor-Lewis esophagectomy (TMIIL) is associated to lower rate of post-operative complication, decreases length of hospital stay and improves quality of life compared to open approach. Nevertheless, adaptation of TMIIL still proceeds at slow pace, mainly due to the difficulty to perform the intra-thoracic anastomosis and heterogeneity of surgical techniques. We present our experience with TMIIL utilizing a stapled side-to-side anastomosis. We retrospectively evaluated 36 patients who underwent a planned TMIIL from January 2017 to September 2020. Esophagogastric anastomoses were performed using a 3-cm linear-stapled side-to-side technique. General features, operative techniques, pathology data and short-term outcomes were analyzed. The median operative time was 365 min (ranging from 240 to 480 min) with a median blood loss of 100 ml (50–1000 ml). The median overall length of stay was 13 (7–64) days and in-hospital mortality rate was 2.8%. Two patients (5.6%) had an anastomotic leak, without need for operative intervention and another patient developed an anastomotic stricture, resolved with a single endoscopic dilation. Chylothorax occurred in three patients; two of these required a surgical intervention. Pulmonary complications occurred in six patients (16.7%). Based on Comprehensive Complications Index (CCI), median values of complications were 27.9 (ranging from 20.9 to 100). The results of our study suggest that TMIIL with a 3-cm linear-stapled anastomosis seems to be safe and effective, with low rates of post-operative anastomotic leak and stricture.
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Affiliation(s)
- Manrica Fabbi
- Department of Digestive Surgery, European Institute of Oncology (IRCCS), 20141, Milan, Italy.
| | - Stefano De Pascale
- Department of Digestive Surgery, European Institute of Oncology (IRCCS), 20141, Milan, Italy
| | - Filippo Ascari
- Department of Digestive Surgery, European Institute of Oncology (IRCCS), 20141, Milan, Italy
| | - Wanda Luisa Petz
- Department of Digestive Surgery, European Institute of Oncology (IRCCS), 20141, Milan, Italy
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14
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Gujjuri RR, Kamarajah SK, Markar SR. Effect of anastomotic leaks on long-term survival after oesophagectomy for oesophageal cancer: systematic review and meta-analysis. Dis Esophagus 2021; 34:5902816. [PMID: 32901259 DOI: 10.1093/dote/doaa085] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/14/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Long-term survival after curative surgery for oesophageal cancer surgery remains poor, and the prognostic impact of anastomotic leak (AL) remains unknown. A meta-analysis was conducted to investigate the impact of AL on long-term survival. METHODS A systematic electronic search for articles was performed for studies published between 2001 and 2020 evaluating the long-term oncological impact of AL. Meta-analysis was performed using the DerSimonian-Laird random-effects model to compute hazard ratios and 95% confidence intervals. RESULTS Nineteen studies met the inclusion criteria, yielding a total of 9885 patients. Long-term survival was significantly reduced after AL (HR: 1.79, 95% CI: 1.33-2.43). AL was associated with significantly reduced overall survival in studies within hospital volume Quintile 1 (HR: 1.35, 95% CI: 1.12-1.63) and Quintile 2 (HR: 1.83, 95% CI: 1.35-2.47). However, no significant association was found for studies within Quintile 3 (HR: 2.24, 95% CI: 0.85-5.88), Quintile 4 (HR: 2.59, 95% CI: 0.67-10.07), and Quintile 5 (HR: 1.29, 95% CI: 0.92-1.81). AL was significantly associated with poor long-term survival in patients with associated overall Clavien Dindo Grades 1-5 (HR: 2.17, 95% CI: 1.31-3.59) and severe Clavien Dindo Grades 3-5 (HR: 1.42, 95% CI: 1.14-1.78) complications. CONCLUSIONS AL has a negative prognostic impact on long-term survival after restorative resection of oesophageal cancers, particularly in low-volume centers. Future efforts must be focused on strategies to minimize the septic and immunological response to AL with early recognition and treatment thus reducing the impact on long-term survival.
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Affiliation(s)
- Rohan R Gujjuri
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sivesh K Kamarajah
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, University of Newcastle, Newcastle upon Tyne, UK
| | - Sheraz R Markar
- Department of Surgery & Cancer, Imperial College London, London, UK
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15
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Chen C, Jiang H. The assessment of intraoperative technique-related risk factors and the treatment of anastomotic leakage after esophagectomy: a narrative review. J Gastrointest Oncol 2021; 12:207-215. [PMID: 33708437 DOI: 10.21037/jgo-21-45] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Anastomotic leakage, including cervical anastomotic leakage and intrathoracic anastomotic leakage, is a serious complication of esophageal cancer and a leading cause of death after esophagectomy. In fact, anastomotic leakage after esophagectomy can be caused by numerous factors in the preoperative, intraoperative, and postoperative periods. Intraoperative technique-related risk factors, including surgical methods, anastomosis sites, anastomosis methods, the type of gastric tube, and reconstruction routes, are the key causes of its occurrence. Anastomotic leakage treatments include both surgical and non-surgical treatments, while surgical treatment has high risks, many complications, and high mortality. Actually, non-surgical methods including naso-leakage drainage, stent, negative pressure therapy, and so on, are also very critical in the treatment of anastomotic leakage. So, the selection of correct and appropriate treatment methods plays an important role in alleviating the suffering of patients, shortening hospitalization time, and reducing mortality. This study undertook a systematic review in which data in the PubMed database were searched and analyzed to assess the safety and efficacy of surgical technique-related factors in esophagectomy, and appropriate treatment of anastomotic leakage after esophagectomy. In conclusion, gastric tube, posterior mediastinal route and stapled anastomosis are safe among esophagectomy surgical techniques, and non-surgical treatment of anastomotic leakage such as naso-leakage drainage is feasible in the majority of cases.
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Affiliation(s)
- Chuangui Chen
- Department of Minimally Invasive Esophagus Surgery, Key Laboratory of Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Hongjing Jiang
- Department of Minimally Invasive Esophagus Surgery, Key Laboratory of Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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16
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Siaw‐Acheampong K, Kamarajah SK, Gujjuri R, Bundred JR, Singh P, Griffiths EA. Minimally invasive techniques for transthoracic oesophagectomy for oesophageal cancer: systematic review and network meta-analysis. BJS Open 2020; 4:787-803. [PMID: 32894001 PMCID: PMC7528517 DOI: 10.1002/bjs5.50330] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Oesophagectomy is a demanding operation that can be performed by different approaches including open surgery or a combination of minimal access techniques. This systematic review and network meta-analysis aimed to evaluate the clinical outcomes of open, minimally invasive and robotic oesophagectomy techniques for oesophageal cancer. METHODS A systematic literature search was conducted for studies reporting open oesophagectomy, laparoscopically assisted oesophagectomy (LAO), thoracoscopically assisted oesophagectomy (TAO), totally minimally invasive oesophagectomy (MIO) or robotic MIO (RAMIO) for oesophagectomy. A network meta-analysis of intraoperative (operating time, blood loss), postoperative (overall complications, anastomotic leaks, chyle leak, duration of hospital stay) and oncological (R0 resection, lymphadenectomy) outcomes, and survival was performed. RESULTS Ninety-eight studies involving 32 315 patients were included in the network meta-analysis (open 17 824, 55·2 per cent; LAO 1576, 4·9 per cent; TAO 2421 7·5 per cent; MIO 9558, 29·6 per cent; RAMIO 917, 2·8 per cent). Compared with open oesophagectomy, both MIO and RAMIO were associated with less blood loss, significantly lower rates of pulmonary complications, shorter duration of stay and higher lymph node yield. There were no significant differences between surgical techniques in surgical-site infections, chyle leak, and 30- and 90-day mortality. MIO and RAMIO had better 1- and 5-year survival rates respectively compared with open surgery. CONCLUSION Minimally invasive and robotic techniques for oesophagectomy are associated with reduced perioperative morbidity and duration of hospital stay, with no compromise of oncological outcomes but no improvement in perioperative mortality.
