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Kitagawa Y, Inoue H, Udagawa H, Uyama I, Osugi H, Kawakubo H, Takeuchi H, Hashizume M, Aoyama J, Amada E, Ishida H, Saito Y, Takeuchi M, Hirata Y. Practice guidelines on endoscopic surgery for qualified surgeons by the endoscopic surgical skill qualification system: Esophagus. Asian J Endosc Surg 2025; 18:e13367. [PMID: 39489497 DOI: 10.1111/ases.13367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 07/15/2024] [Indexed: 11/05/2024]
Affiliation(s)
- Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Haruhiro Inoue
- The Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Harushi Udagawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Ichiro Uyama
- Department of Advanced Robotic and Endoscopic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Harushi Osugi
- Department of Gastroenterology, Kamifukuoka General Hospital, Saitama, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | | | - Junya Aoyama
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - En Amada
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Ishida
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiyuki Saito
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masashi Takeuchi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Hirata
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Velotta JB, Seder CW, Bonnell LN, Hayanga JA, Kidane B, Inra M, Shahian DM, Habib RH. 2024 Update of The Society of Thoracic Surgeons Short-term Esophagectomy Risk Model: More Inclusive and Improved Calibration. Ann Thorac Surg 2024; 118:834-842. [PMID: 38950724 DOI: 10.1016/j.athoracsur.2024.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/19/2024] [Accepted: 05/06/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND The Society of Thoracic Surgeons General Thoracic Surgery Database (STS-GTSD) previously reported short-term risk models for esophagectomy for esophageal cancer. We sought to update existing models using more inclusive contemporary cohorts, with consideration of additional risk factors based on clinical evidence. METHODS The study population consisted of adult patients in the STS-GTSD who underwent esophagectomy for esophageal cancer between January 2015 and December 2022. Separate esophagectomy risk models were derived for 3 primary end points: operative mortality, major morbidity, and composite morbidity or mortality. Logistic regression with backward selection was used, with predictors retained in models if P < .10. All derived models were validated using 9-fold cross-validation. Model discrimination and calibration were assessed for the overall cohort and specified subgroups. RESULTS A total of 18,503 patients from 254 centers underwent esophagectomy for esophageal cancer. Operative mortality, morbidity, and composite morbidity or mortality rates were 3.4%, 30.5%, and 30.9%, respectively. Novel predictors of short-term outcomes in the updated models included body surface area and insurance payor type. Overall discrimination was similar or superior to previous STS-GTSD models for operative mortality (C statistic = 0.72) and for composite morbidity or mortality (C statistic = 0.62), Model discrimination was comparable across procedure- and demographic-specific subcohorts. Model calibration was excellent in all patient subgroups. CONCLUSIONS The newly derived esophagectomy risk models showed similar or superior performance compared with previous models, with broader applicability and clinical face validity. These models provide robust preoperative risk estimation and can be used for shared decision making, assessment of provider performance, and quality improvement.
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Affiliation(s)
- Jeffrey B Velotta
- Division of Thoracic Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California.
| | - Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University, Chicago, Illinois
| | - Levi N Bonnell
- STS Research and Analytic Center, The Society of Thoracic Surgeons, Chicago, Illinois
| | - J Awori Hayanga
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Biniam Kidane
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew Inra
- Division of Cardiovascular and Thoracic Surgery, Northwell Health, New York, New York
| | - David M Shahian
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert H Habib
- STS Research and Analytic Center, The Society of Thoracic Surgeons, Chicago, Illinois
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Terayama M, Okamura A, Kuriyama K, Takahashi N, Tamura M, Kanamori J, Imamura Y, Watanabe M. Minimally Invasive Esophagectomy Provides Better Short- and Long-Term Outcomes Than Open Esophagectomy in Locally Advanced Esophageal Cancer. Ann Surg Oncol 2024; 31:5748-5756. [PMID: 38896227 DOI: 10.1245/s10434-024-15596-z] [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: 03/20/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Minimally invasive esophagectomy (MIE) has been increasingly performed for locally advanced esophageal cancer in place of open transthoracic esophagectomy (OE). This study explored the significance of MIE for esophageal squamous cell carcinoma (ESCC), focusing mainly on the depth of primary esophageal tumors. METHODS This study retrospectively assessed short- and long-term outcomes of patients who underwent esophagectomy for ESCC from 2005 through 2021. The inverse probability of the treatment-weighting (IPTW) method was used to compare the outcomes between OE and MIE. The outcomes also were evaluated in the subgroups stratified by cT category. RESULTS Among 1117 patients, 447 (40%) underwent OE and 670 (60%) underwent MIE. After IPTW adjustment, the incidence of any postoperative complications was significantly higher in the OE group than in the MIE group (60.8% vs 53.7%; p = 0.032), whereas the R0 resection rate was significantly higher in the MIE group (98.6% vs 92.7%; p < 0.001). The MIE group showed better 3 year overall and cancer-specific survival than the OE group (p < 0.001). The incidence of locoregional recurrence within the surgical field was significantly more frequent in the OE group (p < 0.001). In the subgroup analysis stratified by cT category, the R0 resection rate was significantly higher and the incidence of locoregional recurrence was lower in the MIE group among the patients with cT3-4 tumors. In the patients with cT1-2 tumors, MIE showed no significant benefit over OE. CONCLUSIONS For the patients with cT3-4 tumors, MIE showed fewer postoperative complications, better locoregional control, and better prognosis than OE. Compared with OE, MIE is beneficial, especially for locally advanced ESCC.
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Affiliation(s)
- Masayoshi Terayama
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Kengo Kuriyama
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoki Takahashi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masahiro Tamura
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Jun Kanamori
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Terayama M, Okamura A, Kanamori J, Watanabe M. ASO Author Reflections: Highlighted Advantages of Minimally Invasive Esophagectomy Over Open Esophagectomy in Locally Advanced Esophageal Cancer. Ann Surg Oncol 2024; 31:6032-6033. [PMID: 38916701 DOI: 10.1245/s10434-024-15671-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024]
Affiliation(s)
- Masayoshi Terayama
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Jun Kanamori
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Knitter S, Maurer MM, Winter A, Dobrindt EM, Seika P, Ritschl PV, Raakow J, Pratschke J, Denecke C. Robotic-Assisted Ivor Lewis Esophagectomy Is Safe and Cost Equivalent Compared to Minimally Invasive Esophagectomy in a Tertiary Referral Center. Cancers (Basel) 2023; 16:112. [PMID: 38201540 PMCID: PMC10778089 DOI: 10.3390/cancers16010112] [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: 09/27/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
In recent decades, robotic-assisted minimally invasive esophagectomy (RAMIE) has been increasingly adopted for patients with esophageal cancer (EC) or cancer of the gastroesophageal junction (GEJ). However, concerns regarding its costs compared to conventional minimally invasive esophagectomy (MIE) have emerged. This study examined outcomes and costs of RAMIE versus total MIE in 128 patients who underwent Ivor Lewis esophagectomy for EC/GEJ at our department between 2017 and 2021. Surgical costs were higher for RAMIE (EUR 12,370 vs. EUR 10,059, p < 0.001). Yet, median daily (EUR 2023 vs. EUR 1818, p = 0.246) and total costs (EUR 30,510 vs. EUR 29,180, p = 0.460) were comparable. RAMIE showed a lower incidence of postoperative pneumonia (8% vs. 25%, p = 0.029) and a trend towards shorter hospital stays (15 vs. 17 days, p = 0.205), which may have equalized total costs. Factors independently associated with higher costs included readmission to the intensive care unit (hazard ratio [HR] = 7.0), length of stay (HR = 13.5), anastomotic leak (HR = 17.0), and postoperative pneumonia (HR = 5.4). In conclusion, RAMIE does not impose an additional financial burden. This suggests that RAMIE may be considered as a valid alternative approach for esophagectomy. Attention to typical cost factors can enhance postoperative care across surgical methods.
