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van der Horst S, Weijs TJ, Braunius WW, Mook S, Mohammed NH, Brosens L, van Rossum PSN, Weusten BLAM, Ruurda JP, van Hillegersberg R. ASO Visual Abstract: Safety and Feasibility of Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) with Three-Field Lymphadenectomy and Neoadjuvant Chemoradiotherapy in Patients with Resectable Esophageal Cancer and Cervical Lymph Node Metastasis. Ann Surg Oncol 2023; 30:2755-2756. [PMID: 36745253 DOI: 10.1245/s10434-022-13079-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- S van der Horst
- Department of Surgery, G04.228, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T J Weijs
- Department of Surgery, G04.228, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W W Braunius
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N Haj Mohammed
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Brosens
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P S N van Rossum
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B L A M Weusten
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, G04.228, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, G04.228, University Medical Center Utrecht, Utrecht, The Netherlands.
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Weijs TJ, van der Horst S, van Hillegersberg R. ASO Author Reflections: Safety and Feasibility of Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) with Three-Field Lymphadenectomy and Neoadjuvant Chemoradiotherapy in Patients with Resectable Esophageal Cancer and Cervical Lymph Node Metastasis. Ann Surg Oncol 2023; 30:2753-2754. [PMID: 36735084 PMCID: PMC10085917 DOI: 10.1245/s10434-023-13137-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 02/04/2023]
Affiliation(s)
- T J Weijs
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S van der Horst
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
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van der Horst S, Weijs TJ, Braunius WW, Mook S, Mohammed NH, Brosens L, van Rossum PSN, Weusten BLAM, Ruurda JP, van Hillegersberg R. Safety and Feasibility of Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) with Three-Field Lymphadenectomy and Neoadjuvant Chemoradiotherapy in Patients with Resectable Esophageal Cancer and Cervical Lymph Node Metastasis. Ann Surg Oncol 2023; 30:2743-2752. [PMID: 36707482 DOI: 10.1245/s10434-022-12996-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/10/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND In the West, patients with cervical lymph node metastasis of resectable esophageal cancer at diagnosis are generally precluded from curative treatment. This study prospectively explored the safety and feasibility of neoadjuvant chemoradiotherapy followed by robot-assisted minimally invasive esophagectomy (RAMIE) with three-field lymphadenectomy for these patients. METHODS Between 2015 and 2021, patients with resectable thoracic esophageal cancer and cervical lymph node metastasis were recruited nationwide in the Netherlands. Patients without interval metastasis following neoadjuvant chemoradiotherapy and good physical condition underwent RAMIE with bilateral three-field lymphadenectomy. Safety was predefined as ≤50% Clavien-Dindo grade ≥3b postoperative complications. RESULTS Neoadjuvant chemoradiotherapy was administered to 29 patients (19 (66%) adenocarcinoma and 10 (34%) squamous cell carcinoma). After restaging, nine (31%) patients were excluded (interval metastasis, clinical deterioration, or withdrawn consent). RAMIE was performed in 20 patients (R0-rate 95%). A median of 42 [range 21-71] lymph nodes were resected of which 13 [range 2-35] were cervical. Only 1 (5%) patient had an unexpected contralateral cervical lymph node metastasis. Complications grade ≥3b occurred in 50%. Most frequent complications of any grade were recurrent laryngeal nerve palsy (45%) and pneumonia (40%). Overall survival at 1 year was 85% and quality of life at 6 months was comparable to esophageal cancer patients treated with curative intent. CONCLUSIONS RAMIE with three-field lymphadenectomy following neoadjuvant chemoradiotherapy for patients with resectable esophageal cancer presenting with cervical lymph node metastasis is feasible in a Western population. Because contralateral cervical metastasis is rare, a unilateral neck dissection would suffice in the majority of cases. CLINICAL TRIAL gov Identifier: NCT02426879. Dutch trial register Identifier: NTR 4552.