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Affiliation(s)
| | - S. K. Kamarajah
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman HospitalNewcastle University NHS Foundation Trust HospitalsNewcastle upon TyneUK
- Institute of Cellular MedicineUniversity of NewcastleNewcastle upon TyneUK
| | - R. Gujjuri
- College of Medical and Dental SciencesNewcastle upon TyneUK
| | - J. R. Bundred
- College of Medical and Dental SciencesNewcastle upon TyneUK
| | - P. Singh
- Regional Oesophago‐Gastric UnitRoyal Surrey County Hospital NHS Foundation TrustGuildfordUK
| | - E. A. Griffiths
- Institute of Cancer and Genomic Sciences, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- Department of Upper Gastrointestinal SurgeryUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
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17
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Gust L, Nafteux P, Allemann P, Tuech JJ, El Nakadi I, Collet D, Goere D, Fabre JM, Meunier B, Dumont F, Poncet G, Passot G, Carrere N, Mathonnet M, Lebreton G, Theraux J, Marchal F, Barabino G, Thomas PA, Piessen G, D'Journo XB. Hiatal hernia after oesophagectomy: a large European survey. Eur J Cardiothorac Surg 2020; 55:1104-1112. [PMID: 30596989 DOI: 10.1093/ejcts/ezy451] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/08/2018] [Accepted: 11/17/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Hiatal hernias (HH) after oesophagectomy are rare, and their surgical management is not well standardized. Our goal was to report on the management of HH after oesophagectomy in high-volume tertiary European French-speaking centres. METHODS We conducted a retrospective multicentre study among 19 European French-speaking departments of upper gastrointestinal and/or thoracic surgery. All patients scheduled or operated on for the repair of an HH after oesophagectomy were collected between 2000 and 2016. Demographics, details of the initial procedure, surgical management and long-term outcome were analysed. RESULTS Seventy-nine of 6608 (1.2%) patients who had oesophagectomies were included in the study. The postoesophagectomy diagnostic interval of an HH after oesophagectomy was ≤90 days (n = 17; 21%), 13 were emergency cases; between 91 days and 1 year, n = 21 (27%), 13 in emergency; ≥1 year, n = 41 (52%), 17 in emergency. The time to occurrence of HH after oesophagectomy was shorter after laparoscopy (median 308 days; interquartile range 150-693) compared to that after laparotomy (median 562 days, interquartile range 138-1768; P = 0.01). The incidence of HH after oesophagectomy was 0.73% (22/3010) after open surgery and 1.4% (26/1761) after laparoscopy (P = 0.03). Among the 79 patients, 78 were operated on: 35 had laparotomies (45%), 19 had laparoscopies (24%) and 24 (31%) had transthoracic approaches. Among the 43 urgent surgeries, 35 were open (25 laparotomies and 10 transthoracic approaches) and 8 were laparoscopies (conversion rate, 25%). Nine patients required bowel resections. Morbidity occurred in 36 (46%) patients with 1 postoperative death (1.2%). During the follow-up period, recurrent HH after oesophagectomy requiring revisional surgery developed in 8 (6 days-26 months) patients. CONCLUSIONS Surgical management of HH after oesophagectomy could be done by laparoscopy in patients with scheduled surgery but laparotomy or thoracotomy was preferred in urgent situations. The incidence of HH after oesophagectomy is higher and its onset earlier when laparoscopy is used at the initial oesophagectomy.
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Affiliation(s)
- Lucile Gust
- Department of Thoracic Surgery, Disease of the Esophagus and Lung Transplantation, North Hospital, Aix-Marseille University, Marseille, France
| | - Philippe Nafteux
- Department of Thoracic Surgery and Disease of the Esophagus, KUZ Gathuisberg, Leuven, Belgium
| | - Pierre Allemann
- Department of Thoracic Surgery, University Hospital Vaudois, Lausanne, Switzerland
| | - Jean-Jacques Tuech
- Department of Visceral Surgery, Rouen University Hospital, Rouen, France
| | - Issam El Nakadi
- Department of Visceral Surgery, ULB-Erasme-Bordet University Hospital, Brussels, Belgium
| | - Denis Collet
- Department of Visceral and Endocrine Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Diane Goere
- Department of Visceral Surgery, Gustave Roussy Institute, Villejuif, France
| | - Jean-Michel Fabre
- Department of Visceral Surgery and Hepatic Transplantation, Montpellier University Hospital, Montpellier, France
| | - Bernard Meunier
- Department of Hepato-Biliary and Visceral Surgery, Rennes University Hospital, Rennes, France
| | - Frédéric Dumont
- Department of Oncological Surgery, Oncologic Institute of the West (Institut de Cancérologie de l'Ouest), Nantes, France
| | - Gilles Poncet
- Department of Visceral Surgery, Édouard-Heriot Hospital, Lyon, France
| | - Guillaume Passot
- Department of Visceral and Endocrine Surgery, Hospices Civils de Lyon-South Hospital, Lyon, France
| | - Nicolas Carrere
- Department of General and Visceral Surgery, Purpan University Hospital, Toulouse, France
| | - Muriel Mathonnet
- Department of General, Visceral and Endocrine Surgery, Dupuytren Hospital, Limoges, France
| | - Gil Lebreton
- Department of Visceral Surgery-Colo-rectal Surgery Unit, Caen University Hospital, Caen, France
| | - Jérémie Theraux
- Department of Visceral Surgery, Brest University Hospital, Brest, France
| | - Frédéric Marchal
- Department of Surgery, Lorraine Oncologic Institute, Nancy, France
| | - Gabriele Barabino
- Department of Visceral and Oncological Surgery, Saint-Étienne University Hospital, Saint-Etienne, France
| | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, Disease of the Esophagus and Lung Transplantation, North Hospital, Aix-Marseille University, Marseille, France
| | - Guillaume Piessen
- Department of General and Visceral Surgery, Lille University Hospital, Lille, France
| | - Xavier-Benoît D'Journo
- Department of Thoracic Surgery, Disease of the Esophagus and Lung Transplantation, North Hospital, Aix-Marseille University, Marseille, France
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18
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Pu S, Chen H, Zhou C, Yu S, Liao X, Zhu L, He J, Wang B. Major Postoperative Complications in Esophageal Cancer After Minimally Invasive Esophagectomy Compared With Open Esophagectomy: An Updated Meta-analysis. J Surg Res 2020; 257:554-571. [PMID: 32927322 DOI: 10.1016/j.jss.2020.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/30/2020] [Accepted: 08/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND To evaluate the existing literature comparing cardiopulmonary complications after minimally invasive esophagectomy (MIE) with open esophagectomy (OE) and conduct a meta-analysis based on the relevant studies. METHODS A systematic search for articles was performed in Medline, Embase, Wiley Online Library, and the Cochrane Library. The relative risks or odds ratios (ORs) were calculated by using fixed or random-effects models. The I2 and X2 tests were used to test for statistical heterogeneity. We performed a metaregression for the pulmonary complications with the adenocarcinoma proportion and tumor stage. Publication bias and small-study effects were assessed using Egger's test and Begg's funnel plot. RESULTS A total of 30,850 participants were enrolled in the 63 studies evaluated in the meta-analysis. Arrhythmia, pulmonary embolism, pulmonary complications, gastric tip necrosis, anastomotic leakage, and vocal cord palsy were chosen as outcomes. The occurrence rate of arrhythmia was significantly lower in patients receiving MIE than in patients receiving OE (OR = 0.69; 95% CI = 0.53-0.89), with heterogeneity (I2 = 30.7%, P = 0.067). The incidence of pulmonary complications was significantly lower in patients receiving MIE (OR = 0.54, 95% CI = 0.45-0.63) but heterogeneity remained (I2 = 72.1%, P = 0.000). The risk of gastric tip necrosis (OR = 1.48, 95% CI = 1.07-2.05) after OE was lower than that after MIE. Anastomotic leakage, pulmonary embolism, and vocal cord palsy showed no significant differences between the two groups. CONCLUSIONS MIE has advantages over OE, especially in reducing the incidence of arrhythmia and pulmonary complications. Thus, MIE can be recommended as the preferred alternative surgery method for resectable esophageal cancer.