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Affiliation(s)
- Sebastian Knitter
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Max M. Maurer
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Axel Winter
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Eva M. Dobrindt
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Philippa Seika
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Paul V. Ritschl
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Jonas Raakow
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Christian Denecke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Froiio C, Uzun E, Hadzijusufovic E, Capovilla G, Berlth F, Lang H, Grimminger PP. Semiprone thoracoscopic approach during totally minimally invasive Ivor-Lewis esophagectomy seems to be beneficial. Dis Esophagus 2023; 36:6627608. [PMID: 35780319 DOI: 10.1093/dote/doac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/24/2022] [Accepted: 06/13/2022] [Indexed: 02/01/2023]
Abstract
Minimally invasive Ivor-Lewis Esophagectomy (MIE) is widely accepted as a surgical treatment of resectable esophageal cancer. Aim of this paper is to describe the surgical details of our standardized MIE technique and its safety. We also evaluate the esophageal mobilization in semiprone compared to the left lateral position. A retrospective analysis of 141 consecutive patients who underwent Ivor-Lewis esophagectomy for cancer, from February 2016 to September 2021, was conducted. All the procedures were performed by totally thoraco-laparoscopic with an intrathoracic end-to-side circular stapled anastomosis. Thoracic phase was performed in left lateral position (LLP-group, n=47) followed by a semiprone position (SP-group, n=94). The intraoperative and postoperative outcomes were prospectively collected and analyzed. The procedure was completed without intraoperative complication in 94.68% of cases in SP-group and in 93.62% of cases in LLP-group (P=0.99). The total operative time and thoracic operative time were significantly shorter in SP-group (P=0.0096; P=0.009). No statistically significant differences were detected in postoperative outcomes between the groups, except for anastomotic strictures (higher in LLP-group, P=0.02) and intensive care unit stay (longer in LLP-group, P=00.1). No reoperation was needed in any cases. Surgical radicality was comparable; the median of harvested lymph nodes was significantly higher in SP-group (P<0.0001). The present semiprone technique of thoraco-laparoscopic Ivor-Lewis esophagectomy is safe and feasible but may also provide some advantages in terms of lymph nodes harvested and total operation time.
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Affiliation(s)
- Caterina Froiio
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Mainz, Germany.,Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milano, Italy
| | - Eren Uzun
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Mainz, Germany
| | - Edin Hadzijusufovic
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Mainz, Germany
| | - Giovanni Capovilla
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Mainz, Germany
| | - Felix Berlth
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Mainz, Germany
| | - Peter P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Mainz, Germany
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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: 9] [Impact Index Per Article: 3.0] [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.
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Claassen L, Hannink G, Luyer MDP, Ainsworth AP, van Berge Henegouwen MI, Cheong E, Daams F, van Det MJ, van Duijvendijk P, Gisbertz SS, Gutschow CA, Heisterkamp J, Kauppi JT, Klarenbeek BR, Kouwenhoven EA, Langenhoff BS, Larsen MH, Martijnse IS, Nieuwenhoven EJV, van der Peet DL, Pierie JPEN, Pierik REGJM, Polat F, Räsänen JV, Rouvelas I, Sosef MN, Wassenaar EB, Wildenberg FJHVD, van der Zaag ES, Nilsson M, Nieuwenhuijzen GAP, van Workum F, Rosman C. Learning Curves of Ivor Lewis Totally Minimally Invasive Esophagectomy by Hospital and Surgeon Characteristics: A Retrospective Multinational Cohort Study. Ann Surg 2022; 275:911-918. [PMID: 33605581 DOI: 10.1097/sla.0000000000004801] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the pooled learning curves of Ivor Lewis totally minimally invasive esophagectomy (TMIE) in hospitals stratified by predefined hospital- and surgeon-related factors. BACKGROUND Ivor Lewis (TMIE is known to have a long learning curve which is associated with considerable learning associated morbidity. It is unknown whether hospital and surgeon characteristics are associated with more efficient learning. METHODS A retrospective analysis of prospectively collected data of consecutive Ivor Lewis TMIE patients in 14 European hospitals was performed. Outcome parameters used as proxy for efficient learning were learning curve length, learning associated morbidity, and the plateau level regarding anastomotic leakage and textbook outcome. Pooled incidences were plotted for the factor-based subgroups using generalized additive models and 2-phase models. Casemix predicted outcomes were plotted and compared with observed outcomes. The investigated factors included annual volume, TMIE experience, clinic visits, courses and fellowships followed, and proctor supervision. RESULTS This study included 2121 patients. The length of the learning curve was shorter for centers with an annual volume >50 compared to centers with an annual volume <50. Analysis with an annual volume cut-off of 30 cases showed similar but less pronounced results. No outcomes suggesting more efficient learning were found for longer experience as consultant, visiting an expert clinic, completing a minimally invasive esophagectomy fellowship or implementation under proctor supervision. CONCLUSIONS More efficient learning was observed in centers with higher annual volume. Visiting an expert clinic, completing a fellowship, or implementation under a proctor's supervision were not associated with more efficient learning.
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Affiliation(s)
- Linda Claassen
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboudumc, Nijmegen, The Netherlands
| | - Misha D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Mark I van Berge Henegouwen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Edward Cheong
- Department of UGI Surgery, Norfolk and Norwich University Hospital Foundation Trust, Norwich, UK
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marc J van Det
- Department of Surgery, Hospital Group Twente, Almelo, The Netherlands
| | | | - Suzanne S Gisbertz
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Christian A Gutschow
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Juha T Kauppi
- Division of Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | | | | | | | | | - Ingrid S Martijnse
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | | | - Donald L van der Peet
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Fatih Polat
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jari V Räsänen
- Division of Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Ioannis Rouvelas
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Solna, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Meindert N Sosef
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Eelco B Wassenaar
- Department of Surgery, Gelre Ziekenhuizen, Apeldoorn, The Netherlands
| | | | | | - Magnus Nilsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Solna, Sweden
| | | | - Frans van Workum
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Camiel Rosman
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
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Xie J, Zhang L, Liu Z, Lu CL, Xu GH, Guo M, Lian X, Liu JQ, Zhang HW, Zheng SY. Advantages of McKeown minimally invasive oesophagectomy for the treatment of oesophageal cancer: propensity score matching analysis of 169 cases. World J Surg Oncol 2022; 20:52. [PMID: 35216598 PMCID: PMC8881864 DOI: 10.1186/s12957-022-02527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Oesophagectomy, the gold standard for oesophageal cancer treatment, causes significantly high morbidity and mortality. McKeown minimally invasive oesophagectomy (MIE) is preferred for treating oesophageal malignancies; however, limited studies with large sample sizes focusing on the surgical and oncological outcomes of this procedure have been reported. We aimed to compare the clinical safety and efficacy of McKeown MIE with those of open oesophagectomy (OE). PATIENTS AND METHODS Overall, 338 oesophageal cancer patients matched by gender, age, location, size, and T and N stages (McKeown MIE: 169 vs OE: 169) were analysed. The clinicopathologic features, operational factors, postoperative complications, and prognoses were compared between the groups. RESULTS McKeown MIE resulted in less bleeding (200 mL vs 300 mL, p<0.01), longer operation time (335.0 h vs 240.0 h, p<0.01), and higher number of harvested lymph nodes (22 vs 9, p<0.01) than OE did. Although the rate of recurrent laryngeal nerve injury in the two groups was not significantly different, incidence of anastomotic leakage (8 vs 24, p=0.003) was significantly lower in the McKeown MIE group. In addition, patients who underwent McKeown MIE had higher 5-year overall survival than those who underwent OE (69.9% vs 40.4%, p<0.001). CONCLUSION McKeown MIE is proved to be feasible and safe to achieve better surgical and oncological outcomes for oesophageal cancer compared with OE.
