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Chen Z, Chen G, Li Y, Kou S, Wang T, Zhang L, Cao Y, Liu L. Comparison of totally laparoscopic and laparoscopic-assisted approach in gastrectomy with D2 lymphadenectomy for advanced gastric cancer after neoadjuvant chemotherapy: a retrospective comparative study. Ann Surg Treat Res 2024; 106:218-224. [PMID: 38586555 PMCID: PMC10995841 DOI: 10.4174/astr.2024.106.4.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Neoadjuvant chemotherapy is strongly recommended for advanced gastric cancer due to good local control and a high rate of R0 dissection with this strategy. Minimally invasive techniques such as laparoscopy-assisted or total laparoscopic approaches is becoming more and more acceptable in the treatment for gastric cancer. However, the safety and efficiency of total laparoscopic D2 gastrectomy (TLG) for advanced gastric cancer after neoadjuvant chemotherapy have not been well evaluated. Methods A retrospective study in a single center from 2014 to 2016 was conducted. A total of 65 locally advanced gastric cancers were treated by laparoscopy-assisted gastrectomy (LAG) or TLG. Parameters which include operation time, blood loss, complications, hospital stay, 3-year overall survival, and 3-year disease-free survival were used for comparison. Results The time of operation in the TLG group was shorter than in the LAG group (P = 0.013), blood loss was less (P = 0.002) and time to first flatus was shorter (P = 0.039) in the TLG group than that in the LLG group. Intraoperative and postoperative complications were comparable in both groups. No significant difference was found in 3-year overall and disease-free survival. Conclusion For patients with locally advanced gastric cancer after neoadjuvant chemotherapy, laparoscopic D2 gastrectomy can be considered as a safe and efficient alternative. A further multicenter prospective randomized controlled study is needed to elucidate the applicability of this technique for advanced gastric cancer.
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Affiliation(s)
- Zhenyu Chen
- General Surgery Center, The General Hospital of Western Theater Command, Chengdu, China
| | - Guangyu Chen
- General Surgery Center, The General Hospital of Western Theater Command, Chengdu, China
| | - Yan Li
- General Surgery Center, The General Hospital of Western Theater Command, Chengdu, China
| | - Sha Kou
- General Surgery Center, The General Hospital of Western Theater Command, Chengdu, China
| | - Tao Wang
- General Surgery Center, The General Hospital of Western Theater Command, Chengdu, China
| | - Lin Zhang
- General Surgery Center, The General Hospital of Western Theater Command, Chengdu, China
| | - Yongkuan Cao
- General Surgery Center, The General Hospital of Western Theater Command, Chengdu, China
| | - Liye Liu
- General Surgery Center, The General Hospital of Western Theater Command, Chengdu, China
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Yanagimoto Y, Kurokawa Y, Doki Y. Surgical and Perioperative Treatments for Esophagogastric Junction Cancer. Ann Thorac Cardiovasc Surg 2024; 30:24-00056. [PMID: 38839368 PMCID: PMC11196162 DOI: 10.5761/atcs.ra.24-00056] [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: 04/01/2024] [Accepted: 05/18/2024] [Indexed: 06/07/2024] Open
Abstract
Esophagogastric junction cancer (EGJC) is a rare malignant disease that occurs in the gastroesophageal transition zone. In recent years, its incidence has been rapidly increasing not only in Western countries but also in East Asia, and it has been attracting the attention of both clinicians and researchers. EGJC has a worse prognosis than gastric cancer (GC) and is characterized by complex lymphatic drainage pathways in the mediastinal and abdominal regions. EGJC was previously treated in the same way as GC or esophageal cancer, but, in recent years, it has been treated as an independent malignant disease, and treatment focusing only on EGJC has been developed. A recent multicenter prospective study revealed the frequency of lymph node metastasis by station and established the optimal extent of lymph node dissection. In perioperative treatment, the combination of multi-drug chemotherapy, radiation therapy, molecular targeted therapy, and immunotherapy is expected to improve the prognosis. In this review, we summarize previous clinical trials and their important evidence on surgical and perioperative treatments for EGJC.