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Affiliation(s)
- Shengyu Pu
- Department of Breast Surgery, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaan'xi Province, China
| | - Heyan Chen
- Department of Breast Surgery, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaan'xi Province, China
| | - Can Zhou
- Department of Breast Surgery, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaan'xi Province, China
| | - Shibo Yu
- Department of Breast Surgery, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaan'xi Province, China
| | - Xiaoqin Liao
- Department of Breast Surgery, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaan'xi Province, China
| | - Lizhe Zhu
- Department of Breast Surgery, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaan'xi Province, China
| | - Jianjun He
- Department of Breast Surgery, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaan'xi Province, China.
| | - Bin Wang
- Department of Breast Surgery, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaan'xi Province, China.
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19
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The Impact of Hybrid Minimally Invasive Esophagectomy with Neck-Abdominal First Approach on the Short- and Long-Term Outcomes for Esophageal Squamous Cell Carcinoma. World J Surg 2020; 44:3829-3836. [PMID: 32591842 DOI: 10.1007/s00268-020-05655-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Currently, there is no consensus for an optimal minimally invasive esophagectomy (MIE) approach. This study aimed to compare hybrid MIE (hMIE) with neck-abdominal first approach to standard open esophagectomy (OE). METHODS Data from a cohort of 301 patients were retrospectively analyzed. All participants received either hMIE or OE for the treatment of esophageal squamous cell carcinoma at Tokyo Medical and Dental University between January 2003 and December 2013. Analyses included propensity score matching and the Kaplan-Meier statistical method to determine overall survival (OS) and disease-free survival (DFS) of the cohort. RESULTS After one-to-one propensity score matching, there were 68 patient pairs. The hMIE group had significantly lower incidence of severe postoperative complications (20.1% vs. 7.4%; p = 0.026) and severe respiratory complications (7.4% vs. 0%; p = 0.058) than the OE group. The 5-year oncological outcomes of the two groups were almost equivalent (OS: OE, 55.0%; hMIE, 69.0%; p = 0.063 and DFS: OE, 54.0%; hMIE, 62.0%; p = 0.28). CONCLUSIONS This study compared hMIE with neck-abdominal first approach to standard OE. The results showed significantly less severe postoperative complications for hMIE with neck-abdominal first approach in comparison with OE, without a compromise in long-term oncological outcomes.
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20
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Patel K, Askari A, Moorthy K. Long-term oncological outcomes following completely minimally invasive esophagectomy versus open esophagectomy. Dis Esophagus 2020; 33:5707339. [PMID: 31950180 DOI: 10.1093/dote/doz113] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/09/2019] [Accepted: 01/02/2020] [Indexed: 12/11/2022]
Abstract
Open esophagectomy (OE) for esophageal and gastroesophageal junctional cancers is associated with high morbidity. Completely minimally invasive esophagectomy (CMIE) techniques have evolved over the last two decades and significantly reduce surgical trauma compared to open surgery. Despite this, long-term oncological outcomes following CMIE compared to OE remain unclear. This systematic review and meta-analysis aimed to compare overall 5-year survival (OFS) and disease-free 5-year survival (DFFS) between CMIE and OE. It was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive electronic literature search from MEDLINE, EMBASE, Web of Science, Scopus and the Cochrane Central Register of Controlled Trials was conducted. The PROSPERO database was also searched for studies comparing OFS and DFFS between CMIE and OE. The Newcastle Ottawa Scale was used to assess study quality for included studies. Overall, seven studies (containing 949 patients: 527 OE and 422 CMIE) were identified from screening. On pooled meta-analysis, there was no significant difference in OFS or DFFS between CMIE and OE cohorts ([odds ratio 1.12; 95% CI: 0.85 to 1.48; P = 0.41] and [odds ratio 1.34; 95% CI: 0.81-2.22; P = 0.25] respectively). Sensitivity and subgroup analysis with high-quality studies, three highest sample sized studies, and three most recent studies also revealed no difference in long-term oncological outcomes between the two operative groups. This review demonstrates long-term oncological outcomes following CMIE appear equivalent to OE based on amalgamation of existing published literature. Limited high-level evidence comparing OFS and DFFS between CMIE and OE exists. Further research with a randomized controlled trial is required to clinically validate these findings.
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Affiliation(s)
- K Patel
- Department of Surgery and Cancer, Imperial College, London, UK
| | - A Askari
- Department of Surgery and Cancer, Imperial College, London, UK
| | - K Moorthy
- Department of Surgery and Cancer, Imperial College, London, UK
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Akhtar NM, Chen D, Zhao Y, Dane D, Xue Y, Wang W, Zhang J, Sang Y, Chen C, Chen Y. Postoperative short-term outcomes of minimally invasive versus open esophagectomy for patients with esophageal cancer: An updated systematic review and meta-analysis. Thorac Cancer 2020; 11:1465-1475. [PMID: 32310341 PMCID: PMC7262946 DOI: 10.1111/1759-7714.13413] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 01/04/2023] Open
Abstract
Background We performed a systematic review and meta‐analysis to synthesize the available evidence regarding short‐term outcomes between minimally invasive esophagectomy (MIE) and open esophagectomy (OE). Methods Studies were identified by searching databases including PubMed, EMBASE, Web of Science and Cochrane Library up to March 2019 without language restrictions. Results of these searches were filtered according to a set of eligibility criteria and analyzed in line with PRISMA guidelines. Results There were 33 studies included with a total of 13 269 patients in our review, out of which 4948 cases were of MIE and 8321 cases were of OE. The pooled results suggested that MIE had a better outcome regarding all‐cause respiratory complications (RCs) (OR = 0.56, 95% CI = 0.41–0.78, P = <0.001), in‐hospital duration (SMD = −0.51; 95% CI = −0.78−0.24; P = <0.001), and blood loss (SMD = −1.44; 95% CI = −1.95−0.93; P = <0.001). OE was associated with shorter duration of operation time, while no statistically significant differences were observed regarding other outcomes. Additionally, subgroup analyses were performed for a number of different postoperative events. Conclusions Our study indicated that MIE had more favorable outcomes than OE from the perspective of short‐term outcomes. Further large‐scale, multicenter randomized control trials are needed to explore the long‐term survival outcomes after MIE versus OE.
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Affiliation(s)
- Naeem M Akhtar
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuhuan Zhao
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - David Dane
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuhang Xue
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wenjia Wang
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiaheng Zhang
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yonghua Sang
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yongbing Chen
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Awad ZT, Abbas S, Puri R, Dalton B, Chesire DJ. Minimally Invasive Ivor Lewis Esophagectomy (MILE): technique and outcomes of 100 consecutive cases. Surg Endosc 2020; 34:3243-3255. [DOI: 10.1007/s00464-020-07529-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023]
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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.
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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
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Souche R, Nayeri M, Chati R, Huet E, Donici I, Tuech JJ, Borie F, Prudhomme M, Jaber S, Fabre JM. Thoracoscopy in prone position with two-lung ventilation compared to conventional thoracotomy during Ivor Lewis procedure: a multicenter case-control study. Surg Endosc 2019; 34:142-152. [PMID: 30868323 DOI: 10.1007/s00464-019-06742-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 03/06/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Intraoperative management based on thoracoscopy, prone position and two-lung ventilation could decrease the rate of postoperative pulmonary complications after esophagectomy. The aim of this study was to compare this multifaceted approach (MIE-PP) and conventional thoracotomy for Ivor Lewis procedure after a systematic laparoscopic dissection. METHODS Data from 137 consecutive patients undergoing Ivor Lewis procedures between 2010 and 2017 at two tertiary centers was analyzed retrospectively. The outcomes of patients who underwent MIE-PP (n = 58; surgeons group 1) were compared with those of patients undergoing conventional approach (n = 79; surgeons group 2). Our primary outcome was major postoperative pulmonary complications. Our main secondary outcomes were anastomotic leak, quality of resection and mortality. RESULTS Female patients were more prevalent in the MIE-PP group (p = 0.002). Other patient characteristics, cTNM staging and neoadjuvant treatment rate were not different between groups. Major postoperative pulmonary complications were significantly lower in the MIE-PP group compared to Conventional group (24 vs. 44%; p = 0.014). Anastomotic leak occurred in 31 versus 18% in MIE-PP group and Conventional groups, respectively (p = 0.103). Complete resection rate (98 vs. 95%; p = 0.303) and mean number of harvested lymph nodes (16 (4-40) vs. 18 (3-37); p = 0.072) were similar between the two groups. Postoperative mortality rates were 0 versus 2% at day 30 (p = 0.508) and 0 versus 7.6% at day 90 (p = 0.038). CONCLUSION Short-term outcomes of minimally invasive Ivor Lewis using thoracoscopy, prone position and two-lung ventilation are at least equivalent to the hybrid approach. Anastomotic leak after MIE-PP remains a major concern.