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Affiliation(s)
- Jun Xie
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Shizi Street No. 188, Suzhou, 215006, Jiangsu, China
| | - Lei Zhang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shanxi Province, China
| | - Zhen Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Chun-Lei Lu
- Digestive Diseases Center of Wuxi Mingci Hospital, No. 599 Zhongnan Road, Jinxing Street, Wuxi City, 214000, Jiangsu Province, China
| | - Guang-Hui Xu
- Department of General Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, 710033, Shan Xi Province, China
| | - Man Guo
- Department of General Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, 710033, Shan Xi Province, China
| | - Xiao Lian
- Department of General Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, 710033, Shan Xi Province, China
| | - Jin-Qiang Liu
- Department of General Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, 710033, Shan Xi Province, China
| | - Hong-Wei Zhang
- Digestive Diseases Center of Wuxi Mingci Hospital, No. 599 Zhongnan Road, Jinxing Street, Wuxi City, 214000, Jiangsu Province, China.
| | - Shi-Ying Zheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Shizi Street No. 188, Suzhou, 215006, Jiangsu, China.
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10
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Froiio C, Berlth F, Capovilla G, Tagkalos E, Hadzijusufovic E, Mann C, Lang H, Grimminger PP. Robotic-assisted surgery for esophageal submucosal tumors: a single-center case series. Updates Surg 2022; 74:1043-1054. [PMID: 35147859 PMCID: PMC9213313 DOI: 10.1007/s13304-022-01247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/15/2022] [Indexed: 11/21/2022]
Abstract
Esophageal submucosal tumors (SMTs) are rare heterogenous clinical entities. The surgical resection can be performed in different surgical approaches. However, the robotic surgical strategy is poorly documented in the treatment of SMTs. We present our series of operated esophageal SMTs approached via robotic-assisted surgery. Six patients with symptomatic esophageal submucosal tumors underwent robotic surgery within a 3-year period. The performed procedures were robotic-assisted enucleation, robotic esophagectomy (RAMIE) and reverse hybrid robotic esophagectomy. Patients’ clinical data, intra/postoperative outcomes, and histopathological features were retrieved from the institution’s prospective database. Five of six patients were scheduled for upfront surgery: four underwent robotic enucleation (three leiomyoma and one suspected GIST) and one underwent reverse hybrid robotic esophagectomy (suspected GIST). One patient, diagnosed with GIST, was treated with neoadjuvant Imatinib therapy, before undergoing a RAMIE. No major intra-operative complications were recorded. Median length of stay was 7 days (6–50), with a longer post-operative course in patients who underwent esophagectomy. Clavien–Dindo > 3a complications occurred in two patients, aspiration pneumonia and delayed gastric emptying. The final histopathological and immuno-histochemical diagnosis were leiomyoma, well-differentiated GIST, low-grade fibromyxoid sarcoma and Schwannoma. Robotic-assisted surgery seems to be a promising option for surgical treatment strategies of benign or borderline esophageal submucosal tumors.
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Affiliation(s)
- Caterina Froiio
- Mainz University, Johannes Gutenberg Universitat Mainz, Mainz, Germany.,Department of General Surgery , IRCCS Policlinico San Donato, University of Milan , Milano, Italy
| | - Felix Berlth
- Mainz University, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | | | | | | | - Carolina Mann
- Mainz University, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Hauke Lang
- Mainz University, Johannes Gutenberg Universitat Mainz, Mainz, Germany
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11
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Chowdappa R, Dharanikota A, Arjunan R, Althaf S, Premalata CS, Ranganath N. Operative Outcomes of Minimally Invasive Esophagectomy versus Open Esophagectomy for Resectable Esophageal Cancer. South Asian J Cancer 2022; 10:230-235. [PMID: 34984201 PMCID: PMC8719958 DOI: 10.1055/s-0041-1730085] [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] [Indexed: 11/23/2022] Open
Abstract
Background
There is a recent rise in the incidence of esophageal carcinoma in India. Surgical resection with or without neoadjuvant chemoradiation is the current treatment modality of choice. Postoperative complications, especially pulmonary complications, affect many patients who undergo open esophagectomy for esophageal cancer. Minimally invasive esophagectomy (MIE) could reduce the pulmonary complications and reduce the postoperative stay.
Methodology
We performed a retrospective analysis of prospectively collected data of 114 patients with esophageal cancer in the department of surgical oncology at a tertiary cancer center in South India between January 2019 and March 2020. We included patients with resectable cancer of middle or lower third of the esophagus, and gastroesophageal junction tumors (Siewert I). MIE was performed in 27 patients and 78 patients underwent open esophagectomy (OE). The primary outcome measured was postoperative complications of Clavien–Dindo grade II or higher within 30 days. Other outcomes measured include overall mortality within 30 days, intraoperative complications, operative duration and the length of hospital stay.
Results
A postoperative complication rate of 18.5% was noted in the MIE group, compared with 41% in the OE group (
p
= 0.034). Pulmonary complications were noted in 7.4% in the MIE group compared to 25.6% in the OE group (
p
= 0.044). Postoperative mortality rates, intraoperative complications, and other nonpulmonary postoperative complications were almost similar with MIE as with open esophagectomy. Although the median operative time was more in the MIE group (260 minutes vs. 180 minutes;
p
< 0.0001), the median length of hospital stay was shorter in patients undergoing MIE (9 days vs. 12 days;
p
= 0.0001).
Conclusions
We found that MIE resulted in lower incidence of postoperative complications, especially pulmonary complications. Although, MIE was associated with prolonged operative duration, it resulted in shorter hospital stay.
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Affiliation(s)
- Ramachandra Chowdappa
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Anvesh Dharanikota
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Syed Althaf
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Chennagiri S Premalata
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Namrata Ranganath
- Department of Anesthesiology and Pain Relief, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
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12
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Groth SS, Burt BM. Minimally invasive esophagectomy: Direction of the art. J Thorac Cardiovasc Surg 2021; 162:701-704. [PMID: 33640124 DOI: 10.1016/j.jtcvs.2021.01.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Shawn S Groth
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
| | - Bryan M Burt
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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13
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Wang CP, Rogers MP, Bach G, Sujka J, Mhaskar R, DuCoin C. Safety comparison of minimally invasive abdomen-only esophagectomy versus minimally invasive Ivor Lewis esophagectomy: a retrospective cohort study. Surg Endosc 2021; 36:1887-1893. [PMID: 33825009 DOI: 10.1007/s00464-021-08468-0] [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: 12/16/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND We report mortality and post-operative complications from esophageal resection in the treatment of gastroesophageal adenocarcinoma or stricture, comparing a minimally invasive abdomen-only esophagectomy (MIAE) approach with a minimally invasive Ivor Lewis esophagectomy (MIILE) approach. METHODS A single-center retrospective cohort study of patients with esophageal adenocarcinoma or stricture treated by either MIAE or MIILE was conducted. MIAE was offered for strictures less than five centimeters or cancers that were American Joint Committee on Cancer (AJCC) Stage ≤ T2 without lymphadenopathy. Patients treated with these surgical techniques were analyzed to assess pre-operative risk, intra and post-operative variables, adverse events, and overall survival. RESULTS This study included 17 patients undergoing MIAE and 32 patients treated with MIILE. There were a fewer median number of lymph nodes resected (p < 0.001) and shorter operative duration (p < 0.001) for MIAE compared to MIILE. MIAE patients also had significantly higher Charlson Comorbidity Index scores and ACS National Surgical Quality Improvement Program (NSQIP) surgical risk values than MIILE patients (p < 0.05). There was no difference in median estimated blood loss, length of stay, pulmonary or cardiac complications between groups. There was no significant difference in 90-day survival. CONCLUSION A minimally invasive abdomen-only approach in a specific patient population is comparable in safety to a minimally invasive Ivor Lewis approach, with associated shorter median operative duration. MIAE patients had significantly greater pre-operative comorbidities and higher calculated peri-operative risk of complication but demonstrated similar post-operative outcomes. This suggests that MIAE may be a suitable surgical approach for treating gastroesophageal adenocarcinoma or stricture in patients deemed unsuitable for MIILE.
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Affiliation(s)
| | - Michael P Rogers
- Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Gregory Bach
- Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Joseph Sujka
- Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Christopher DuCoin
- Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA.
