1
|
Qureshi S, Khan S, Waseem HF, Shafique K, Abdul Jalil H, Quraishy MS. Three-staged minimally invasive esophagectomy with end-to-end esophago-gastric anastomosis for thoracic esophageal cancers: An experience from a low middle-income country. Asian J Surg 2024; 47:425-432. [PMID: 37777408 DOI: 10.1016/j.asjsur.2023.09.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/16/2023] [Accepted: 09/14/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Esophageal cancer is on a steady rise and carries significant mortality and morbidity. Depending upon the clinical stage at presentation, either chemotherapy, radiotherapy with or without surgical resection is the treatments in practice. Traditionally, open esophagectomy was performed but over time, the importance of minimally invasive esophagectomy has been established. In this study, we aimed to report our data of totally minimally invasive esophagectomies performed for thoracic esophageal cancers in last four years. METHODOLOGY A prospective cross-sectional study was conducted at the Department of Upper GI Surgery, Dow University of Health Sciences, Karachi. All diagnosed cases of esophageal carcinoma undergoing minimally invasive esophagectomy, from 2019 to 2022 were included in this study. Outcomes measured were operative time, intra operative complications, conversion rate to open, postoperative complications, number of lymph nodes harvested, margin clearance, in-hospital mortality and 90-days mortality. RESULTS A total of 53 cases were included in the study, the most prevalent histological type was squamous cell carcinoma 42(79.2%) as compared to adenocarcinoma 8(15.1%). Most common tumor site was lower thoracic esophagus (30-38 cm) in 20 (56.6%) cases. Neo-adjuvant chemotherapy was given in all 53(100%) cases, whereas neo-adjuvant radiation therapy was offered to 49(92.5%) patients. There was a significant and favorable patient response to the neo-adjuvant treatment in 37(69.8%) cases, leading to a decrease in tumor size. Laparoscopic McKeown Esophagectomies were performed in 44 (83.0%) and 9(17.0%) were Robot-assisted Minimally Invasive esophagectomy (RAMIE). Intraoperative injuries (i.e., lung parenchymal injury and bleeding) were reported in only 2(3.8%) patients. Post-operative complications were recorded in 12(22.6%) patients. Margin clearance was observed in 53 (100%) of the patients. The 90-day mortality rate was 3(5.7%), one due to bleeding and other two mortalities were due to COVID related respiratory complications. CONCLUSION Minimally invasive esophagectomy was found to be safe and feasible technique with encouraging results in terms of decreased intraoperative and post operative complications as well as achieving the standard oncological surgery with acceptable lymph node yield and margin clearance and in hospital and 90 days mortality.
Collapse
Affiliation(s)
- Sajida Qureshi
- Dow Medical College, Dow University of Health Sciences, Pakistan.
| | - Sumayah Khan
- Dow Medical College, Dow University of Health Sciences, Pakistan.
| | | | - Kashif Shafique
- School of Public Health, Dow University of Health Sciences (DUHS) Director, Office of Research, Innovation & Commercialization, DUHS Dow University of Health Sciences, Pakistan.
| | - Hira Abdul Jalil
- Department of Surgery Dow Medical College, Dow University of Health Sciences, Pakistan.
| | - M Saeed Quraishy
- Dow Medical College, Dow University of Health Sciences, Pakistan.