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Affiliation(s)
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Bîrlă R, Hoara P, Achim F, Dinca V, Ciuc D, Constantinoiu S, Constantin A. Minimally invasive surgery for gastro-oesophageal junction adenocarcinoma: Current evidence and future perspectives. World J Gastrointest Oncol 2023; 15:1675-1690. [PMID: 37969407 PMCID: PMC10631441 DOI: 10.4251/wjgo.v15.i10.1675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/04/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
Minimally invasive surgery is increasingly indicated in the management of malignant disease. Although oesophagectomy is a difficult operation, with a long learning curve, there is actually a shift towards the laparoscopic/thoracoscopic/ robotic approach, due to the advantages of visualization, surgeon comfort (robotic surgery) and the possibility of the whole team to see the operation as well as and the operating surgeon. Although currently there are still many controversial topics, about the surgical treatment of patients with gastro-oesophageal junction (GOJ) adenocarcinoma, such as the type of open or minimally invasive surgical approach, the type of oesophago-gastric resection, the type of lymph node dissection and others, the minimally invasive approach has proven to be a way to reduce postoperative complications of resection, especially by decreasing pulmonary complications. The implementation of new technologies allowed the widening of the range of indications for this type of surgical approach. The short-term and long-term results, as well as the benefits for the patient - reduced surgical trauma, quick and easy recovery - offer this type of surgical treatment the premises for future development. This article reviews the updates and perspectives on the minimally invasive approach for GOJ adenocarcinoma.
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Affiliation(s)
- Rodica Bîrlă
- Department of General Surgery, Carol Davila University, Bucharest 011172, Romania
| | - Petre Hoara
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Florin Achim
- Department of General Surgery, Carol Davila University, Bucharest 011172, Romania
| | - Valeriu Dinca
- Faculty of Medicine, “Titu Maiorescu” University, Bucharest 031593, Romania
| | - Diana Ciuc
- Faculty of Medicine, “Titu Maiorescu” University, Bucharest 031593, Romania
| | - Silviu Constantinoiu
- Department of General Surgery, Carol Davila University, Bucharest 011172, Romania
| | - Adrian Constantin
- Department of General Surgery, Carol Davila University, Bucharest 011172, Romania
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Lin X, Tan C, Li Z, Wu W, Cheng X, Qian F, Shi Y, Zhao Y. Long-term oncologic and surgical outcomes of robotic and laparoscopic gastrectomy for Siewert II/III esophagogastric junction carcinoma: A propensity score-matched retrospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106898. [PMID: 37019806 DOI: 10.1016/j.ejso.2023.03.234] [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: 02/03/2023] [Revised: 03/16/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND This study aimed to investigate the short-term surgical and long-term survival outcomes after robotic gastrectomy (RG) or laparoscopic gastrectomy (LG) for patients with Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG). METHODS We retrospectively analyzed 84 and 312 patients with Siewert type II/III AEG who underwent RG or LG between January 2005 and September 2016 in our center. We performed a 1:2 matched propensity score matching (PSM) analysis between the RG and LG group for clinical features to reduce confounding bias. Additionally, the long- and short-term outcomes between the RG and LG group were compared. RESULTS The clinicopathological characteristics of 246 patients (RG group: n = 82; LG group: n = 164) were well balanced after PSM. Patients in the RG group showed less estimated blood loss, less time to first flatus, less time to first ambulation, less drainage tube removed time, and retrieved more lymph nodes than the LG group. The overall complication rate was comparable between the RG and LG groups. The 5-year overall survival (OS) was 44.4% in the RG group and 43.7% in the LG group (p = 0.898). The 5-year disease-free survival (DFS) was 43.2% in the RG group and 43.2% in the LG group (p = 0.990). The RG and LG groups exhibited a similar recurrence rate and pattern within 5 years after surgery. CONCLUSION Robotic gastrectomy could be a feasible and safe option for patients with Siewert II/III AEG in terms of surgical and oncologic outcomes.
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Affiliation(s)
- Xia Lin
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China; Department of Gastrointestinal Surgery, Three Gorges Hospital, Chongqing University, Chongqing, China
| | - Chenjun Tan
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zhengyan Li
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Weigao Wu
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xiaogao Cheng
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Feng Qian
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yan Shi
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yongliang Zhao
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, China.
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Yanagimoto Y, Kurokawa Y, Doki Y. Essential updates 2021/2022: Perioperative and surgical treatments for gastric and esophagogastric junction cancer. Ann Gastroenterol Surg 2023; 7:698-708. [PMID: 37663969 PMCID: PMC10472390 DOI: 10.1002/ags3.12711] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 09/05/2023] Open
Abstract
In recent years, important clinical trials for gastric cancer (GC) and esophagogastric junction cancer (EGJC) have been reported, changing the strategies of surgical and perioperative treatment. Although laparoscopic gastrectomy has already been shown to be effective for early-stage cancer, recent evidence from both Asia (JLSSG0901, CLASS-01 and KLASS-02) and Europe (LOGICA and STOMACH trials) has demonstrated that it is useful for advanced GC. Robotic surgery has been rapidly gaining popularity in recent years, and randomized controlled trials are ongoing to evaluate its efficacy. A prospective nationwide multicenter study mapped sites with frequent metastasis and revealed lymphatic flow specific to EGJC, thus establishing the optimal lymph node dissection area and surgical approach based on esophageal involvement. Perioperative chemotherapy, the mainstay of treatment in Europe, also has been established in Asia by the PRODIGY and RESOLVE studies. New clinical trials have been conducted to evaluate the efficacy of combining immunotherapy or molecular-targeted therapy with perioperative chemotherapy or chemoradiotherapy. In this review, we present important recent clinical trials regarding the treatment of GC and EGJC published in 2021 or 2022.