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14
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Wang K, Zhong J, Liu Q, Lin P, Fu J. A Propensity Score-Matched Analysis of Thoracolaparoscopic vs Open McKeown's Esophagectomy. Ann Thorac Surg 2021; 113:473-481. [PMID: 33621558 DOI: 10.1016/j.athoracsur.2021.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The effectiveness and survival benefit of minimally invasive esophagectomy compared to open esophagectomy (OE) remain controversial. The aim of this study was to evaluate the safety, efficacy, and oncologic outcomes of McKeown's total minimally invasive esophagectomy (tMIE) and McKeown's OE in the treatment of patients with esophageal squamous cell carcinoma. METHODS A series of 917 consecutive patients (306 OE and 611 tMIE) who underwent McKeown's esophagectomy for esophageal squamous cell carcinoma in the Department of Thoracic Surgery at Sun Yat-sen University Cancer Center from January 2011 to December 2016 were evaluated. We performed propensity matching between the tMIE and OE groups on the basis of estimated propensity scores for each patient. RESULTS After propensity-matched analysis, 288 patients were selected from each group. The rate of postoperative complications, such as pneumonia, respiratory insufficiency, cervical anastomotic leakage, and wound infection, in the OE group was significantly higher than that in the tMIE group. Intraoperative blood loss and operative duration were not significantly different between the matched groups, whereas the tMIE group had a shorter length of intensive care unit stay and postoperative hospital stay than the OE group. The R0 resection rate and the number of lymph nodes harvested were not significantly different between groups. There was no significant difference in median overall survival between the 2 groups after matching. CONCLUSIONS McKeown's tMIE was shown to be a safe and effective procedure with long-term survival comparable to that of OE for the patients with esophageal squamous cell carcinoma.
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Affiliation(s)
- Kexi Wang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, China; State Key Laboratory of Oncology in South China, Guangzhou City, China
| | - Jian Zhong
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, China; State Key Laboratory of Oncology in South China, Guangzhou City, China
| | - Qianwen Liu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, China; State Key Laboratory of Oncology in South China, Guangzhou City, China; Guangdong Esophageal Cancer Institute, Guangzhou City, China
| | - Peng Lin
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, China; State Key Laboratory of Oncology in South China, Guangzhou City, China; Guangdong Esophageal Cancer Institute, Guangzhou City, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, China; State Key Laboratory of Oncology in South China, Guangzhou City, China; Guangdong Esophageal Cancer Institute, Guangzhou City, China.
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15
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Babic B, Schiffmann LM, Schröder W, Bruns CJ, Fuchs HF. [Evidence in minimally invasive oncological surgery of the esophagus]. Chirurg 2021; 92:299-303. [PMID: 33432385 DOI: 10.1007/s00104-020-01337-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Thoracoabdominal esophagectomy still plays a major role in the oncological treatment for esophageal cancer. Minimally invasive procedures were developed to reduce the high rate of postoperative morbidity and mortality without negatively affecting the oncological outcome. OBJECTIVE What evidence supports minimally invasive oncological surgery of the esophagus? Do patients benefit from minimally invasive esophagectomy compared to an open approach? Is the reduction of surgical access trauma specifically advantageous? MATERIAL AND METHODS Review, evaluation and critical analysis of the international literature. RESULTS A reduction in postoperative morbidity by decreasing surgical trauma was confirmed by three prospective randomized clinical trials, while showing at least similar oncological outcomes. Diverse retrospective analyses and meta-analyses also came to the same result. CONCLUSION A minimization of surgical access trauma during thoracoabdominal esophagectomy reduces postoperative morbidity compared to conventional open surgery. Recent evidence suggests that oncological outcomes are not altered depending on the surgical approach.
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Affiliation(s)
- B Babic
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - L M Schiffmann
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - W Schröder
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - C J Bruns
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - H F Fuchs
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
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16
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Thammineedi SR, Patnaik SC, Nusrath S. Minimal Invasive Esophagectomy-a New Dawn of EsophagealSurgery. Indian J Surg Oncol 2020; 11:615-624. [PMID: 33299280 PMCID: PMC7714894 DOI: 10.1007/s13193-020-01191-7] [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: 01/15/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022] Open
Abstract
Surgery is the mainstay of esophageal cancer. However, esophagectomy is a major surgical trauma on a patient with high morbidity and mortality. The intent of minimally invasive esophagectomy (MIE) is to decrease the degree of surgical trauma and perioperative morbidity associated with open surgery, and provide faster recovery and shorter hospital stay with the equivalent oncological outcome. It also allows for lesser pulmonary morbidity, less blood loss, less pain, and a better quality of life. MIE is safe and effective but has a steep learning curve with high technical expertise. Recently, it is increasingly accepted and adopted all over the globe. In this article, we discuss the safety, efficacy, short-term, and oncological outcomes of thoracoscopic- and laparoscopic-assisted minimally invasive esophagectomy and robotic surgery compared with open esophagectomy with a special focus on the Indian perspective.
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Affiliation(s)
| | - Sujit Chyau Patnaik
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Syed Nusrath
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
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17
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de Groot EM, van der Horst S, Kingma BF, Goense L, van der Sluis PC, Ruurda JP, van Hillegersberg R. Robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open esophagectomy: long-term follow-up of a randomized clinical trial. Dis Esophagus 2020; 33:6006403. [PMID: 33241302 DOI: 10.1093/dote/doaa079] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/22/2020] [Accepted: 07/04/2020] [Indexed: 12/11/2022]
Abstract
Initial results of the ROBOT, which randomized between robot-assisted minimally invasive esophagectomy (RAMIE) and open transthoracic esophagectomy (OTE), showed significantly better short-term postoperative outcomes in favor of RAMIE. However, it is not yet clarified if RAMIE is equivalent to OTE regarding long-term outcomes. The aim of this study was to report the long-term oncological results of the ROBOT trial in terms of survival and disease-free survival. This study is a follow-up study of the ROBOT trial, which was a randomized controlled trial comparing RAMIE to OTE in 112 patients with intrathoracic esophageal cancer. Both the trial protocol and short-term results were previously published. The primary outcome of the current study was 5-year overall survival. Secondary outcomes were disease-free survival and recurrence patterns. Analysis was by intention to treat. During the recruitment period, 109 patients were included in the survival analysis (RAMIE n = 54, OTE n = 55). Majority of patients had clinical stage III or IV (RAMIE 63%, OTE 55%) and received neoadjuvant chemoradiotherapy (80%). Median follow-up was 60 months (range 31-60). The combined 5-year overall survival rates for RAMIE and OTE were 41% (95% CI 27-55) and 40% (95% CI 26-53), respectively (log rank test P = 0.827). The 5-year disease-free survival rate was 42% (95% CI 28-55) in the RAMIE group and 43% (95% CI 29-57) in the OTE group (log rank test P = 0.749). Out of 104 patients, 57 (55%) developed recurrent disease detected at a median of 10 months (range 0-56) after surgery. No statistically difference in recurrence rate nor recurrence pattern was observed between both groups. Overall survival and disease-free survival of RAMIE are comparable to OTE. These results continue to support the use of robotic surgery for esophageal cancer.
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Affiliation(s)
- Eline M de Groot
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sylvia van der Horst
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B Feike Kingma
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lucas Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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18
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Song WA, Fan BS, Di SY, Liu JQ, Zhao JH, Chen SY, Yue CY, Zhou SH, Gong TQ. Three-Field Lymphadenectomy in Minimally Invasive Esophagectomy for Squamous Cell Carcinoma. Ann Thorac Surg 2020; 112:928-934. [PMID: 33152329 DOI: 10.1016/j.athoracsur.2020.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Minimally invasive esophagectomy (MIE) has been used widely for the treatment of esophageal cancer. However, there is still a lack of consensus on the extent of lymphadenectomy in MIE. The objective of this study was to investigate the safety and efficacy of three-field lymphadenectomy (3-FL) in MIE, compared with the standard two-field lymphadenectomy (2-FL). METHODS A single-center randomized controlled trial was conducted, enrolling patients with resectable thoracic esophageal cancer (cT1-3,N0-3,M0) between June 2016 and May 2019. Eligible patients were randomized into two groups to receive either 3-FL or 2-FL during MIE procedures. Perioperative outcomes of the two groups were compared. The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-INR-16007957). RESULTS Seventy-six eligible patients were randomly assigned to the 3-FL group (n = 38) and the 2-FL group (n = 38). Compared with patients in the 2-FL group, patients in the 3-FL group had more lymph nodes harvested (54.7 ± 16.5vs 30.9 ± 9.6, P < .001) and more metastatic lymph nodes identified (3.5 ± 4.5 vs 1.7 ± 2.0, P = .027). Patients in the 3-FL group were diagnosed with a more advanced final pathologic TNM stage than patients in the 2-FL group. There was no significant difference between the two groups in blood loss, major postoperative complications, or duration of hospital stay, except that the operation time was longer in the 3-FL group than in the 2-FL group (270.5 ± 45.4 minutes vs 236.7 ± 47.0 minutes, P = .002). CONCLUSIONS Three-field lymphadenectomy allowed harvesting of more lymph nodes and more accurate staging without increased surgical risks compared with 2-FL MIE for esophageal cancer.