| |
Collapse
|
2
|
Banks KC, Barnes KE, Wile RK, Hung YY, Santos J, Hsu DS, Choe G, Elmadhun NY, Ashiku SK, Patel AR, Velotta JB. Outcomes of Anastomotic Evaluation Using Indocyanine Green Fluorescence during Minimally Invasive Esophagectomy. Am Surg 2023; 89:5124-5130. [PMID: 36327490 DOI: 10.1177/00031348221138084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Limited evidence exists assessing whether anastomotic evaluation using indocyanine green fluorescence (IGF) during minimally invasive esophagectomy (MIE) predicts or improves outcomes. We hypothesized that IGF helps surgeons predict anastomotic complications and reduces anastomotic leaks after MIE. METHODS In September 2019, our institution began routinely using IGF for intraoperative evaluation of anastomoses during MIE. Data were collected from patients undergoing MIE in the two years before and after this technology began being routinely used. Baseline characteristics and outcomes, including anastomotic leak, in patients who underwent indocyanine green fluorescence evaluation (ICG) and those who did not (nICG) were compared. Outcomes were also compared between ICG patients with normal versus abnormal fluorescence. RESULTS Overall, 181 patients were included. Baseline demographic and clinical characteristics did not differ between the ICG and nICG groups. ICG patients experienced higher rates of anastomotic leak (10.2% vs. 1.6%, P = .015) and 90-day mortality (8.5% vs. 1.6%, P = .04) compared to nICG patients. Due to lack of equipment availability, 19 nICG patients underwent MIE after the use of IGF became routine, and none developed leaks. ICG patients with abnormal fluorescence had higher rates of anastomotic leak (71.4% vs 1.9%, P < .001) and 30-day mortality (28.6% vs 0%, P = .012) compared to those with normal fluorescence. DISCUSSION Abnormal intraoperative IGF was associated with increased rate of anastomotic leak, suggesting predictive potential of IGF. However, its use was associated with an increased leak rate and higher mortality. Further studies are warranted to assess possible physiologic effects of indocyanine green on the esophageal anastomosis.
Collapse
Affiliation(s)
- Kian C Banks
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Surgery, UCSF East Bay, Oakland, CA, USA
| | | | - Rachel K Wile
- School of Medicine, University of California, San Francisco, CA, USA
| | - Yun-Yi Hung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jesse Santos
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Surgery, UCSF East Bay, Oakland, CA, USA
| | - Diana S Hsu
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Surgery, UCSF East Bay, Oakland, CA, USA
| | - Giye Choe
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Nassrene Y Elmadhun
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Simon K Ashiku
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Ashish R Patel
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jeffrey B Velotta
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA
| |
Collapse
|
3
|
Alcasid NJ, Banks KC, Velotta JB. A Deeper Look at Dilations After Minimally Invasive Esophagectomy. Ann Thorac Surg 2023; 116:719-720. [PMID: 37393980 DOI: 10.1016/j.athoracsur.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/11/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Nathan J Alcasid
- Department of Thoracic Surgery, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA 94611
| | - Kian C Banks
- Department of Thoracic Surgery, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA 94611
| | - Jeffrey B Velotta
- Department of Thoracic Surgery, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA 94611.
| |
Collapse
|
4
|
Outcomes of Minimally Invasive and Robot-Assisted Esophagectomy for Esophageal Cancer. Cancers (Basel) 2022; 14:cancers14153667. [PMID: 35954331 PMCID: PMC9367610 DOI: 10.3390/cancers14153667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary This is an invited review for the special edition, “Minimally Invasive Surgery for Cancer: Indications and Outcomes.” Indications to perform minimally invasive techniques for esophagectomy rather than the classic open technique do not exist. This review outlines the current research by comparing outcomes among minimally invasive esophagectomy, robot-assisted esophagectomy, and open esophagectomy. After determining the benefits of each technique in terms of each outcome, the discussion focuses on how surgeons may use the presented information to determine which approach is most appropriate. We hope this study provides a comprehensive review of the current state of the literature regarding minimally invasive esophagectomy, as well as a guide for surgeons who treat patients with esophageal cancer. Abstract With the evolution of minimally invasive esophagectomy (MIE) and robot-assisted minimally invasive esophagectomy (RAMIE), questions remain regarding the benefits and indications of these methods. Given that set indications do not exist, this article aims first to review the reported outcomes of MIE, RAMIE, and open esophagectomy. Then, considerations based on the reported outcomes are discussed to guide surgeons in selecting the best approach. MIE and RAMIE offer the potential to improve outcomes for esophagectomy patients; however, surgeon experience as well as individual patient factors play important roles when deciding upon the surgical approach.
Collapse
|