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Affiliation(s)
| | - Yukinori Kurokawa
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
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Nishi M, Wada Y, Yoshikawa K, Takasu C, Tokunaga T, Nakao T, Kashihara H, Yoshimoto T, Shimada M. Utility of robotic surgery for Siewert type II/III adenocarcinoma of esophagogastric junction: transhiatal robotic versus laparoscopic approach. BMC Surg 2023; 23:128. [PMID: 37194030 DOI: 10.1186/s12893-023-02045-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/12/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Robotic surgery (RS) has been rapidly adopted for gastric cancer and adenocarcinoma of the esophagogastric junction (AEG). However, the utility of RS for Siewert type II/III AEG remains unclear. METHODS Forty-one patients who underwent either transhiatal RS (n = 15) or laparoscopic surgery (LS) (n = 26) for Siewert type II/III AEG were enrolled in this study. The surgical outcomes of the two groups were compared. RESULTS In the entire cohort, there were no significant intergroup differences in the operative time, blood loss volume, or number of retrieved lymph nodes. The length of the postoperative hospital stay was shorter in the RS group than in the LS group (14.20 ± 7.10 days vs. 18.73 ± 17.82 days, respectively; p = 0.0388). The morbidity rate (Clavien-Dindo grade ≥ 2) was similar between the groups. In the Siewert II cohort, there were no significant intergroup differences in short-term outcomes. In the entire cohort, there was no significant difference between the RS and LS groups in the 3-year overall survival rate (91.67% vs. 91.48%, N.S.) or 3-year disease-free survival rate (91.67% vs. 91.78%, N.S.), respectively. Likewise, in the Siewert type II cohort, there was no significant difference between the RS and LS groups in the 3-year overall survival rate (80.00% vs. 93.33%, N.S.) or 3-year disease-free survival rate (80.00% vs. 94.12%, N.S.), respectively. CONCLUSIONS Transhiatal RS for Siewert II/III AEG was safe and contributed to similar short-term and long-term outcomes compared with LS.
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Affiliation(s)
- Masaaki Nishi
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan.
| | - Yuma Wada
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Kozo Yoshikawa
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Chie Takasu
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Takuya Tokunaga
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Toshihiro Nakao
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Hideya Kashihara
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Toshiaki Yoshimoto
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Mitsuo Shimada
- Department of Surgery, University of Tokushima Graduate School, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
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Salvador-Rosés H, Escartín A, Muriel P, Santamaría M, González M, Jara J, Vela F, Olsina JJ. Robotic versus open approach in total gastrectomy for gastric cancer: a comparative single-center study of perioperative outcomes. J Robot Surg 2023:10.1007/s11701-023-01591-1. [PMID: 37004708 DOI: 10.1007/s11701-023-01591-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/26/2023] [Indexed: 04/04/2023]
Abstract
The robotic approach to gastric cancer has been gaining interest in recent years; however, its benefit over the open procedure in total gastrectomy with D2 lymphadenectomy is still controversial. The aims of the study were to compare postoperative morbidity and mortality, hospital stay, and anatomopathological findings between the robotic and open approaches to oncologic total gastrectomy. We analyzed a prospectively collected database, which included patients who underwent total gastrectomy with D2 lymphadenectomy in our center using a robotic or an open approach between 2014 and 2021. Comparative analysis of clinicopathological, intraoperative, postoperative and anatomopathological variables between the robot-assisted group and the open group was performed. Thirty patients underwent total gastrectomy with D2 lymphadenectomy by a robotic approach and 48 patients by an open procedure. Both groups were comparable. The robot-assisted group presented a lower rate of Clavien-Dindo complications ≥ stage II (20 vs. 48%, p = 0.048), a shorter hospital stay (7 days vs. 9 days, p = 0.003) and had a higher total number of lymph nodes resected (22 nodes vs. 15 nodes, p = 0.001) compared to the open approach. Operative time was longer in the robotic group (325 min vs. 195 min, p < 0.001) compared to the open group. The robotic approach is associated with a longer surgical time, a lower rate of Clavien-Dindo complications ≥ stage II and a shorter hospital stay, and more lymph nodes were resected compared to the open approach.