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Affiliation(s)
- Wei-An Song
- Department of Thoracic Surgery, Sixth Medical Center, Chinese People's Liberation Army General Hospital, Second Clinical College of Southern Medical University, Beijing, China
| | - Bo-Shi Fan
- Department of Thoracic Surgery, Sixth Medical Center, Chinese People's Liberation Army General Hospital, Second Clinical College of Southern Medical University, Beijing, China
| | - Shou-Yin Di
- Department of Thoracic Surgery, Sixth Medical Center, Chinese People's Liberation Army General Hospital, Second Clinical College of Southern Medical University, Beijing, China
| | - Jun-Qiang Liu
- Department of Thoracic Surgery, Sixth Medical Center, Chinese People's Liberation Army General Hospital, Second Clinical College of Southern Medical University, Beijing, China
| | - Jia-Hua Zhao
- Department of Thoracic Surgery, Sixth Medical Center, Chinese People's Liberation Army General Hospital, Second Clinical College of Southern Medical University, Beijing, China
| | - Si-Yu Chen
- Department of Thoracic Surgery, Sixth Medical Center, Chinese People's Liberation Army General Hospital, Second Clinical College of Southern Medical University, Beijing, China
| | - Cai-Ying Yue
- Department of Thoracic Surgery, Sixth Medical Center, Chinese People's Liberation Army General Hospital, Second Clinical College of Southern Medical University, Beijing, China
| | - Shao-Hua Zhou
- Department of Thoracic Surgery, Sixth Medical Center, Chinese People's Liberation Army General Hospital, Second Clinical College of Southern Medical University, Beijing, China
| | - Tai-Qian Gong
- Department of Thoracic Surgery, Sixth Medical Center, Chinese People's Liberation Army General Hospital, Second Clinical College of Southern Medical University, Beijing, China.
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19
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Minimally invasive esophagectomy: clinical evidence and surgical techniques. Langenbecks Arch Surg 2020; 405:1061-1067. [PMID: 33026466 PMCID: PMC7686170 DOI: 10.1007/s00423-020-02003-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/24/2020] [Indexed: 12/18/2022]
Abstract
Background Surgical esophagectomy plays a crucial role in the curative and palliative treatment of esophageal cancer. Thereby, minimally invasive esophagectomy (MIE) is increasingly applied all over the world. Combining minimal invasiveness with improved possibilities for meticulous dissection, robot-assisted minimal invasive esophagectomy (RAMIE) has been implemented in many centers. Purpose This review focuses on the development of MIE as well as RAMIE and their value based on evidence in current literature. Conclusion Although MIE and RAMIE are highly complex procedures, they can be performed safely with improved postoperative outcome and equal oncological results compared with open esophagectomy (OE). RAMIE offers additional advantages regarding surgical dissection, lymphadenectomy, and extended indications for advanced tumors.
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20
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Siaw‐Acheampong K, Kamarajah SK, Gujjuri R, Bundred JR, Singh P, Griffiths EA. Minimally invasive techniques for transthoracic oesophagectomy for oesophageal cancer: systematic review and network meta-analysis. BJS Open 2020; 4:787-803. [PMID: 32894001 PMCID: PMC7528517 DOI: 10.1002/bjs5.50330] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Oesophagectomy is a demanding operation that can be performed by different approaches including open surgery or a combination of minimal access techniques. This systematic review and network meta-analysis aimed to evaluate the clinical outcomes of open, minimally invasive and robotic oesophagectomy techniques for oesophageal cancer. METHODS A systematic literature search was conducted for studies reporting open oesophagectomy, laparoscopically assisted oesophagectomy (LAO), thoracoscopically assisted oesophagectomy (TAO), totally minimally invasive oesophagectomy (MIO) or robotic MIO (RAMIO) for oesophagectomy. A network meta-analysis of intraoperative (operating time, blood loss), postoperative (overall complications, anastomotic leaks, chyle leak, duration of hospital stay) and oncological (R0 resection, lymphadenectomy) outcomes, and survival was performed. RESULTS Ninety-eight studies involving 32 315 patients were included in the network meta-analysis (open 17 824, 55·2 per cent; LAO 1576, 4·9 per cent; TAO 2421 7·5 per cent; MIO 9558, 29·6 per cent; RAMIO 917, 2·8 per cent). Compared with open oesophagectomy, both MIO and RAMIO were associated with less blood loss, significantly lower rates of pulmonary complications, shorter duration of stay and higher lymph node yield. There were no significant differences between surgical techniques in surgical-site infections, chyle leak, and 30- and 90-day mortality. MIO and RAMIO had better 1- and 5-year survival rates respectively compared with open surgery. CONCLUSION Minimally invasive and robotic techniques for oesophagectomy are associated with reduced perioperative morbidity and duration of hospital stay, with no compromise of oncological outcomes but no improvement in perioperative mortality.
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Affiliation(s)
| | - S. K. Kamarajah
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman HospitalNewcastle University NHS Foundation Trust HospitalsNewcastle upon TyneUK
- Institute of Cellular MedicineUniversity of NewcastleNewcastle upon TyneUK
| | - R. Gujjuri
- College of Medical and Dental SciencesNewcastle upon TyneUK
| | - J. R. Bundred
- College of Medical and Dental SciencesNewcastle upon TyneUK
| | - P. Singh
- Regional Oesophago‐Gastric UnitRoyal Surrey County Hospital NHS Foundation TrustGuildfordUK
| | - E. A. Griffiths
- Institute of Cancer and Genomic Sciences, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- Department of Upper Gastrointestinal SurgeryUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
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21
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Patel K, Askari A, Moorthy K. Long-term oncological outcomes following completely minimally invasive esophagectomy versus open esophagectomy. Dis Esophagus 2020; 33:5707339. [PMID: 31950180 DOI: 10.1093/dote/doz113] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/09/2019] [Accepted: 01/02/2020] [Indexed: 12/11/2022]
Abstract
Open esophagectomy (OE) for esophageal and gastroesophageal junctional cancers is associated with high morbidity. Completely minimally invasive esophagectomy (CMIE) techniques have evolved over the last two decades and significantly reduce surgical trauma compared to open surgery. Despite this, long-term oncological outcomes following CMIE compared to OE remain unclear. This systematic review and meta-analysis aimed to compare overall 5-year survival (OFS) and disease-free 5-year survival (DFFS) between CMIE and OE. It was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive electronic literature search from MEDLINE, EMBASE, Web of Science, Scopus and the Cochrane Central Register of Controlled Trials was conducted. The PROSPERO database was also searched for studies comparing OFS and DFFS between CMIE and OE. The Newcastle Ottawa Scale was used to assess study quality for included studies. Overall, seven studies (containing 949 patients: 527 OE and 422 CMIE) were identified from screening. On pooled meta-analysis, there was no significant difference in OFS or DFFS between CMIE and OE cohorts ([odds ratio 1.12; 95% CI: 0.85 to 1.48; P = 0.41] and [odds ratio 1.34; 95% CI: 0.81-2.22; P = 0.25] respectively). Sensitivity and subgroup analysis with high-quality studies, three highest sample sized studies, and three most recent studies also revealed no difference in long-term oncological outcomes between the two operative groups. This review demonstrates long-term oncological outcomes following CMIE appear equivalent to OE based on amalgamation of existing published literature. Limited high-level evidence comparing OFS and DFFS between CMIE and OE exists. Further research with a randomized controlled trial is required to clinically validate these findings.