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Affiliation(s)
- S van der Horst
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T J Weijs
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W W Braunius
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N Haj Mohammed
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Brosens
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P S N van Rossum
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B L A M Weusten
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
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Wedel T, Heinze T, Möller T, van Hillegersberg R, Bleys RLAW, Weijs TJ, van der Sluis PC, Grimminger PP, Sallum RA, Becker T, Egberts JH. Surgical anatomy of the upper esophagus related to robot-assisted cervical esophagectomy. Dis Esophagus 2021; 34:6102595. [PMID: 33458744 DOI: 10.1093/dote/doaa128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/27/2020] [Indexed: 12/11/2022]
Abstract
Robot-assisted cervical esophagectomy (RACE) enables radical surgery for tumors of the middle and upper esophagus, avoiding a transthoracic approach. However, the cervical access, narrow working space, and complex topographic anatomy make this procedure particularly demanding. Our study offers a stepwise description of appropriate dissection planes and anatomical landmarks to facilitate RACE. Macroscopic dissections were performed on formaldehyde-fixed body donors (three females, three males), according to the surgical steps during RACE. The topographic anatomy and surgically relevant structures related to the cervical access route to the esophagus were described and illustrated, along with the complete mobilization of the cervical and upper thoracic segment. The carotid sheath, intercarotid fascia, and visceral fascia were identified as helpful landmarks, used as optimal dissection planes to approach the cervical esophagus and preserve the structures at risk (trachea, recurrent laryngeal nerves, thoracic duct, sympathetic trunk). While ventral dissection involved detachment of the esophagus from the tracheal cartilage and membranous part, the dorsal dissection plane comprised the prevertebral compartment harboring the thoracic duct and right intercosto-bronchial artery. On the left side, the esophagus was attached to the aortic arch by the aorto-esophageal ligament; on the right side, the esophagus was bordered by the azygos vein, right vagus nerve, and cardiac nerves. The stepwise, illustrated topographic anatomy addressed specific surgical demands and perspectives related to the left cervical approach and dissection of the esophagus, providing an anatomical basis to facilitate and safely implement the RACE procedure.
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Affiliation(s)
- Thilo Wedel
- Institute of Anatomy, Center of Clinical Anatomy, Kurt Semm Center for Minimal Invasive and Robotic Surgery, Kiel University, Kiel, Germany
| | - Tillmann Heinze
- Institute of Anatomy, Center of Clinical Anatomy, Kurt Semm Center for Minimal Invasive and Robotic Surgery, Kiel University, Kiel, Germany
| | - Thorben Möller
- Department for General, Visceral, Thoracic, Transplant, and Pediatric Surgery, Kurt Semm Center for Minimal Invasive and Robotic Surgery, University Hospital Schleswig Holstein, Kiel, Germany
| | | | - Ronald L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Teun J Weijs
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Peter P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Rubens A Sallum
- University of São Paulo, Department of Gastroenterology, São Paulo, Brazil
| | - Thomas Becker
- Department for General, Visceral, Thoracic, Transplant, and Pediatric Surgery, Kurt Semm Center for Minimal Invasive and Robotic Surgery, University Hospital Schleswig Holstein, Kiel, Germany
| | - Jan-Hendrik Egberts
- Department for General, Visceral, Thoracic, Transplant, and Pediatric Surgery, Kurt Semm Center for Minimal Invasive and Robotic Surgery, University Hospital Schleswig Holstein, Kiel, Germany
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Seesing MFJ, Wirsching A, van Rossum PSN, Weijs TJ, Ruurda JP, van Hillegersberg R, Low DE. Defining pneumonia after esophagectomy for cancer: validation of the Uniform Pneumonia Score in a high volume center in North America. Dis Esophagus 2018; 31:4970820. [PMID: 29668913 DOI: 10.1093/dote/doy002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/13/2018] [Indexed: 12/11/2022]
Abstract
Surgery is a central component of multimodality therapy for esophageal and gastroesophageal junction cancer. Pneumonia is a common sequela of esophagectomy, leading to an increase in intensive care unit stay, hospital stay, readmission rates, and postoperative mortality. Developing strategies to reduce pneumonia after esophagectomy is hampered by the absence of a standardized methodology for defining pneumonia. This study aims to validate the Uniform Pneumonia Score (UPS) in a high volume center in the USA. The UPS was developed to define pneumonia after esophagectomy for cancer and is based on the assessment of temperature (°C), leukocyte count (×109/L), and pulmonary radiography. The UPS has been validated utilizing a prospective, Institutional Review Board approved database of esophageal cancer patients treated in a high volume esophagectomy center in the USA between 2010 and 2015. One hundred ninety-three consecutive patients were included and 21 (10.9%) were treated for pneumonia. The UPS was able to predict treatment for suspected pneumonia with a good sensitivity (85.7%, confidence interval (CI): 63.7%-96.7%), specificity (97.1%, CI: 93.4%-99.1%), positive predictive value (78.3%, CI: 59.9%-89.7%), and negative predictive value (98.2%, CI: 95.1%-99.4%). The diagnostic accuracy was 95.9%, CI: 92.0%-98.2%. The UPS demonstrated to be a reliable scoring system to define pneumonia after esophagectomy for cancer. Global application of this model will standardize the definition of pneumonia after esophagectomy. This will improve outcome reporting and comparisons of complications between individual institutions, clinical trials, and national audits.