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Affiliation(s)
- Helena Salvador-Rosés
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain.
| | - Alfredo Escartín
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Pablo Muriel
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Maite Santamaría
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Marta González
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Jimy Jara
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Fulthon Vela
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Jorge-Juan Olsina
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
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Song QY, Li XG, Zhang LY, Wu D, Li S, Zhang BL, Xu ZY, Wu RLG, Guo X, Wang XX. Laparoscopic-assisted vs open transhiatal gastrectomy for Siewert type II adenocarcinoma of the esophagogastric junction: A retrospective cohort study. World J Gastrointest Surg 2022; 14:304-314. [PMID: 35664362 PMCID: PMC9131839 DOI: 10.4240/wjgs.v14.i4.304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/15/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The studies of laparoscopic-assisted transhiatal gastrectomy (LTG) in patients with Siewert type II adenocarcinoma of the esophagogastric junction (AEG) are scarce.
AIM To compare the surgical efficiency of LTG with the open transhiatal gastrectomy (OTG) for patients with Siewert type II AEG.
METHODS We retrospectively evaluated a total of 578 patients with Siewert type II AEG who have undergone LTG or OTG at the First Medical Center of the Chinese People’s Liberation Army General Hospital from January 2014 to December 2019. The short-term and long-term outcomes were compared between the LTG (n = 382) and OTG (n = 196) groups.
RESULTS Compared with the OTG group, the LTG group had a longer operative time but less blood loss, shorter length of abdominal incision and an increased number of harvested lymph nodes (P < 0.05). Patients in the LTG group were able to eat liquid food, ambulate, expel flatus and discharge sooner than the OTG group (P < 0.05). No significant differences were found in postoperative complications and R0 resection. The 3-year overall survival and disease-free survival performed better in the LTG group compared with that in the OTG group (88.2% vs 79.2%, P = 0.011; 79.7% vs 73.0%, P = 0.002, respectively). In the stratified analysis, both overall survival and disease-free survival were better in the LTG group than those in the OTG group for stage II/III patients (P < 0.05) but not for stage I patients.
CONCLUSION For patients with Siewert type II AEG, LTG is associated with better short-term outcomes and similar oncology safety. In addition, patients with advanced stage AEG may benefit more from LTG in the long-term outcomes.
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Affiliation(s)
- Qi-Ying Song
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Xiong-Guang Li
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Li-Yu Zhang
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Di Wu
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Shuo Li
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Ben-Long Zhang
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Zi-Yao Xu
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Ri-Li-Ge Wu
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Xin Guo
- Air Force Medical University Xijing Hospital, Xi’an 710000, Shaanxi Province, China
| | - Xin-Xin Wang
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
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Side-overlap esophagogastric tube (SO-EG) reconstruction after minimally invasive Ivor Lewis esophagectomy or laparoscopic proximal gastrectomy for cancer of the esophagogastric junction. Langenbecks Arch Surg 2021; 407:861-869. [PMID: 34775522 DOI: 10.1007/s00423-021-02377-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/04/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Both laparoscopic proximal gastrectomy with lower esophagectomy (extended LPG) and minimally invasive Ivor Lewis esophagectomy (MIILE) are acceptable treatments for adenocarcinoma of the esophagogastric junction (AEG), but the optimal reconstruction technique for mediastinal esophagogastrostomy (one that provides adequate reflux prevention) has not been established. We devised a novel side-overlap esophagogastric-tube (SO-EG) reconstruction. METHODS We performed a retrospective review of patient records after LPG or MIILE. In each patient, we created a 3-cm wide gastric tube, overlapping the esophagus by 5 cm. A linear stapler was inserted into the left side of the esophageal stump and the anterior gastric wall along the greater curvature. The entry hole was closed to make a slit-like anastomosis, and the right side of the esophageal wall was fixed to the anterior gastric wall. RESULTS Ten consecutive patients underwent this procedure between June 2020 and July 2021. Five patients had Siewert type II AEG: 4 with lower thoracic esophageal cancer and 1 with benign lower esophageal stenosis. A total of 3 patients underwent extended LPG, and 7 underwent MIILE. The median operative time was 352 min (range, 221-556 min). The postoperative course was uneventful in 9 patients; a single patient developed pneumonia. Seven patients underwent follow-up endoscopy at 6 months. One patient with anastomotic stenosis and 2 with mild reflux esophagitis were treated conservatively. CONCLUSION Our novel SO-EG reconstruction is simple and feasible, with acceptable results for preventing reflux esophagitis. This technique can be performed with either extended LPG or MIILE.