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Affiliation(s)
- K Patel
- Department of Surgery and Cancer, Imperial College, London, UK
| | - A Askari
- Department of Surgery and Cancer, Imperial College, London, UK
| | - K Moorthy
- Department of Surgery and Cancer, Imperial College, London, UK
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Akhtar NM, Chen D, Zhao Y, Dane D, Xue Y, Wang W, Zhang J, Sang Y, Chen C, Chen Y. Postoperative short-term outcomes of minimally invasive versus open esophagectomy for patients with esophageal cancer: An updated systematic review and meta-analysis. Thorac Cancer 2020; 11:1465-1475. [PMID: 32310341 PMCID: PMC7262946 DOI: 10.1111/1759-7714.13413] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 01/04/2023] Open
Abstract
Background We performed a systematic review and meta‐analysis to synthesize the available evidence regarding short‐term outcomes between minimally invasive esophagectomy (MIE) and open esophagectomy (OE). Methods Studies were identified by searching databases including PubMed, EMBASE, Web of Science and Cochrane Library up to March 2019 without language restrictions. Results of these searches were filtered according to a set of eligibility criteria and analyzed in line with PRISMA guidelines. Results There were 33 studies included with a total of 13 269 patients in our review, out of which 4948 cases were of MIE and 8321 cases were of OE. The pooled results suggested that MIE had a better outcome regarding all‐cause respiratory complications (RCs) (OR = 0.56, 95% CI = 0.41–0.78, P = <0.001), in‐hospital duration (SMD = −0.51; 95% CI = −0.78−0.24; P = <0.001), and blood loss (SMD = −1.44; 95% CI = −1.95−0.93; P = <0.001). OE was associated with shorter duration of operation time, while no statistically significant differences were observed regarding other outcomes. Additionally, subgroup analyses were performed for a number of different postoperative events. Conclusions Our study indicated that MIE had more favorable outcomes than OE from the perspective of short‐term outcomes. Further large‐scale, multicenter randomized control trials are needed to explore the long‐term survival outcomes after MIE versus OE.
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Affiliation(s)
- Naeem M Akhtar
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuhuan Zhao
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - David Dane
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuhang Xue
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wenjia Wang
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiaheng Zhang
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yonghua Sang
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yongbing Chen
- Department of Thoracic Surgery, School of Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Awad ZT, Abbas S, Puri R, Dalton B, Chesire DJ. Minimally Invasive Ivor Lewis Esophagectomy (MILE): technique and outcomes of 100 consecutive cases. Surg Endosc 2020; 34:3243-3255. [DOI: 10.1007/s00464-020-07529-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023]
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Wei ZD, Zhang HL, Yang YS, Chen LQ. Effectiveness of Transthoracic Hybrid Minimally Invasive Esophagectomy: A Meta-Analysis. J INVEST SURG 2020; 34:963-973. [PMID: 32036710 DOI: 10.1080/08941939.2020.1725189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transthoracic hybrid minimally invasive esophagectomy (HMIE) is frequently performed in patients with esophageal cancer. However, no conclusive benefit has been defined for HMIE compared with open esophagectomy (OE) or totally MIE (TMIE). The aim of this meta-analysis is to evaluate the effectiveness of HMIE compared with OE and TMIE. METHODS PubMed, Embase (via OVID) and Cochrane databases were comprehensively searched for relevant studies up to January 2019. Studies comparing the efficacy of transthoracic HMIE with OE or TMIE were included in this meta-analysis. RESULTS Twenty-nine relevant studies comprising 3994 patients were identified and included in the analysis of HMIE vs OE. HMIE decreased the incidence of postoperative total morbidity (OR = 0.66, 95% CI 0.55 to 0.80, p = 0.00), pneumonia (OR = 0.55, 95% CI 0.45 to 0.66, p = 0.00), in-hospital mortality (OR = 0.54, 95% CI 0.36 to 0.83, p = 0.01), duration of hospitalization (SMD=-1.03, 95% CI -1.73 to -0.33, p = 0.00) and the estimated intraoperative blood loss (SMD=-1.01, 95% CI -1.62 to -0.40, p = 0.00) compared with OE. Twenty-one relevant studies comprising 3007 patients were identified and included in the analysis of HMIE vs TMIE. HMIE increased estimated intraoperative blood loss [standardized mean difference (SMD) = 1.02, 95% CI 0.45 to 1.58, p = 0.00] and the incidence of postoperative pneumonia (OR = 1.69, 95% CI 1.26 to 2.26, p = 0.00) compared with TMIE. No statistical differences were observed for other surgical outcomes. CONCLUSIONS In our opinion, HMIE is a promising surgical technique. But further RCTs are still needed to confirm the advantages and disadvantages of HMIE mentioned above.
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Affiliation(s)
- Zheng-Dao Wei
- Medical Office Administration, The General Hospital of Western Theater Command, Chengdu, China.,Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Han-Lu Zhang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
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Long-term Survival in Esophageal Cancer After Minimally Invasive Compared to Open Esophagectomy. Ann Surg 2019; 270:1005-1017. [DOI: 10.1097/sla.0000000000003252] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Chiu CH, Chao YK. Pushing the envelope of minimally invasive esophagectomy. J Thorac Dis 2019; 11:E171-E173. [PMID: 31737331 DOI: 10.21037/jtd.2019.09.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chien-Hung Chiu
- Division of Thoracic Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan
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Evans R, Bundred JR, Kaur P, Hodson J, Griffiths EA. Meta-analysis of the influence of a positive circumferential resection margin in oesophageal cancer. BJS Open 2019; 3:595-605. [PMID: 31592511 PMCID: PMC6773635 DOI: 10.1002/bjs5.50183] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 04/23/2019] [Indexed: 01/05/2023] Open
Abstract
Background The evidence regarding the prognostic impact of a positive circumferential resection margin (CRM) in oesophageal cancer is conflicting, and there is global variability in the definition of a positive CRM. The aim of this study was to determine the impact of a positive CRM on survival in patients undergoing oesophagectomy for oesophageal cancer. Methods A systematic review and meta‐analysis was performed. PubMed and Embase databases were searched for articles to May 2018 examining the effect of a positive CRM on survival. Cohort studies written in English were included. Meta‐analyses of univariable and multivariable hazard ratios (HRs) were performed using both Royal College of Pathologists (RCP) and College of American Pathologists (CAP) criteria. Risk of bias was assessed using the Newcastle–Ottawa Scale. Egger regression, and Duval and Tweedie trim‐and‐fill statistics were used to assess publication bias. Results Of 133 studies screened, 29 incorporating 6142 patients were finally included for analysis. Pooled univariable HRs for overall survival in patients with a positive CRM were 1·68 (95 per cent c.i. 1·48 to 1·91; P < 0·001) and 2·18 (1·84 to 2·60; P < 0·001) using RCP and CAP criteria respectively. Subgroup analyses demonstrated similar results for patients by T category, neoadjuvant therapy and tumour type. Pooled HRs from multivariable analyses suggested that a positive CRM was independently predictive of a worse overall survival (RCP: 1·41, 1·21 to 1·64, P < 0·001; CAP: 2·37, 1·60 to 3·51, P < 0·001). Conclusion A positive CRM is associated with a worse prognosis regardless of classification system, T category, tumour type or neoadjuvant therapy.