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Affiliation(s)
- R Souche
- Digestive and Minimally Invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
| | - M Nayeri
- Digestive Surgery Department, Carémeau Hospital, University of Montpellier - Nîmes, Place du professeur Debré, 30900, Nîmes, France
| | - R Chati
- Digestive Surgery Department, Charles Nicolle Hospital, University of Rouen, 1 rue de Germont, 76031, Rouen, France
| | - E Huet
- Digestive Surgery Department, Charles Nicolle Hospital, University of Rouen, 1 rue de Germont, 76031, Rouen, France
| | - I Donici
- Digestive Surgery Department, Carémeau Hospital, University of Montpellier - Nîmes, Place du professeur Debré, 30900, Nîmes, France
| | - J J Tuech
- Digestive Surgery Department, Charles Nicolle Hospital, University of Rouen, 1 rue de Germont, 76031, Rouen, France
| | - F Borie
- Digestive Surgery Department, Carémeau Hospital, University of Montpellier - Nîmes, Place du professeur Debré, 30900, Nîmes, France
| | - M Prudhomme
- Digestive Surgery Department, Carémeau Hospital, University of Montpellier - Nîmes, Place du professeur Debré, 30900, Nîmes, France
| | - S Jaber
- Department of Reanimation and Anesthesiology, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - J M Fabre
- Digestive and Minimally Invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France
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Linder G, Jestin C, Sundbom M, Hedberg J. Safe Introduction of Minimally Invasive Esophagectomy at a Medium Volume Center. Scand J Surg 2019; 109:121-126. [PMID: 30739555 DOI: 10.1177/1457496919826722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Minimally invasive esophagectomy is a favored alternative in high-volume centers. We evaluated the introduction of, and transition to, minimally invasive esophagectomy at a medium volume tertiary referral center (10-20 esophagectomies annually) with focus on surgical results. MATERIAL AND METHODS Patients who underwent minimally invasive esophagectomy or open transthoracic surgery for carcinoma of the esophagus or gastroesophageal junction (Siewert I and II) during 2007-2016 were retrospectively studied. Sorted on surgical approach, perioperative data, surgical outcomes, and postoperative complications were analyzed and multivariate regression models were used to adjust for possible confounders. RESULTS One hundred and sixteen patients were included, 51 minimally invasive esophagectomy (21 hybrid and 30 totally minimally invasive) and 65 open resections. The groups were well matched. However, higher body mass index, neoadjuvant chemoradiotherapy, and cervical anastomosis were more frequent in the minimally invasive esophagectomy group. Minimally invasive esophagectomy was associated with less peroperative bleeding (384 vs 607 mL, p = 0.036) and reduced length of stay (14 vs 15 days, p = 0.042). Duration of surgery, radical resection rate, and postoperative complications did not differ between groups. Lymph node yield was higher in the minimally invasive esophagectomy group, 18 (13-23) vs 12 (8-16), p < 0.001, confirmed in a multivariate regression model (adjusted odds ratio 3.15, 95% class interval 1.11-8.98, p = 0.032). CONCLUSION The introduction of minimally invasive esophagectomy at a medium volume tertiary referral center resulted in superior lymph node yield, less peroperative blood loss and shorter length of stay, without compromising the rate of radical resection, or increasing the complication rate.
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Affiliation(s)
- G Linder
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - C Jestin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - M Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - J Hedberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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The original Ivor Lewis two stage esophagectomy revisited in the era of minimally invasive surgery. Am J Surg 2018; 217:454-457. [PMID: 30545686 DOI: 10.1016/j.amjsurg.2018.11.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/26/2018] [Accepted: 11/28/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Esophagectomy has high cardiac and pulmonary complication rates that can reach 43% and 58% respectively. The original Ivor Lewis esophagectomy was a two-stage procedure. We revisited this procedure using a hybrid minimally-invasive approach. METHODS Thirty-five consecutive patients with esophageal cancer were operated on over an eight-year period. The first stage used laparoscopic mobilization of the stomach, while the second stage used open thoracotomy. Six patients were aborted due to unresectable disease. RESULTS Twenty-nine patients were studied. The mean operative times for stage-one and stage-two were 108 ± 18 and 226 ± 63 min respectively. All patients were extubated in the operating room. One (3.4%) patients had cardiac complication and one (3.4%) patient had pulmonary complication. CONCLUSION Metachronous hybrid two-stage esophagectomy was associated with a low rate of cardio-pulmonary complications. It may be considered as an alternative to the one-stage esophagectomy, especially in low-volume centers, to decrease these high-risk cardio-pulmonary complications.
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27
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The first postesophagectomy chest X-ray predicts respiratory failure and the need for tracheostomy. J Surg Res 2018; 224:89-96. [DOI: 10.1016/j.jss.2017.11.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/11/2017] [Accepted: 11/21/2017] [Indexed: 02/07/2023]
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28
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Minimally invasive esophagectomy via Sweet approach in combination with cervical mediastinoscopy for esophageal squamous cell carcinoma: a case series. INTERNATIONAL JOURNAL OF SURGERY-ONCOLOGY 2017; 2:e45. [PMID: 29302639 PMCID: PMC5732631 DOI: 10.1097/ij9.0000000000000045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 09/01/2017] [Indexed: 02/06/2023]
Abstract
Objective: Minimally invasive esophagectomy (MIE) is increasingly used for the treatment of esophageal cancer. However, MIE via the Sweet approach has seldom been reported owing to the challenging procedure for a mediastinal lymph node. Thus, the approach of MIE via left-sided thoracoscopy coupled with video-assisted cervical mediastinoscopy (MIE-SM) was explored for eradicating the mediastinal lymph nodes and recurrent laryngeal nerve; the incidence of perioperative complications, mortality, and surgical radicality were analyzed. Materials and Methods: Thirty patients with esophageal carcinoma underwent MIE-SM between June 2014 and February 2016. The primary outcome was postoperative morbidity within 2 weeks postsurgery. The secondary outcome was surgical radicality, including the circumferential margins, and the number of lymph nodes dissected. Results: The MIE-SM was completed in all patients within 367.6±68.7 minutes. The incidences of postoperative morbidities including pulmonary complications, anastomotic leakage, chylothorax, or recurrent nerve injury were 43.3%. Conclusion: The MIE-SM was utilized for the first time to reduce the disadvantage of purely Sweet and McKeown approach, with favorable efficacy in the mediastinal and laryngeal recurrent nerve lymph node eradication. Thus, MIE-SM might be a promising alternative approach in treating esophageal cancer in selected patients.