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Surgical and survival outcomes after laparoscopic and open gastrectomy for serosa-invasive Siewert type II/III esophagogastric junction carcinoma: a propensity score matching analysis. Surg Endosc 2021; 36:5055-5066. [PMID: 34761283 DOI: 10.1007/s00464-021-08867-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/01/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The potential advantage of laparoscopic gastrectomy (LG) compared with open gastrectomy (OG) for serosa-invasive (pT4a) Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG) remains uncertain. Thus, the purpose of this study was to investigate the short- and long-term outcomes of LG compared to OG for pT4a Siewert type II/III AEG cancers. METHODS We retrospectively evaluated 283 patients with pathological confirmed T4a Siewert type II and type III AEG who underwent LG or OG in our center between January 2004 and September 2015. The short- and long-term outcomes were compared between the groups using a 1:1 matched propensity score matching method (PSM). RESULTS The LG group had a longer operation time, less estimated blood loss, less time to first flatus, less time to start liquid diet, less time to first ambulation, and shorter length of incision than the OG group. The conversion rates were 5.4% in the LG groups. There was no significant difference in the overall complication rate between the LG and OG groups. The 5-year overall survival (OS) and the 5-year disease-free survival (DFS) were comparable between the LG and OG groups (35.4% vs 32.1%, p = 0.541; 34.1% vs 31.0%, p = 0.523, respectively). There was no significant difference in the recurrence rate and pattern between the LG and OG groups. CONCLUSIONS Laparoscopic gastrectomy is associated with better short-term outcomes and similar long-term outcomes for pT4a Siewert type II/III AEG. This study reveals that LG could be a safe and feasible option for pT4a Siewert type II/III AEG compared to OG.
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11
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Feng Q, Long D, Du MS, Wang XS, Li ZS, Zhao YL, Qian F, Wen Y, Yu PW, Shi Y. Short-Term Clinical Efficacy of Neoadjuvant Chemotherapy Combined With Laparoscopic Gastrectomy for Locally Advanced Siewert Type II and III Adenocarcinoma of the Esophagogastric Junction: A Retrospective, Propensity Score-Matched Study. Front Oncol 2021; 11:690662. [PMID: 34660265 PMCID: PMC8511681 DOI: 10.3389/fonc.2021.690662] [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: 04/03/2021] [Accepted: 08/24/2021] [Indexed: 02/03/2023] Open
Abstract
Background Laparoscopic gastrectomy (LG) has been increasingly used for the treatment of locally advanced Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG). However, whether LG can achieve the same short-term efficacy in the treatment of patients who receive neoadjuvant chemotherapy (NACT) remains controversial. Thus, the aim of this study was to investigate the clinical outcomes of NACT combined with LG for Siewert type II and III AEG. Methods This retrospective study identified patients with locally advanced Siewert type II and III AEG diagnosed between May 2011 and October 2020 using the clinical tumor-node-metastasis (cTNM) staging system. The short-term outcomes were compared between the matched groups using a 1:3 propensity score matching (PSM) method, which was performed to reduce bias in patient selection. Results After PSM, 164 patients were selected, including 41 in the NACT group and 123 in the LG group. The baseline characteristics were similar between the two groups. Compared with the LG group, the NACT group exhibit a smaller tumor size and significantly less advanced pathological tumor classification and nodal classification stages. The time to first flatus of the NACT group was significantly shorter, but the hospital stay was significantly longer than that of the LG group. The NACT group showed similar overall (29.3% vs 25.2%, P=0.683), systemic (24.4% vs 21.1%, P=0.663), local (12.2% vs 9.8%, P=0.767), minor (19.5% vs 19.5%, P=1.000) and major (9.8% vs 5.7%, P=0.470) complications as the LG group. Subgroup analyses showed no significant differences in most stratified parameters. Operation time≥ 300 minutes was identified as an independent risk factor for overall complications. Age≥ 60 years was identified as an independent risk factor for major complications. Conclusion NACT combined with LG for AEG does not increase the risk of postoperative morbidity and mortality compared with LG.