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Affiliation(s)
- M F J Seesing
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A Wirsching
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - P S N van Rossum
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - T J Weijs
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J P Ruurda
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R van Hillegersberg
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - D E Low
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, Washington, USA
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Berkelmans GHK, Fransen L, Weijs TJ, Lubbers M, Nieuwenhuijzen GAP, Ruurda JP, Kouwenhoven EA, van Det MJ, Rosman C, van Hillegersberg R, Luyer MDP. The long-term effects of early oral feeding following minimal invasive esophagectomy. Dis Esophagus 2018; 31:1-8. [PMID: 29025081 DOI: 10.1093/dote/dox114] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A nil-by-mouth regime with enteral nutrition via an artificial route is frequently applied following esophagectomy. However, early initiation of oral feeding could potentially improve recovery and has shown to be beneficial in many types of abdominal surgery. Although short-term nutritional safety of oral intake after an esophagectomy has been documented, long-term effects of this feeding regimen are unknown. In this cohort study, data from patients undergoing minimal invasive Ivor-Lewis esophagectomy between 04-2012 and 09-2015 in three centers in Netherlands were collected. Patients in the oral feeding group were retrieved from a previous prospective study and compared with a cohort of patients with early enteral jejunostomy feeding but delayed oral intake. Body mass index (BMI) measurements, complications, and nutritional re-interventions (re- or start of artificial feeding, start of total parenteral nutrition) were gathered over the course of one year after surgery. One year after surgery the median BMI was 22.8 kg/m2 and weight loss was 7.0 kg (9.5%) in 114 patients. Patients in the early oral feeding group lost more weight during the first postoperative month (P = 0.004). However, in the months thereafter this difference was not observed anymore. In the early oral feeding group, 28 patients (56%) required a nutritional re-intervention, compared to 46 patients (72%) in the delayed oral feeding group (P = 0.078). During admission, more re-interventions were performed in the delayed oral feeding group (17 vs. 46 patients P < 0.001). Esophagectomy reduces BMI in the first year after surgery regardless of the feeding regimen. Direct start of oral intake following esophagectomy has no impact on early nutritional re-interventions and long-term weight loss.
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Affiliation(s)
| | - L Fransen
- Department of Surgery Catharina Hospital, Eindhoven
| | - T J Weijs
- Department of Surgery, University Medical Center, Utrecht
| | - M Lubbers
- Department of Surgery, Ziekenhuisgroep Twente, Almelo
| | | | - J P Ruurda
- Department of Surgery, University Medical Center, Utrecht
| | | | - M J van Det
- Department of Surgery, Ziekenhuisgroep Twente, Almelo
| | - C Rosman
- Department of Surgery, University Medical Center Radboud, Nijmegen, The Netherlands
| | | | - M D P Luyer
- Department of Surgery Catharina Hospital, Eindhoven
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Weijs TJ, Ruurda JP, Broekhuizen ME, Bracco Gartner TC, van Hillegersberg R. Outcome of a Step-Up Treatment Strategy for Chyle Leakage After Esophagectomy. Ann Thorac Surg 2017; 104:477-484. [DOI: 10.1016/j.athoracsur.2017.01.117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/30/2016] [Accepted: 01/30/2017] [Indexed: 12/14/2022]
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Abstract
Implementation of (robot assisted) minimally invasive esophagectomy and increased knowledge of the relation between the autonomic nervous system and the immune response have led to new insights regarding the surgical anatomy of the esophagus. First, two layers of connective tissue were identified; the aorto-esophageal and aorto-pleural ligaments that separate the peri-esophageal compartment, containing vagus nerves, carinal lymph nodes and trachea, from the para-aortic compartment; containing thoracic duct and azygos vein. Second the surgical anatomy of the pulmonary vagus nerve branches has been described in detail. Based on the hypothesis that sparing the vagal nerve branches may be important a method to spare the pulmonary branches of the vagus nerve during thoracoscopic esophagectomy was validated in a cadaver study. Further studies will now investigate the impact of these new insights in the surgical anatomy of the esophagus in clinical practice.