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29
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Ahmadi N, Crnic A, Seely AJ, Sundaresan SR, Villeneuve PJ, Maziak DE, Shamji FM, Gilbert S. Impact of surgical approach on perioperative and long-term outcomes following esophagectomy for esophageal cancer. Surg Endosc 2017; 32:1892-1900. [PMID: 29067584 DOI: 10.1007/s00464-017-5881-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 09/13/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Surgical resection remains a critical component of esophageal cancer treatment with curative-intent. The aim of this study was to compare open (OE) to minimally invasive Ivor Lewis esophagectomy (MIE) with respect to perioperative and oncologic outcomes. METHODS Retrospective single-institution review of MIE and OE patients operated between 2001 and 2015 was conducted. Univariable and multivariable models were created using Cox regression. The Kaplan-Meier method was used to compare oncologic outcomes. Propensity score matching was used to compare oncological outcomes in MIE and OE patients. RESULTS Of 210 esophageal resection patients, 47% had OE (137/291) and 25% had MIE (73/291). The MIE and OE groups were comparable with respect to patient factors and operative details. Fewer OE patients received neoadjuvant chemoradiation. MIE was associated with improved lymph node yield, (MIE = 30 [IQR:22-39]; OE = 14 [IQR:7-19], p < 0.001), less intraoperative blood loss (MIE = 312 mL [100-400]; OE = 657 mL [350-700], p < 0.001), and shorter median length of stay (MIE = 10 days [IQR = 8-14]; OE = 14 days [IQR = 11-22] p < 0.01). The OE group had significantly more adverse events resulting in reoperation or intensive care unit admission (MIE = 21%; OE = 34%; p < 0.01). On multivariable analysis, age and positive resection margins were associated with decreased odds of survival. The number of lymph nodes retrieved, positive resection margins, and pathologic stage were significant predictors of disease-free survival. Analysis of 69 matched pairs showed equivalent median overall survival (MIE = 49 months [18-67]; OE = 29 months [17-69]; p = 0.26) and disease-free survival (MIE = 9 [6-22]; OE = 13 [6-22]; p = 0.45) between the two groups. CONCLUSIONS Although long-term oncologic outcomes appear to be similar, MIE is associated with significantly less intraoperative blood loss, improved lymph node yield, less risk of severe postoperative adverse events, and shorter length of stay.
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Affiliation(s)
- Negar Ahmadi
- Department of General Surgery, University of Ottawa, Ottawa, Canada
| | - Agnes Crnic
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Andrew J Seely
- Division of Thoracic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sudhir R Sundaresan
- Division of Thoracic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - P James Villeneuve
- Division of Thoracic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Donna E Maziak
- Division of Thoracic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Farid M Shamji
- Division of Thoracic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Sebastien Gilbert
- Division of Thoracic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada.
- The Ottawa Hospital Research Institute, Ottawa, Canada.
- Minimally Invasive Aerodigestive Surgery Program, The Ottawa Hospital, General Campus Suite 6363, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
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30
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Zhang Z, Xu M, Guo M, Liu X. Long-term outcomes of minimally invasive Ivor Lewis esophagostomy for esophageal squamous cell carcinoma: Compared with open approach. Int J Surg 2017; 45:98-104. [DOI: 10.1016/j.ijsu.2017.07.104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/25/2017] [Accepted: 07/31/2017] [Indexed: 01/24/2023]
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Brenkman HJF, Parry K, Noble F, van Hillegersberg R, Sharland D, Goense L, Kelly J, Byrne JP, Underwood TJ, Ruurda JP. Hiatal Hernia After Esophagectomy for Cancer. Ann Thorac Surg 2017; 103:1055-1062. [PMID: 28267979 DOI: 10.1016/j.athoracsur.2017.01.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/04/2016] [Accepted: 01/05/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Hiatal hernia (HH) after esophagectomy is becoming more relevant due to improvements in survival. This study evaluated and compared the occurrence and clinical course of HH after open and minimally invasive esophagectomy (MIE). METHODS The prospectively recorded characteristics of patients treated with esophagectomy for cancer at 2 tertiary referral centers in the United Kingdom and the Netherlands between 2000 and 2014 were reviewed. Computed tomography reports were reviewed to identify HH. RESULTS Of 657 patients, MIE was performed in 432 patients (66%) and open esophagectomy in 225 (34%). A computed tomography scan was performed in 488 patients (74%). HH was diagnosed in 45 patients after a median of 20 months (range, 0 to 101 months). The development of HH after MIE was comparable to the open approach (8% vs 5%, p = 0.267). At the time of diagnosis, 14 patients presented as a surgical emergency. Of the remaining 31 patients, 17 were symptomatic and 14 were asymptomatic. An elective operation was performed in 10 symptomatic patients, and all others were treated conservatively. During conservative treatment, 2 patients presented as a surgical emergency. An emergency operation resulted in a prolonged intensive care unit stay compared with an elective procedure (3 vs 0 days, p < 0.001). In-hospital deaths were solely seen after emergency operations (19%). CONCLUSIONS HH is a significant long-term complication after esophagectomy, occurring in a substantial proportion of the patients. The occurrence of HH after MIE and open esophagectomy is comparable. Emergency operation is associated with dismal outcomes and should be avoided.
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Affiliation(s)
- Hylke J F Brenkman
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kevin Parry
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Fergus Noble
- Department of Surgery, University Hospital Southampton, Southampton, United Kingdom
| | | | - Donna Sharland
- Department of Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Lucas Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jamie Kelly
- Department of Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - James P Byrne
- Department of Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Timothy J Underwood
- Department of Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
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32
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Underwood TJ, Noble F, Madhusudan N, Sharland D, Fraser R, Owsley J, Grant M, Kelly JJ, Byrne JP. The Development, Application and Analysis of an Enhanced Recovery Programme for Major Oesophagogastric Resection. J Gastrointest Surg 2017; 21:614-621. [PMID: 28120276 PMCID: PMC5359364 DOI: 10.1007/s11605-017-3363-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/04/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Enhanced recovery programmes improve outcomes in surgery, but their implementation after upper gastrointestinal resection has been limited. The aim of this study was to compare short-term outcomes for patients undergoing oesophagogastric surgery in an enhanced recovery programme (EROS). METHODS EROS was developed after a multidisciplinary meeting by multiple rounds of revision. EROS was applied to all patients undergoing major upper GI resection at a university teaching hospital in the UK from 20/9/13, with data reviewed at 18/09/15. EROS was assessed to identify predictors for compliance. RESULTS One hundred six patients underwent major upper GI resection including 81 oesophagectomies, 24 gastrectomies and 1 colonic interposition graft. Major complications (Clavien Dindo ≥3) occurred in 12 patients with 1 in-hospital death. Thirty-five patients (44%) were discharged on target day 8 of the EROS programme. Age and complications were independently associated with missing this discharge target. CONCLUSION Enhanced recovery is feasible and safe after major upper gastrointestinal surgery.
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Affiliation(s)
- Timothy J. Underwood
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK ,Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Somers Cancer Research Building, MP824, Southampton General Hospital, Southampton, Hampshire SO16 6YD UK
| | - F. Noble
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK ,Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Somers Cancer Research Building, MP824, Southampton General Hospital, Southampton, Hampshire SO16 6YD UK
| | - N. Madhusudan
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - D. Sharland
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - R. Fraser
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - J. Owsley
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - M. Grant
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - J. J. Kelly
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - James P. Byrne
- Department of Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
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Mitzman B, Lutfi W, Wang CH, Krantz S, Howington JA, Kim KW. Minimally Invasive Esophagectomy Provides Equivalent Survival to Open Esophagectomy: An Analysis of the National Cancer Database. Semin Thorac Cardiovasc Surg 2017; 29:244-253. [DOI: 10.1053/j.semtcvs.2017.03.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2017] [Indexed: 11/11/2022]
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34
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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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Lv L, Hu W, Ren Y, Wei X. Minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: a meta-analysis. Onco Targets Ther 2016; 9:6751-6762. [PMID: 27826201 PMCID: PMC5096744 DOI: 10.2147/ott.s112105] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and objectives The safety and effectiveness of minimally invasive esophagectomy (MIE) in comparison with the open esophagectomy (OE) remain uncertain in esophageal cancer treatment. The purpose of this meta-analysis is to compare the outcomes of the two surgical modalities. Methods Searches were conducted in MEDLINE, EMBASE, and ClinicalTrials.gov with the following index words: “esophageal cancer”, “VATS”, “MIE”, “thoracoscopic esophagectomy”, and “open esophagectomy” for relative studies that compared the effects between MIE and OE. Random-effect models were used, and heterogeneity was assessed. Results A total of 20 studies were included in the analysis, consisting of four randomized controlled trials and 16 prospective studies. MIE has reduced operative blood loss (P=0.0009) but increased operation time (P=0.009) in comparison with OE. Patients get less respiratory complications (risk ratio =0.74, 95% CI =0.58–0.94, P=0.01) and better overall survival (hazard ratio =0.54, 95% CI =0.42–0.70, P<0.00001) in the MIE group than the OE group. No statistical difference was observed between the two groups in terms of lymph node harvest, R0 resection, and other major complications. Conclusion MIE is a better choice for esophageal cancer because patients undergoing MIE may benefit from reduced blood loss, less respiratory complications, and also improved overall survival condition compared with OE. However, more randomized controlled trials are still needed to verify these differences.