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Affiliation(s)
- Qing Feng
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Du Long
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Ming-Shan Du
- Radiology Department, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Xiao-Song Wang
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Zhen-Shun Li
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Yong-Liang Zhao
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Feng Qian
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Yan Wen
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Pei-Wu Yu
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Yan Shi
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
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12
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Omori T, Yamamoto K, Yanagimoto Y, Shinno N, Sugimura K, Takahashi H, Yasui M, Wada H, Miyata H, Ohue M, Yano M, Sakon M. A Novel Valvuloplastic Esophagogastrostomy Technique for Laparoscopic Transhiatal Lower Esophagectomy and Proximal Gastrectomy for Siewert Type II Esophagogastric Junction Carcinoma-the Tri Double-Flap Hybrid Method. J Gastrointest Surg 2021; 25:16-27. [PMID: 32157606 DOI: 10.1007/s11605-020-04547-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/13/2020] [Indexed: 01/31/2023]
Abstract
UNLABELLED We developed a novel technique for valvuloplastic esophagogastrostomy, named tri double-flap hybrid method (TDF). TDF is shown to be simple and useful for Siewert type II esophagogastric junction carcinoma. BACKGROUND Research has found valvuloplastic esophagogastrostomy using the conventional hand-sutured double-flap (CDF) technique to be a useful anti-reflux procedure after proximal gastrectomy. However, no study has focused on this reconstruction procedure after laparoscopic transhiatal lower esophagectomy and proximal gastrectomy (LEPG) for esophagogastric junction carcinoma primarily because of its profound difficulty. Thus, we devised a novel technique for valvuloplastic esophagogastrostomy comprising triangular linear-stapled esophagogastrostomy and hand-sutured flap closure, which we term the tri double-flap hybrid (TDF) method. METHODS After reviewing our institution's prospective gastric cancer database, 59 consecutive patients with Siewert type II esophagogastric junction carcinoma who underwent LEPG with valvuloplastic esophagogastrostomy from January 2014 to August 2018 were analyzed. Short- and mid-term surgical outcomes were then compared between the LEPG-TDF and LEPG-CDF groups to evaluate the efficacy of the TDF method. RESULTS The median operative time was 316 min (184-613 min) and blood loss was 22.5 ml (0-180 ml). In comparison between the two groups, the LEPG-TDF group had a significantly shorter operative time (298 vs. 336 min, p = 0.041) and significantly lower postoperative anastomotic leak/stenosis rates (0 vs. 14.2%, p = 0.045), compared to the LEPG-CDF group. No patient suffered from severe gastroesophageal reflux symptoms (Visick score ≥ III). CONCLUSIONS This study showed that double-flap valvuloplastic esophagogastrostomy is safe and feasible for reconstruction after LEPG for Siewert type II esophagogastric junction carcinoma. Moreover, the TDF method is a simple and useful technique that offers a shorter operative time and lower morbidity compared to the CDF technique.
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Affiliation(s)
- Takeshi Omori
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Yoshitomo Yanagimoto
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Naoki Shinno
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Keijirou Sugimura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hidenori Takahashi
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Masayoshi Yasui
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hiroshi Miyata
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Masahiko Yano
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Masato Sakon
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
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13
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Chen XD, He FQ, Liao MS, Chen M. Laparoscopic versus open transhiatal approach for adenocarcinoma of the esophagogastric junction: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 47:778-788. [PMID: 33268214 DOI: 10.1016/j.ejso.2020.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/04/2020] [Accepted: 10/18/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing worldwide. Laparoscopic transhiatal approach (LTH) has gained growing popularity in the treatment of AEG. However, its safety and efficacy need to be evaluated. METHODS Original studies comparing LTH with open transhiatal approach (OTH) were searched. Meta-analysis was performed using RevMan 5.3. RESULTS Nine studies involving 2149 patients were eligible. Compared with OTH, LTH was associated with longer operation time (mean difference [MD] = 31min, 95%CI [20,41], P < 0.001) while less blood loss (MD = -103ml [-135, -72], P < 0.001), and harvested similar number of lymph nodes (MD = 0.1 [-1.2, 1.4], P = 0.89). There were no differences in time to ambulation (MD = -0.79 days [-1.77, 0.20], P = 0.12) or time to first flatus (MD = -0.82 days [-1.76, 0.11], P = 0.08); however, LTH was associated with shorter postoperative hospital stay (MD = -1.70 days [-2.34, -1.05], P < 0.001). The mortality after surgery was comparable for LTH and OTH (risk difference [RD] = -0.00 [-0.01, 0.01], P = 0.55). The incidence of total major complications was similar in LTH (6.1%) and OTH (8.4%) (RD = -0.02 [-0.05, 0.01], P = 0.12); there were no significant differences in the incidence of each complication. Furthermore, LTH achieved similar 2-year overall survival (OS) rate (risk ratio [RR] = 1.17 [0.86, 1.60], P = 0.31) while higher 5-year OS rate (RR = 1.43 [1.18, 1.73], P = 0.0003) and significant improvement of OS (univariable hazard ratio = 0.65 [0.50, 0.84], P = 0.0009; multivariable hazard ratio = 0.59 [0.44, 0.80], P = 0.0006). CONCLUSIONS LTH is feasible and safe for AEG, and may provide more favorable short-term outcomes and potential long-term survival benefit, which needs to be confirmed by randomized trials.