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Affiliation(s)
- Teun J Weijs
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Miguel A Cuesta
- Department of Surgery, VU Medisch Centrum, Amsterdam, The Netherlands
| | | | - Ronaldus L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
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Weijs TJ, Goense L, van Rossum PSN, Meijer GJ, van Lier ALHMW, Wessels FJ, Braat MNG, Lips IM, Ruurda JP, Cuesta MA, van Hillegersberg R, Bleys RLAW. The peri-esophageal connective tissue layers and related compartments: visualization by histology and magnetic resonance imaging. J Anat 2016; 230:262-271. [PMID: 27659172 DOI: 10.1111/joa.12552] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 12/16/2022] Open
Abstract
An organized layer of connective tissue coursing from aorta to esophagus was recently discovered in the mediastinum. The relations with other peri-esophageal fascias have not been described and it is unclear whether this layer can be visualized by non-invasive imaging. This study aimed to provide a comprehensive description of the peri-esophageal fascias and determine whether the connective tissue layer between aorta and esophagus can be visualized by magnetic resonance imaging (MRI). First, T2-weighted MRI scanning of the thoracic region of a human cadaver was performed, followed by histological examination of transverse sections of the peri-esophageal tissue between the thyroid gland and the diaphragm. Secondly, pretreatment motion-triggered MRI scans were prospectively obtained from 34 patients with esophageal cancer and independently assessed by two radiologists for the presence and location of the connective tissue layer coursing from aorta to esophagus. A layer of connective tissue coursing from the anterior aspect of the descending aorta to the left lateral aspect of the esophagus, with a thin extension coursing to the right pleural reflection, was visualized ex vivo in the cadaver on MR images, macroscopic tissue sections, and after histologic staining, as well as on in vivo MR images. The layer connecting esophagus and aorta was named 'aorto-esophageal ligament' and the layer connecting aorta to the right pleural reflection 'aorto-pleural ligament'. These connective tissue layers divides the posterior mediastinum in an anterior compartment containing the esophagus, (carinal) lymph nodes and vagus nerve, and a posterior compartment, containing the azygos vein, thoracic duct and occasionally lymph nodes. The anterior compartment was named 'peri-esophageal compartment' and the posterior compartment 'para-aortic compartment'. The connective tissue layers superior to the aortic arch and at the diaphragm corresponded with the currently available anatomic descriptions. This study confirms the existence of the previously described connective tissue layer coursing from aorta to esophagus, challenging the long-standing paradigm that no such structure exists. A comprehensive, detailed description of the peri-esophageal fascias is provided and, furthermore, it is shown that the connective tissue layer coursing from aorta to esophagus can be visualized in vivo by MRI.
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Affiliation(s)
- T J Weijs
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P S N van Rossum
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G J Meijer
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A L H M W van Lier
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F J Wessels
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M N G Braat
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I M Lips
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M A Cuesta
- Department of Surgery, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
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Haverkamp L, Ruurda JP, Offerhaus GJA, Weijs TJ, van der Sluis PC, van Hillegersberg R. Laparoscopic gastrectomy in Western European patients with advanced gastric cancer. Eur J Surg Oncol 2015; 42:110-5. [PMID: 26603678 DOI: 10.1016/j.ejso.2015.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/29/2015] [Accepted: 09/21/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The advantage of laparoscopic gastrectomy compared to open gastrectomy has been established in Asian patient series with early gastric cancer. However, its feasibility in Western European patients with locally advanced gastric cancer is unknown. METHODS Between 2006 and 2014 70 consecutive patients with advanced gastric cancer underwent laparoscopic gastrectomy with D2 lymph node dissection. A Billroth II reconstruction was performed after distal gastrectomy. In case of total gastrectomy a jejunal J-pouch reconstruction was performed. RESULTS Total gastrectomy was performed in 56 patients and distal gastrectomy in 14 patients. Perioperative chemotherapy was administered in 45/70 (64%) patients. A radical resection was achieved in 63/70 (90%). The median number of dissected lymph nodes was 17 (2-62). The median intraoperative blood loss was 305 (30-2700) milliliters. The median postoperative hospital stay was 11 (5-91) days. The 30-day mortality was 4.3%. CONCLUSIONS Laparoscopic gastrectomy can be performed in Western European patients with advanced gastric cancer and meets the oncologic standard with low intraoperative blood loss and short hospital stay.
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Affiliation(s)
- L Haverkamp
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - G J A Offerhaus
- Department of Pathology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - T J Weijs
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - P C van der Sluis
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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