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Affiliation(s)
- Lu Lv
- Hubei Key Laboratory of Tumor Biological Behaviors, Department of Thoracic Oncology, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Weidong Hu
- Hubei Key Laboratory of Tumor Biological Behaviors, Department of Thoracic Oncology, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Yanchen Ren
- Hubei Key Laboratory of Tumor Biological Behaviors, Department of Thoracic Oncology, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Xiaoxuan Wei
- Hubei Key Laboratory of Tumor Biological Behaviors, Department of Thoracic Oncology, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
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Oor JE, Wiezer MJ, Hazebroek EJ. Hiatal Hernia After Open versus Minimally Invasive Esophagectomy: A Systematic Review and Meta-analysis. Ann Surg Oncol 2016; 23:2690-8. [DOI: 10.1245/s10434-016-5155-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Indexed: 12/17/2022]
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Rodríguez-Sanjuán JC, Gómez-Ruiz M, Trugeda-Carrera S, Manuel-Palazuelos C, López-Useros A, Gómez-Fleitas M. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions. World J Gastroenterol 2016; 22:1975-2004. [PMID: 26877605 PMCID: PMC4726673 DOI: 10.3748/wjg.v22.i6.1975] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/20/2015] [Accepted: 11/30/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated.
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Javed A, Manipadam JM, Jain A, Kalayarasan R, Uppal R, Agarwal AK. Minimally invasive oesophagectomy in prone versus lateral decubitus position: A comparative study. J Minim Access Surg 2016; 12:10-5. [PMID: 26917913 PMCID: PMC4746968 DOI: 10.4103/0972-9941.171954] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Thoracoscopic oesophageal mobilisation during a minimally invasive oesophagectomy (MIE) is most commonly performed with the patient placed in the lateral decubitus position (LDP). The prone position (PP) for thoracoscopic oesophageal mobilisation has been proposed as an alternative. MATERIALS AND METHODS This was a retrospective, comparative study designed to compare early outcomes following a minimally invasive thoracolaparoscopic oesophagectomy for oesophageal cancer in LDP and in PP. RESULTS During the study period, between January 2011 and February 2014, 104 patients underwent an oesophagectomy for cancer. Of these, 42 were open procedures (transhiatal and transthoracic oesophagectomy) and 62 were minimally invasive. The study group included patients who underwent thoracolaparoscopic oesophagectomy in LDP (n = 23) and in PP (n = 25). The median age of the study population was 55 (24-71) years, and there were 25 males. Twenty-one (21) patients had tumours in the middle third of the oesophagus, 24 in the lower third, and 3 arising from the gastro-oesophageal junction. The most common histology was squamous cell cancer (85.4%). The median duration of surgery was similar in the two groups; however, the estimated median intraoperative blood loss was less in the PP group [200 (50-400) mL vs 300 (100-600) mL; P = 0.01)]. In the post-operative period, 26.1% patients in the LDP group and 8% in the PP group (8%) developed respiratory complications. The incidence of other post-operative complications, including cervical oesophagogastric anastomosis, hoarseness of voice and chylothorax, was not different in the two groups. The T stage of the tumour was similar in the two groups, with the majority (37) having T3 disease. A mean of 8 lymph nodes (range 2-33) were retrieved in the LDP group, and 17.5 (range 5-41) lymph nodes were retrieved in the PP group (P = 0.0004). The number of patients with node-positive disease was also higher in the PP group (19 vs 10, P = 0.037). CONCLUSION MIE in the PP is an effective alternative to LDP. The exposure obtained is excellent even without the need for a complete lung collapse, thereby obviating the need for a double-lumen endotracheal tube. A more meticulous dissection can be performed resulting in a higher lymph nodal yield.
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Affiliation(s)
- Amit Javed
- Department of Gastrointestinal Surgery, GB Pant Hospital and MAM College, Delhi University, New Delhi, India
| | - John Mathew Manipadam
- Department of Gastrointestinal Surgery, GB Pant Hospital and MAM College, Delhi University, New Delhi, India
| | - Amit Jain
- Department of Gastrointestinal Surgery, GB Pant Hospital and MAM College, Delhi University, New Delhi, India
| | - R Kalayarasan
- Department of Gastrointestinal Surgery, GB Pant Hospital and MAM College, Delhi University, New Delhi, India
| | - Rajeev Uppal
- Department of Gastrointestinal Surgery, GB Pant Hospital and MAM College, Delhi University, New Delhi, India
| | - Anil K Agarwal
- Department of Gastrointestinal Surgery, GB Pant Hospital and MAM College, Delhi University, New Delhi, India
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Rodham P, Batty JA, McElnay PJ, Immanuel A. Does minimally invasive oesophagectomy provide a benefit in hospital length of stay when compared with open oesophagectomy? Interact Cardiovasc Thorac Surg 2015; 22:360-7. [PMID: 26669851 DOI: 10.1093/icvts/ivv339] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 10/25/2015] [Indexed: 12/17/2022] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: 'in patients undergoing oesophagectomy, does a minimally invasive approach convey a benefit in hospital length of stay (LOS), when compared to an open approach?' A total of 647 papers were identified, using an a priori defined search strategy; 24 papers represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group, study type, relevant outcomes and key results are tabulated. Of the studies identified, data from two randomized controlled trials were available. The first randomized study compared the use of open thoracotomy and laparotomy versus thoracoscopy and laparoscopy. Those undergoing minimally invasive oesophagectomy (MIO) left hospital on average 3 days earlier than those treated with the open oesophagectomy (OO) technique (P = 0.044). The other randomized trial, which compared thoracotomy with thoracoscopy and laparoscopy, demonstrated a reduction of 1.8 days in the LOS when employing the MIO technique (P < 0.001). With the addition of the remaining 22 non-randomized studies, comprising 3 prospective and 19 retrospective cohort studies, which are heterogeneous with regard to their design, study populations and outcomes; data are available representing 3173 MIO and 25 691 OO procedures. In total, 13 studies (including the randomized trials) demonstrate a significant reduction in hospital LOS associated with MIO; 10 suggest no significant difference between techniques; and only 1 suggests a significantly greater length of stay associated with MIO. The only two randomized trials comparing MIO and OO demonstrated a reduction in length of stay in the MIO group, without compromising survival or increasing complication rates. All bar one of the non-randomized studies demonstrated either a significant reduction in length of stay with MIO or no difference. The benefit in reduced length of stay was not at the cost of worsened survival or increased complications, and conversion rates in all studies were low.
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Affiliation(s)
- Paul Rodham
- Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Jonathan A Batty
- Department of Colorectal Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Philip J McElnay
- Department of Upper Gastrointestinal Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Arul Immanuel
- Department of Upper Gastrointestinal Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Combined thoracoscopic-laparoscopic esophagectomy versus open esophagectomy: a meta-analysis of outcomes. Surg Endosc 2015; 30:3873-81. [PMID: 26659248 DOI: 10.1007/s00464-015-4692-x] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/17/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES At present there is controversy regarding the optimal surgical method for esophageal cancer. Specifically, whether combined thoracoscopic-laparoscopic esophagectomy is superior to open esophagectomy with respect to the surgical wound, perioperative morbidities and mortality, and the overall survival rate is of great concern. This article aimed to compare thoracoscopic-laparoscopic esophagectomy versus open esophagectomy on the perioperative morbidities and long-term survival. METHODS PubMed, Embase, and Google Scholar databases were searched for relevant studies comparing combined thoracoscopic-laparoscopic esophagectomy with open esophagectomy using the Preferred Reporting Items for Systemic Reviews and Meta-Analyses standards. Odds ratios were extracted to give pooled estimates of the perioperative effect of the two surgical procedures. Hazard ratios were extracted to compare overall survival between the two surgical procedures. RESULTS Thirteen studies involving 1549 patients were included in this meta-analysis. We found that patients that underwent combined thoracoscopic-laparoscopic esophagectomy had lower total complication rates (relative risk 1.20; 95 % CI 1.08-1.34; p = 0.0009), wound infection rates, pulmonary complications, and less intraoperative blood loss. Moreover, our study also showed combined thoracoscopic-laparoscopic esophagectomy did not compromise the 5-year survival rate (hazard risk 0.920; 95 % CI 0.720-1.176; p = 0.505) and even improved 2-year survival rate. The 30-day mortality and other common morbidities, including anastomotic leakage, anastomotic stricture, pulmonary infection, chylothorax, arrhythmia, or recurrent laryngeal nerve injury, were not significantly different between combined thoracoscopic-laparoscopic esophagectomy and traditional open esophagectomy (p > 0.05). CONCLUSIONS Combined thoracoscopic-laparoscopic esophagectomy is a feasible and reliable surgical procedure that can achieve uncompromising long-term survival rates and reduce perioperative complications.