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Affiliation(s)
- Xiao-Dong Chen
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, China.
| | - Fu-Qian He
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, China.
| | - Mao-Shan Liao
- Department of Laboratory Medicine, Santai People's Hospital, China
| | - Mi Chen
- Department of Surgery, Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, China
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Ogun E, Ekrem UA, Yuksel C, Serdar C, Basceken SI, Umit M, Salim D. Laparoscopic Gastric Resection for Gastric Cancer: Is Intracorporeal Anastomosis Necessary? Pak J Med Sci 2020; 36:1177-1182. [PMID: 32968376 PMCID: PMC7501006 DOI: 10.12669/pjms.36.6.1915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/13/2019] [Accepted: 08/06/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND OBJECTIVE In surgical dissection, laparoscopic approach and open techniques do not differ significantly, but there is still no consensus on how anastomosis should be performed in both cardia and distal gastric tumors. Anastomosis can be performed by laparoscopy-assisted mini-laparotomy or by intracorporeal suture techniques. In this study, we aim to present our four years of clinical experience and short-term surgical results from 133 cases in order to evaluate the necessity of laparoscopic anastomosis. METHODS This study was approved by Ethics Committee (No: 1-8-19, date: 14/01/2019). Patients who underwent curative resection with the diagnosis of gastric adenocarcinoma between January 2014 and January 2018 in the Ankara University Surgical Oncology Department were included in the study. RESULTS Of the 133 patients included in the study, 108 (81.2) were male and the mean age was 60.51 ± 12.0 years. The time of anastomosis was significantly longer in patients undergoing intracorporeal anastomosis (p = 0.021). The incidence of anastomotic leakage was significantly higher in the group undergoing intracorporeal anastomosis (p = 0.004). CONCLUSIONS We think that esophagojejunostomy and jejunojejunostomy anastomoses in patients undergoing total gastrectomy should be performed with intracorporeal techniques in terms of benefit risk assessment. We believe that it is more feasible to continue the case with mini laparotomy when anastomosis is reached in patients who are planned to have gastrojejunostomy. In addition, in terms of intracorporeal anastomoses and advanced laparoscopic techniques, intracorporeal anastomoses performed in gastric cancer surgery for a laparoscopist who has completed the learning curve do not appear to be very different in terms of anastomosis safety.
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Affiliation(s)
- Ersen Ogun
- Ersen Ogun, Ankara University, General Surgery, Surgical Oncology, Ankara, Turkey
| | - Unal Ali Ekrem
- Unal Ali Ekrem, Ankara University, General Surgery, Surgical Oncology, Ankara, Turkey
| | - Cemil Yuksel
- Cemil Yuksel, Ankara University, General Surgery, Surgical Oncology, Ankara, Turkey
| | - Culcu Serdar
- Culcu Serdar Ankara Oncology Hospital, Surgical Oncology, Ankara, Turkey
| | - Salim Ilksen Basceken
- Bascseken Ilksen Salim Diyarbakır Oncology Hospital, Surgical Oncology, Diyarbakır, Turkey
| | - Mercan Umit
- Mercan Umit, Ankara University, General Surgery, Surgical Oncology, Ankara, Turkey
| | - Demirci Salim
- Demirci Salim, Ankara University, General Surgery, Surgical Oncology, Ankara, Turkey
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15
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Liao C, Feng Q, Xie S, Chen J, Shi Y. Laparoscopic versus open gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a meta-analysis. Surg Endosc 2020; 35:860-871. [PMID: 32076857 DOI: 10.1007/s00464-020-07458-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 02/11/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The potential advantages of laparoscopic gastrectomy (LG) compared with open gastrectomy (OG) for Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG) have not been fully clarified. The aim of this meta-analysis was to evaluate the safety and efficacy of LG for Siewert type II/III AEG, compared with OG. METHODS A comprehensive search was performed in various medical databases up to December 30, 2018. Seven non-randomized controlled trials comparing LG and OG for Siewert type II/III AEG were included. Outcomes evaluated including operation time, estimated blood loss, number of retrieved lymph nodes (LNs), post-operation complications, postoperative hospital stay, time to first flatus, time to ambulation, and overall survival (OS). RESULTS Seven studies of 1915 patients were included for meta-analysis. The estimated blood loss [weighted mean difference (WMD) = - 77.49, 95%CI - 111.84 to - 43.15; P < 0.00001] was significantly less and the postoperative hospital stay (WMD = - 1.98, 95%CI - 2.14 to - 1.83; P < 0.00001) was significantly shorter in the LG group than in the OG group, while the operation time, number of retrieved LNs, time to first flatus, and time to ambulation showed no significant difference between LG and OG groups. The overall postoperative complications [odds ratio (OR) 0.78, 95%CI 0.60-1.02; P = 0.07] in LG group were less than those in OG group, although the difference was not significant between the two groups. CONCLUSION LG can achieve short-term surgical outcomes comparable to OG, with respect to safety and efficiency in treatment of Siewert type II/III AEG.