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Affiliation(s)
- R Evans
- Department of Upper Gastrointestinal Surgery University Hospitals Birmingham NHS Foundation Trust Birmingham UK
| | - J R Bundred
- Department of Upper Gastrointestinal Surgery University Hospitals Birmingham NHS Foundation Trust Birmingham UK.,College of Medical and Dental Sciences University of Birmingham Birmingham UK
| | - P Kaur
- Department of Upper Gastrointestinal Surgery University Hospitals Birmingham NHS Foundation Trust Birmingham UK
| | - J Hodson
- Institute of Translational Medicine University Hospitals Birmingham NHS Foundation Trust Birmingham UK
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery University Hospitals Birmingham NHS Foundation Trust Birmingham UK.,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences University of Birmingham Birmingham UK
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van Workum F, Stenstra MHBC, Berkelmans GHK, Slaman AE, van Berge Henegouwen MI, Gisbertz SS, van den Wildenberg FJH, Polat F, Irino T, Nilsson M, Nieuwenhuijzen GAP, Luyer MD, Adang EM, Hannink G, Rovers MM, Rosman C. Learning Curve and Associated Morbidity of Minimally Invasive Esophagectomy: A Retrospective Multicenter Study. Ann Surg 2019; 269:88-94. [PMID: 28857809 DOI: 10.1097/sla.0000000000002469] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the morbidity that is associated with the learning curve of minimally invasive esophagectomy. BACKGROUND Although learning curves have been described, it is currently unknown how much extra morbidity is associated with the learning curve of technically challenging surgical procedures. METHODS Prospectively collected data were retrospectively analyzed of all consecutive patients undergoing minimally invasive Ivor Lewis esophagectomy in 4 European expert centers. The primary outcome parameter was anastomotic leakage. Secondary outcome parameters were operative time and textbook outcome ("optimal outcome"). Learning curves were plotted using weighted moving average and CUSUM analysis was used to determine after how many cases the plateau was reached. Learning associated morbidity was calculated with area under the curve analysis. RESULTS This study included 646 patients. Three of the 4 hospitals reached the plateau of 8% anastomotic leakage. The length of the learning curve was 119 cases. The mean incidence of anastomotic leakage decreased from 18.8% during the learning phase to 4.5% after the plateau had been reached (P < 0.001). Thirty-six extra patients (10.1% of all patients operated on during the learning curve) experienced learning associated anastomotic leakage, that could have been avoided if patients were operated by surgeons who had completed the learning curve. The incidence of textbook outcome increased from 28% to 53% and the mean operative time decreased from 344 minutes to 270 minutes. CONCLUSIONS A considerable number of 36 extra patients (10.1%) experienced learning associated anastomotic leakage. More research is urgently needed to investigate how learning associated morbidity can be reduced to increase patient safety during learning curves.
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Affiliation(s)
| | | | | | - Annelijn E Slaman
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Suzanne S Gisbertz
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Fatih Polat
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Tomoyuki Irino
- Division of Surgery, Karolinska institutet and Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Nilsson
- Division of Surgery, Karolinska institutet and Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Misha D Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Eddy M Adang
- Department of Health Evidence, Radboudumc, Nijmegen, the Netherlands
| | - Gerjon Hannink
- Department of Orthopedic Research, Radboudumc, Nijmegen, the Netherlands
| | - Maroeska M Rovers
- Departments of Health Evidence and Operating Rooms, Radboudumc, Nijmegen, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboudumc, Nijmegen, the Netherlands
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29
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An Augmented Reality Endoscope System for Ureter Position Detection. J Med Syst 2018; 42:138. [PMID: 29938379 DOI: 10.1007/s10916-018-0992-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/12/2018] [Indexed: 01/30/2023]
Abstract
Iatrogenic injury of ureter in the clinical operation may cause the serious complication and kidney damage. To avoid such a medical accident, it is necessary to provide the ureter position information to the doctor. For the detection of ureter position, an ureter position detection and display system with the augmented ris proposed to detect the ureter that is covered by human tissue. There are two key issues which should be considered in this new system. One is how to detect the covered ureter that cannot be captured by the electronic endoscope and the other is how to display the ureter position that provides stable and high-quality images. Simultaneously, any delayed processing of the system should disturb the surgery. The aided hardware detection method and target detection algorithms are proposed in this system. To mark the ureter position, a surface-lighting plastic optical fiber (POF) with the encoded light-emitting diode (LED) light is used to indicate the ureter position. The monochrome channel filtering algorithm (MCFA) is proposed to locate the ureter region more precisely. The ureter position is extracted using the proposed automatic region growing algorithm (ARGA) that utilizes the statistical information of the monochrome channel for the selection of growing seed point. In addition, according to the pulse signal of encoded light, the recognition of bright and dark frames based on the aided hardware (BDAH) is proposed to expedite the processing speed. Experimental results demonstrate that the proposed endoscope system can identify 92.04% ureter region in average.
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Intraoperative conversion does not affect the oncological outcomes of minimally invasive esophagectomy for treatment of esophageal cancer. Surg Endosc 2018; 32:4517-4526. [DOI: 10.1007/s00464-018-6202-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
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Lubbers M, van Det MJ, Kreuger MJ, Hoekstra R, Hendriksen EM, Vermeer M, Kouwenhoven EA. Totally minimally invasive esophagectomy after neoadjuvant chemoradiotherapy: Long-term oncologic outcomes. J Surg Oncol 2018; 117:651-658. [DOI: 10.1002/jso.24935] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/02/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Merel Lubbers
- Department of Surgery; Hospital Group Twente (ZGT) Almelo; Almelo The Netherlands
| | - Marc J. van Det
- Department of Surgery; Hospital Group Twente (ZGT) Almelo; Almelo The Netherlands
| | - Mariska J. Kreuger
- Department of Surgery; Hospital Group Twente (ZGT) Almelo; Almelo The Netherlands
| | - Ronald Hoekstra
- Department of Medical Oncology; Hospital Group Twente (ZGT) Almelo; Almelo The Netherlands
| | - Ellen M. Hendriksen
- Department of Radiation Oncology; Medisch Spectrum Twente (MST) Enschede; Enschede The Netherlands
| | - Marloes Vermeer
- Department of Epidemiology and Statistics; Hospital Group Twente (ZGT) Almelo; Almelo The Netherlands
| | - Ewout A. Kouwenhoven
- Department of Surgery; Hospital Group Twente (ZGT) Almelo; Almelo The Netherlands
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Guo X, Ye B, Yang Y, Sun Y, Hua R, Zhang X, Mao T, Li Z. Impact of unplanned events on early postoperative results of minimally invasive esophagectomy. Thorac Cancer 2018; 9:94-98. [PMID: 29083537 PMCID: PMC5754283 DOI: 10.1111/1759-7714.12544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Minimally invasive esophagectomy (MIE) is increasingly performed worldwide. Unplanned events during thoracoscopy or laparoscopy can jeopardize the procedure, sometimes necessitating conversion to open surgery. The aim of this study was to evaluate the impact of unplanned events on early postoperative outcomes after MIE. METHOD A consecutive group of 303 patients who underwent MIE between January 2011 and December 2015 were reviewed. The patients were allocated to two groups comprising those with (G-UPE, 85 patients) and without unplanned events (G-Regular, 218 patients). Unplanned events, defined as events that clearly changed or prolonged the procedure included intraoperative bleeding, chest and/or peritoneal adhesions, tumor invasion (sT4a + T4b), non-radical resection (R2 resection), and conversion for any reason. Differences in postoperative complications between the groups were analyzed. RESULTS The most common unplanned events were pleural and/or peritoneal adhesions (28/89, 31.5%), followed by intraoperative discovery of tumor invasion (sT4a + T4b, 25/89, 28.1%). There were significant differences in the incidence of respiratory (57.6% vs. 8.3%) and nervous system complications (10.6% vs. 2.7%), postoperative infection (32.9% vs. 5.0%), and chylothorax (8.2% vs. 0.9%) between the G-UPE and G-Regular groups, respectively (P < 0.05). The most common reasons for conversion to open procedures were pleural and/or peritoneal adhesions (9/38, 23.8%) and intraoperative bleeding (7/38, 18.4%). The main reasons for R2 resection were tumor invasion of the trachea or bronchus (7/21, 33.2%) and of the aorta (5/21, 23.8%). CONCLUSION Unplanned events during MIE increase the incidence of postoperative complications. Improved clinical staging and more careful surgery minimize unplanned events.