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Metzger R, Schütze F, Mönig S. Evidence-Based Operative Details in Esophageal Cancer Treatment: Surgical Approach, Lymphadenectomy, Anastomosis. VISZERALMEDIZIN 2015; 31:337-40. [PMID: 26989389 PMCID: PMC4789948 DOI: 10.1159/000441017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background This review depicts surgical treatment strategies in the management of esophageal cancer under the focus of evidence-based medicine. The main emphasis lies on technical details, i.e. surgical approach, lymphadenectomy, and current techniques of anastomosis. Methods The current literature on operative details in esophageal cancer treatment was reviewed. Surgical approaches and different techniques of anastomotic reconstruction utilizing a gastric tube were compared. The grade of evidence regarding the necessity and extent of lymphadenectomy was discussed. Results There is no level-1 evidence-based difference regarding the surgical approach for esophagectomy. The preferred anastomosis site is intrathoracic compared to the neck. Extended lymphadenectomy is still imperative in esophagectomy although neoadjuvant protocols might also result in a downstaging effect of lymph nodes. Neoadjuvant regimens have no negative influence on complication rate and anastomotic integrity. Conclusion A tailored interdisciplinary approach to the patients' physiology and esophageal cancer stage is the most important factor that influences operative outcome and oncological results after esophagectomy.
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Affiliation(s)
- Ralf Metzger
- Department of General-, Visceral-, Thoracic and Cancer Surgery, CaritasKlinikum Saarbrücken, Saarbrücken, Germany
| | - Frank Schütze
- Department of General-, Visceral-, Thoracic and Cancer Surgery, CaritasKlinikum Saarbrücken, Saarbrücken, Germany
| | - Stefan Mönig
- Department of General-, Visceral-, and Cancer Surgery, University Hospital Cologne, Cologne, Germany
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Braghetto MI, Cardemil HG, Mandiola BC, Masia LG, Gattini SF. Impact of minimally invasive surgery in the treatment of esophageal cancer. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27:237-42. [PMID: 25626930 PMCID: PMC4743213 DOI: 10.1590/s0102-67202014000400003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/24/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Surgical treatment of esophageal cancer is associated to a high morbidity and mortality rate. The open transthoracic or transhiatal esophagectomy are considerably invasive procedures and have been associated to high rates of complications and operative mortality. In this way, minimally invasive esophageal surgery has been suggested as an alternative to the classic procedures because would produce improvement in clinical longterm postoperative outcomes. AIM To assess survival, mortality and morbidity results of esophagectomy due to esophageal cancer submitted to minimally invasive techniques and compare them to results published in international literature. METHOD An observational, prospective study. Between 2003 and 2012, 69 patients were submitted to a minimally invasive esophagectomy due to cancer. It was recorded postoperative morbidity and mortality according to the Clavien-Dindo classification. The survival rate was analyzed with the Kaplan-Meier method. The number of lymph nodes obtained during the lymph node dissection, as an index of the quality of the surgical technique, was analysed. RESULTS 63.7% of patients had minor complications (type I-II Clavien Dindo), while nine (13%) required surgical re-exploration. The most common postoperative complication corresponded to leak of the cervical anastomosis seen in 44 (63.7%) patients but without clinical repercusion, only two of them required reoperation. The mortality rate was 4.34%, and reoperation was necessary in nine (13%) cases. The average survival time was 22.59 ± 25.38 months, with the probability of a 3-year survival rate estimated at 30%. The number of resected lymph nodes was 17.17 ± 9.62. CONCLUSION Minimally invasive techniques have lower morbidity and mortality rate, very satisfactory lymphnodes resection and similar long term outcomes in term of quality of life and survival compared to results observed after open surgery.
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Affiliation(s)
- M Italo Braghetto
- Universidad de Chile Clinical Hospital, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - H Gonzalo Cardemil
- Universidad de Chile Clinical Hospital, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - B Carlos Mandiola
- Universidad de Chile Clinical Hospital, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - L Gonzalo Masia
- Universidad de Chile Clinical Hospital, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - S Francesca Gattini
- Universidad de Chile Clinical Hospital, Faculty of Medicine, Universidad de Chile, Santiago, Chile
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Ecker BL, Savulionyte GE, Datta J, Dumon KR, Kucharczuk J, Williams NN, Dempsey DT. Laparoscopic transhiatal esophagectomy improves hospital outcomes and reduces cost: a single-institution analysis of laparoscopic-assisted and open techniques. Surg Endosc 2015; 30:2535-42. [PMID: 26416370 DOI: 10.1007/s00464-015-4519-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/06/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Several case series have demonstrated that laparoscopic transhiatal esophagectomy (LTHE) is associated with favorable perioperative outcomes compared to historical data for open transhiatal esophagectomy (OTHE). Contemporaneous evaluation of open and laparoscopic THE is rare, limiting meaningful comparison of techniques. METHODS All patients who underwent OTHE (n = 32) and LTHE (n = 41) during the introduction of the latter procedure at our institution (1/2012-4/2014) were identified, and patient charts were retrospectively reviewed. RESULTS Indications for operation included 69 patients with esophageal malignancy (adenocarcinoma: 64; squamous cell carcinoma: 4; melanoma: 1) and 4 patients with benign disease. There were no significant differences in clinicopathologic variables between OTHE and LTHE cohorts, except for an increased rate of cardiovascular disease in the LTHE cohort (p = 0.04). There was no significant difference in median operative time or operative complications, yet LTHE was associated with a lower incidence of intraoperative blood transfusion (p < 0.01). There were no 30-day mortalities. LTHE was associated with a reduced time to reach 24-h tube feeding goals (p = 0.02), shorter length of hospital stay (p = 0.01), and 6 % reduced median direct cost (p = 0.04). There were no significant differences in rates of major perioperative morbidities. Patients were followed for a median of 11.0 months during which there were no significant differences between cohorts in disease-free survival or overall survival. CONCLUSION When compared to OTHE, LTHE improves surgical outcomes and decreases hospital costs; short-term oncologic outcomes are similar. LTHE is preferable to OTHE in patients requiring transhiatal esophagectomy.
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Affiliation(s)
- Brett L Ecker
- Department of Surgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Goda E Savulionyte
- Department of Surgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Jashodeep Datta
- Department of Surgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Kristoffel R Dumon
- Department of Surgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - John Kucharczuk
- Department of Surgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Noel N Williams
- Department of Surgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Daniel T Dempsey
- Department of Surgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
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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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Rubenstein JH, Shaheen NJ. Epidemiology, Diagnosis, and Management of Esophageal Adenocarcinoma. Gastroenterology 2015; 149:302-17.e1. [PMID: 25957861 PMCID: PMC4516638 DOI: 10.1053/j.gastro.2015.04.053] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 03/27/2015] [Accepted: 04/02/2015] [Indexed: 02/06/2023]
Abstract
Esophageal adenocarcinoma (EAC) is rapidly increasing in incidence in Western cultures. Barrett's esophagus is the presumed precursor lesion for this cancer. Several other risk factors for this cancer have been described, including chronic heartburn, tobacco use, white race, and obesity. Despite these known associations, most patients with EAC present with symptoms of dysphagia from late-stage tumors; only a small number of patients are identified by screening and surveillance programs. Diagnostic analysis of EAC usually commences with upper endoscopy followed by cross-sectional imaging. Endoscopic ultrasonography is useful to assess the local extent of disease as well as the involvement of regional lymph nodes. T1a EAC may be treated endoscopically, and some patients with T1b disease may also benefit from endoscopic therapy. Locally advanced disease is generally managed with esophagectomy, often accompanied by neoadjuvant chemoradiotherapy or chemotherapy. The prognosis is based on tumor stage; patients with T1a tumors have an excellent prognosis, whereas few patients with advanced disease have long-term survival.