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Affiliation(s)
- CunXiang Liao
- Department of General Surgery, Southwest Hospital, Army Medical University, Gaotanyan Main Street 29, Shapingba District, Chongqing, 400038, People's Republic of China
| | - Qing Feng
- Department of General Surgery, Southwest Hospital, Army Medical University, Gaotanyan Main Street 29, Shapingba District, Chongqing, 400038, People's Republic of China
| | - ShaoHui Xie
- Department of General Surgery, Southwest Hospital, Army Medical University, Gaotanyan Main Street 29, Shapingba District, Chongqing, 400038, People's Republic of China
| | - Jun Chen
- Department of General Surgery, Southwest Hospital, Army Medical University, Gaotanyan Main Street 29, Shapingba District, Chongqing, 400038, People's Republic of China
| | - Yan Shi
- Department of General Surgery, Southwest Hospital, Army Medical University, Gaotanyan Main Street 29, Shapingba District, Chongqing, 400038, People's Republic of China.
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16
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Long-term oncological outcomes of laparoscopic versus open transhiatal resection for patients with Siewert type II adenocarcinoma of the esophagogastric junction. Surg Endosc 2020; 35:340-348. [PMID: 32025923 DOI: 10.1007/s00464-020-07406-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Insufficient information is available about the long-term outcomes of patients with Siewert type II adenocarcinoma of the esophagogastric junction (AEG) who undergo laparoscopic transhiatal approach (LTH). Here we evaluated the oncological safety of LTH for patients with Siewert type II AEG compared with the open transhiatal approach (OTH). METHODS Subjects included 79 patients with Siewert type II AEG who underwent gastrectomy combined with lower esophagectomy from 2008 to 2018 at our institution. Overall survival (OS), recurrence-free survival (RFS), status of adjuvant chemotherapy, late-phase complications, and recurrence patterns were compared between the OTH (n = 29) and LTH groups (n = 43). RESULTS The median observation periods were 60 months (6-120 months) and 36 months (1-88) for the OTH and LTH groups, respectively. The 5-year OS rates were significantly different: 74% (95% CI 71-77%) and 98% (95% CI 97-99) in the OTH and LTH groups (HR 0.10, 95% CI 0.01-0.83), respectively, though the OTH group included more patients with advanced disease. After stratification, according to pathological stage to adjust for selection bias, the 5-year OS and RFS rates were longer, but not significantly different among patients in the LTH group with pStage III (HR 0.42, 95% CI 0.05-3.47; HR 0.47, 95% CI 0.10-2.12, respectively). Recurrence patterns were similar in the both groups. CONCLUSIONS Long-term outcomes of the LTH group were not inferior to those of the OTH group, suggesting the possibility of LTH as a treatment option for selected patients with Siewert type II AEG.
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Díez Del Val I, Loureiro González C, Asensio Gallego JI, Bettonica Larrañaga C, Leturio Fernández S, Eizaguirre Letamendia E, Miró Martín M, García Fernández MM, Martí Gelonch L, Aranda Danso H, Barrenetxea Asua J, Estremiana García F, Ortiz Lacorzana J, Farran Teixidó L. Minimally invasive and robotic surgery in the surgical treatment of esophagogastric junction cancer. Cir Esp 2019; 97:451-458. [PMID: 31047649 DOI: 10.1016/j.ciresp.2019.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 11/24/2022]
Abstract
Minimally invasive surgery provides for the treatment of esophagogastric junction tumors under safe conditions, reducing respiratory and abdominal wall complications. Recovery is improved, while maintaining the oncological principles of surgery to obtain an optimal long-term outcome. It is important to have a sufficient volume of activity to progress along the learning curve with close expert supervision in order to guarantee R0 resection and adequate lymphadenectomy. Minimal invasiveness ought not become an objective in itself. Should total gastrectomy be performed, the risk of a positive proximal margin makes intraoperative biopsy compulsory, without ruling out a primary open approach. Meanwhile, minimally invasive esophagectomy has been gaining ground. Its main difficulty, the intrathoracic anastomosis, can be safely carried out either with a mechanical side-to-side suture or a robot-assisted manual suture, thanks to the 3-D vision and versatility of the instruments.
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Affiliation(s)
- Ismael Díez Del Val
- Sección de Cirugía esofagogástrica, Hospital Universitario Basurto, Bilbao, España.
| | | | | | - Carla Bettonica Larrañaga
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | | | - Mónica Miró Martín
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Laura Martí Gelonch
- Sección de Cirugía esofagogástrica, Hospital Universitario Donostia, Donostia-San Sebastián, España
| | - Humberto Aranda Danso
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Fernando Estremiana García
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Leandre Farran Teixidó
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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