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Hu W, Yuan P, Yuan Y, Chen L, Hu Y. Learning curve for inflatable mediastinoscopic and laparoscopic-assisted esophagectomy. Surg Endosc 2023:10.1007/s00464-023-09903-0. [PMID: 36809587 DOI: 10.1007/s00464-023-09903-0] [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: 10/23/2022] [Accepted: 01/18/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To identify the morbidity that is associated with the learning curve of inflatable mediastinoscopic and laparoscopic-assisted esophagectomy (IMLE), and investigate the strategies to ride out the early period. METHODS Our study included a retrospective series of 108 consecutive patients undergoing IMLE by a single surgeon with advanced training in minimally invasive esophageal surgery in independent practice at high-volume tertiary center from July 2017 to November 2020. The cumulative sum (CUSUM) method was used to analyze the learning curve. Patients were stratified into two groups in chronological order, defining the surgeon's early (Group 1: the first 27 cases) and late experience (Group 2: the next 81 cases). Intraoperative characteristics and short-term surgical outcomes were compared between the two groups. RESULTS A total of 108 patients were included. Three patients converted into thoracoscopic surgery. The number of patients with postoperative pulmonary infection was 16 (14.8%), and vocal cord palsy had occurred in 12 patients (11.1%). One patient died within 90 days after surgery. CUSUM plots revealed decreasing total operative time, thoracic procedure time, abdominal procedure time, assistant-adjustment time after patients 27, 17, 26, and 35, respectively. CONCLUSION IMLE is technically feasible, in terms of perioperative outcomes, for using as a radical surgery for thoracic esophageal cancer. For a surgeon experienced in minimally invasive esophageal surgery, experience of 27 cases is required to gain early proficiency of IMLE.
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Affiliation(s)
- Weipeng Hu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Peisong Yuan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Yong Yuan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Longqi Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Yang Hu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China.
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Yang J, Liu Q, Bai Y, Zhao H, He T, Zhao Z, Huang M, Jiang M, Zhang R, Zhang M. Prognostic value of lymph node micrometastasis in esophageal cancer: A systematic review and meta-analysis. Front Oncol 2023; 12:1025855. [PMID: 36686727 PMCID: PMC9845692 DOI: 10.3389/fonc.2022.1025855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023] Open
Abstract
Objective Whether lymph node micrometastasis (LNM) increases the risk in esophageal cancer patients remains controversial. We conducted a systematic review and meta-analysis to explore the prognosis value of LNM in esophageal cancer patients. Methods Two reviewers independently searched electronic databases, including PubMed, Embase, and the Cochrane Library, for eligible citations until February 2022. We calculated pooled estimates of the hazards ratio with a random-effects model. The certainty of evidence was determined by the Grade of Recommendations Assessment, Development, and Evaluation (GRADE) method. A sensitivity analysis was performed to assess the stability. Publication bias was assessed using funnel plots and Egger's test. We also performed subgroup analysis to explore the source of heterogeneity. Results A total of 16 studies, with 1,652 patients, were included. The overall survival (OS) was significantly increased with LNM negativity compared with LNM positivity (HR 1.95; 95% CI, 1.53-2.49; P < 0.001; I2 = 0.0%, P = 0.930; certainty of evidence: low). Relapse-free survival (RFS) was significantly increased with LNM negativity compared with LNM positivity (HR 3.39; 95% CI, 1.87-6.16; P < 0.001; I2 = 50.18%, P = 0.060; certainty of evidence: moderate). No significant difference was observed in recurrence between the two groups (certainty of evidence: low). Sensitivity analysis revealed a stable trend. In addition, the funnel plot and Egger's test did not show significant publication bias. Conclusion LNM positivity worsens the prognosis in esophageal cancer, and the evidence for RFS is moderate. Future relevant high-quality studies are warranted to validate our results further and provide a reference for guidelines. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier (CRD42022321768).
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Affiliation(s)
- Jing Yang
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,Department of Pathology, The 940th Hospital of Joint Logistics Support Force of Chinese People´s Liberation Army, Lanzhou, China
| | - Qianqian Liu
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,Department of Pathology, The 940th Hospital of Joint Logistics Support Force of Chinese People´s Liberation Army, Lanzhou, China
| | - Yuping Bai
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,The Department of Pathology, Hainan Provincial Hospital, Haikou, Hainan, China
| | - Haitong Zhao
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Tingting He
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,Department of Pathology, The 940th Hospital of Joint Logistics Support Force of Chinese People´s Liberation Army, Lanzhou, China
| | - Ziru Zhao
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,Department of Pathology, The 940th Hospital of Joint Logistics Support Force of Chinese People´s Liberation Army, Lanzhou, China
| | - Min Huang
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,Department of Pathology, The 940th Hospital of Joint Logistics Support Force of Chinese People´s Liberation Army, Lanzhou, China
| | - Mengyuan Jiang
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,Department of Pathology, The 940th Hospital of Joint Logistics Support Force of Chinese People´s Liberation Army, Lanzhou, China
| | - Rui Zhang
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,Department of Pathology, The 940th Hospital of Joint Logistics Support Force of Chinese People´s Liberation Army, Lanzhou, China
| | - Min Zhang
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,*Correspondence: Min Zhang,
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