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Affiliation(s)
- Joel H Rubenstein
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan; Barrett's Esophagus Program, Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
| | - Nicholas J Shaheen
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
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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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Mungo B, Lidor AO, Stem M, Molena D. Early experience and lessons learned in a new minimally invasive esophagectomy program. Surg Endosc 2015; 30:1692-8. [PMID: 26123339 DOI: 10.1007/s00464-015-4343-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/17/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Minimally invasive esophagectomy (MIE) is gaining increasing popularity in the treatment of esophageal cancer. In fact, while surgical and oncologic outcomes are not inferior to those achieved through a traditional open approach, patients undergoing MIE benefit from shorter length of stay, lesser pain and prompter recovery. This technique is, however, highly challenging, and the development of a MIE program, even in the setting of a tertiary center, requires time and progressive honing of surgical skills. METHODS We use a minimally invasive Ivor Lewis approach. The abdominal phase of the procedure includes complete celiac lymphadenectomy and tubularization of the stomach, which will constitute the neo-esophagus. The video-assisted thoracoscopic surgery portion of the operation takes place in left lateral decubitus and allows for optimal thoracic lymphadenectomy and anastomosis. RESULTS From October 2011 to January 2015, we treated 52 patients with the above-described procedure. The evolution of our anastomotic technique included a first group of circular stapled anastomosis with Orvil™ and 3.5-mm EEA™ (n = 16 patients), subsequently abandoned in favor of a linear anastomosis (n = 12), before going back to the Orvil™ coupled with 4.8-mm EEA™ (n = 22) in more recent times. There were also an additional two anastomoses that did not fall under any of these categories. We experienced two postoperative deaths. The overall leak rate was 14%, but fell down to 4% in the last group. Median LOS was 9 days. Lymph node retrieval was adequate throughout the whole series. CONCLUSIONS Developing a MIE program requires a significant learning curve before the results plateau. Only once a technique of choice is refined and mastered, the advantages granted by MIE become apparent.
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Affiliation(s)
- Benedetto Mungo
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Blalock 240, Baltimore, MD, 21287, USA
| | - Anne O Lidor
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Miloslawa Stem
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniela Molena
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Blalock 240, Baltimore, MD, 21287, USA.
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Mei X, Xu M, Guo M, Xie M, Liu C, Wang Z. Minimally invasive Ivor-Lewis oesophagectomy is a feasible and safe approach for patients with oesophageal cancer. ANZ J Surg 2015; 86:274-9. [PMID: 25962993 DOI: 10.1111/ans.13161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Xinyu Mei
- Department of Thoracic Surgery; Shandong Provincial Hospital affiliated to Shandong University; Jinan China
- Department of Thoracic Surgery; Anhui Provincial Hospital; Hefei China
| | - Meiqing Xu
- Department of Thoracic Surgery; Anhui Provincial Hospital; Hefei China
| | - Mingfa Guo
- Department of Thoracic Surgery; Anhui Provincial Hospital; Hefei China
| | - Mingran Xie
- Department of Thoracic Surgery; Anhui Provincial Hospital; Hefei China
| | - Changqing Liu
- Department of Thoracic Surgery; Anhui Provincial Hospital; Hefei China
| | - Zhou Wang
- Department of Thoracic Surgery; Shandong Provincial Hospital affiliated to Shandong University; Jinan China
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Guo W, Ma L, Zhang Y, Ma X, Yang S, Zhu X, Zhang J, Zhang Y, Xiang J, Li H. Totally minimally invasive Ivor-Lewis esophagectomy with single-utility incision video-assisted thoracoscopic surgery for treatment of mid-lower esophageal cancer. Dis Esophagus 2014; 29:139-45. [PMID: 25515694 DOI: 10.1111/dote.12306] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The study aims to evaluate the safety and availability of totally minimally invasive Ivor-Lewis esophagectomy (MIIE) with single-utility incision video-assisted thoracoscopic surgery. Forty-one patients with mid-lower thoracic esophageal cancer were prospectively treated with totally MIIE. Two stages of laparoscopic-thoracoscopic procedures were performed. The first 29 patients were treated with four-port video-assisted thoracoscopic surgery (Group 1); the others were treated with single-utility incision video-assisted thoracoscopic surgery (Group 2). Short-term clinicopathological outcomes were examined. All patients had negative tumor margins and were pathologically staged from T1N0M0 to T3N2M0. Among Group 1, there was one conversion to open surgery. The mean duration of surgery was 268.4 ± 37.8 minutes, and mean blood loss was 207.2 ± 74.1 mL without significant differences between groups. The average thoracic or abdominal lymph node yield was 12.6 ± 7.1 or 6 ± 5.8, respectively. The median postoperative hospital stay was 7 days. No mortalities occurred. Minor morbidity complicated by late-stage gastroparesis occurred in two patients (4.9%) after discharge. Major morbidities, including intestinal obstruction and anastomotic leakage, occurred in three patients (7.3%) after discharge. Among Group 2, the average operative duration was 275.4 ± 31.2 minutes, and the mean blood loss was 220 ± 94.9 mL. One patient developed late-stage anastomotic leakage. The average thoracic or abdominal lymph node yield was 14.7 ± 8.8 and 6.3 ± 5.7, respectively. No statistically significant differences were identified between Group 1 and Group 2. MIIE with single-utility incision video-assisted thoracoscopic surgery is feasible in patients with mid-lower thoracic esophageal cancer without compromising the extent of surgical resection and perioperative outcomes.
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Affiliation(s)
- W Guo
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - L Ma
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Y Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - X Ma
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - S Yang
- Department of Thoracic Surgery, Nan Jing Chest Hospital, Nanjing, China
| | - X Zhu
- Department of Pathology, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - J Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Y Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - J Xiang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - H Li
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Predicting blood transfusion in patients undergoing minimally invasive oesophagectomy. Int J Surg 2014; 12:1342-7. [PMID: 25448656 DOI: 10.1016/j.ijsu.2014.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 05/07/2014] [Accepted: 10/19/2014] [Indexed: 12/20/2022]
Abstract
AIM To evaluate predictors of allogenic blood transfusion requirements in patients undergoing minimal invasive oesophagectomy at a tertiary high volume centre for oesophago-gastric surgery. METHODS Retrospective analysis of all patients undergoing minimal access oesophagectomy in our department between January 2010 and December 2011. Patients were divided into two groups depending on whether they required a blood transfusion at any time during their index admission. Factors that have been shown to influence perioperative blood transfusion requirements in major surgery were included in the analysis. Binary logistic regression analysis was performed to determine the impact of patient and perioperative characteristics on transfusion requirements during the index admission. RESULTS A total of 80 patients underwent minimal access oesophagectomy, of which 61 patients had a laparoscopic assisted oesophagectomy and 19 patients had a minimal invasive oesophagectomy. Perioperative blood transfusion was required in 28 patients at any time during hospital admission. On binary logistic regression analysis, a lower preoperative haemoglobin concentration (p < 0.01), suffering a significant complication (p < 0.005) and laparoscopic assisted oesophagectomy (p < 0.05) were independent predictors of blood transfusion requirements. DISCUSSION It has been reported that requirement for blood transfusion can affect long-term outcomes in oesophageal cancer resection. Two factors which could be addressed preoperatively; haemoglobin concentration and type of oesophageal resection, may be valuable in predicting blood transfusions in patients undergoing minimally invasive oesophagectomy. CONCLUSION Our analysis revealed that preoperative haemoglobin concentration, occurrence of significant complications and type of minimal access oesophagectomy predicted blood transfusion requirements in the patient population examined.
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