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Affiliation(s)
- Xufeng Guo
- Department of Thoracic Surgery, Esophageal Cancer Division, Shanghai Chest HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Bo Ye
- Department of Thoracic Surgery, Esophageal Cancer Division, Shanghai Chest HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Yu Yang
- Department of Thoracic Surgery, Esophageal Cancer Division, Shanghai Chest HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Yifeng Sun
- Department of Thoracic Surgery, Esophageal Cancer Division, Shanghai Chest HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Rong Hua
- Department of Thoracic Surgery, Esophageal Cancer Division, Shanghai Chest HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Xiaobing Zhang
- Department of Thoracic Surgery, Esophageal Cancer Division, Shanghai Chest HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Teng Mao
- Department of Thoracic Surgery, Esophageal Cancer Division, Shanghai Chest HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Zhigang Li
- Department of Thoracic Surgery, Esophageal Cancer Division, Shanghai Chest HospitalShanghai Jiaotong UniversityShanghaiChina
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Liu Y, Li JJ, Zu P, Liu HX, Yu ZW, Ren Y. Two-step method for creating a gastric tube during laparoscopic-thoracoscopic Ivor-Lewis esophagectomy. World J Gastroenterol 2017; 23:8035-8043. [PMID: 29259379 PMCID: PMC5725298 DOI: 10.3748/wjg.v23.i45.8035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/15/2017] [Accepted: 09/05/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To introduce a two-step method for creating a gastric tube during laparoscopic-thoracoscopic Ivor-Lewis esophagectomy and assess its clinical application.
METHODS One hundred and twenty-two patients with middle or lower esophageal cancer who underwent laparoscopic-thoracoscopic Ivor-Lewis esophagectomy at Liaoning Cancer Hospital and Institute from March 2014 to March 2016 were included in this study, and divided into two groups based on the procedure used for creating a gastric tube. One group used a two-step method for creating a gastric tube, and the other group used the conventional method. The two groups were compared regarding the operating time, surgical complications, and number of stapler cartridges used.
RESULTS The mean operating time was significantly shorter in the two-step method group than in the conventional method group [238 (179-293) min vs 272 (189-347) min, P < 0.01]. No postoperative death occurred in either group. There was no significant difference in the rate of complications [14 (21.9%) vs 13 (22.4%), P = 0.55] or mean number of stapler cartridges used [5 (4-6) vs 5.2 (5-6), P = 0.007] between the two groups.
CONCLUSION The two-step method for creating a gastric tube during laparoscopic-thoracoscopic Ivor-Lewis esophagectomy has the advantages of simple operation, minimal damage to the tubular stomach, and reduced use of stapler cartridges.
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Affiliation(s)
- Yu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Ji-Jia Li
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Peng Zu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Hong-Xu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Zhan-Wu Yu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Yi Ren
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
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Zhang X, Yang Y, Ye B, Sun Y, Guo X, Hua R, Mao T, Fang W, Li Z. Minimally invasive esophagectomy is a safe surgical treatment for locally advanced pathologic T3 esophageal squamous cell carcinoma. J Thorac Dis 2017; 9:2982-2991. [PMID: 29221271 DOI: 10.21037/jtd.2017.07.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Previous studies have shown that minimally invasive esophagectomy (MIE) is safe and feasible. However, several of these studies had selection bias because they included more patients with early-stage cancer, and no study has compared the outcomes of locally advanced pathologic T3 (pT3) esophageal carcinoma between MIE and open surgery. Methods This retrospective analysis included 229 patients with stage pT3 esophageal squamous cell carcinoma (ESCC) who underwent esophagectomy from January 2013 to June 2015. The outcomes included operative outcomes, postoperative complications, recurrence, and mid-term survival. Results Sixty-six patients underwent MIE and 163 patients underwent open surgery. No significant difference was noted in blood loss or resection completeness (R0) between the two groups. The operative duration was longer in the MIE than open surgery group (266.5±52.5 vs. 218.1±47.4, P<0.01), and the number of lymph nodes dissected was higher in the MIE than open surgery group (15.2±5.3 vs. 12.9±7.3, P=0.01). There was no significant difference in the length of stay or 30-day mortality rate between the two groups, but the intensive care unit stay was shorter in the MIE group (3 vs. 4, P=0.01). No difference in complications or recurrence was noted between the two groups. The 2-year overall survival (OS) rate was 72.8% for MIE and 69.4% for open surgery, and the 2-year disease-free survival (DFS) rate was 69.4% for MIE and 57.2% for open surgery. Conclusions For patients with locally advanced stage pT3 ESCC, MIE has perioperative outcomes comparable to those of open surgery without compromising recurrence or survival.
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Affiliation(s)
- Xiaobin Zhang
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yu Yang
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Bo Ye
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yifeng Sun
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xufeng Guo
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Rong Hua
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Teng Mao
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wentao Fang
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Zhigang Li
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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Minimally Invasive Versus Open Esophageal Resection: Three-year Follow-up of the Previously Reported Randomized Controlled Trial: the TIME Trial. Ann Surg 2017; 266:232-236. [PMID: 28187044 DOI: 10.1097/sla.0000000000002171] [Citation(s) in RCA: 370] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate 3-year survival following a randomized controlled trial comparing minimally invasive with open esophagectomy in patients with esophageal cancer. BACKGROUND Research on minimally invasive esophagectomy (MIE) has shown faster postoperative recovery and a marked decrease in pulmonary complications. Debate is ongoing as to whether the procedure is equivalent to open resection regarding oncologic outcomes. The study is a follow-up study of the TIME-trial (traditional invasive vs minimally invasive esophagectomy, a multicenter, randomized trial). METHODS Between June 2009 and March 2011, patients with a resectable intrathoracic esophageal carcinoma, including the gastroesophageal junction tumors (Siewert I), were randomized between open and MI esophagectomy with curative intent. Primary outcome was 3-year disease-free survival. Secondary outcomes include overall survival, lymph node yield, short-term morbidity, mortality, complications, radicality, local recurrence, and metastasis. Analysis was by intention-to-treat. This trial is registered with the Netherlands Trial Register, NTR TC 2452. Both trial protocol and short-term results have been published previously. RESULTS One hundred fifteen patients were included from 5 European hospitals and randomly assigned to open (n = 56) or MI esophagectomy (n = 59). Combined overall 3-year survival was 40.4% (SD 7.7%) in the open group versus 50.5% (SD 8%) in the minimally invasive group (P = 0.207). The hazard ratio (HR) is 0.883 (0.540 to 1.441) for MIE compared with open surgery. Disease-free 3-year survival was 35.9% (SD 6.8%) in the open versus 40.2% (SD 6.9%) in the MI group [HR 0.691 (0.389 to 1.239). CONCLUSIONS The study presented here depicted no differences in disease-free and overall 3-year survival for open and MI esophagectomy. These results, together with short-term results, further support the use of minimally invasive surgical techniques in the treatment of esophageal cancer.
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Adisa AO, Onakpoya OH, Adenekan AT, Awe OO. Intraocular Pressure Changes With Positioning During Laparoscopy. JSLS 2017; 20:JSLS.2016.00078. [PMID: 28028381 PMCID: PMC5147681 DOI: 10.4293/jsls.2016.00078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background and Objectives: Pneumoperitoneum during laparoscopy can produce changes in intraocular pressure (IOP) that may be influenced by several factors. In this study, we investigated changes in IOP during laparoscopy with different positioning. Methods: We recruited adult patients without eye disease scheduled to undergo laparoscopic operation requiring a reverse Trendelenburg tilt (rTr; group A; n = 20) or Trendelenburg tilt (Tr; Group B; n = 20). IOP was measured at 7 time points (T1–T7). All procedures were performed with standardized anaesthetic protocol. Mean arterial pressure (MAP), heart rate (HR), peak and plateau airway pressure, and end-tidal carbon dioxide (ETCO2) measurements were taken at each time point. Results: Both groups were similar in age, sex, mean body mass index (BMI), duration of surgery, and preoperative IOP. A decrease in IOP was observed in both groups after induction of anaesthesia (T2), whereas induction of pneumoperitoneum produced a mild increase in IOP (T3) in both groups. The Trendelenburg tilt produced IOP elevations in 80% of patients compared to 45% after the reverse Trendelenburg tilt (P = .012). A significant IOP increase of 5 mm Hg or more was recorded in 3 (15%) patients in the Trendelenburg tilt group and in none in the reverse Trendelenburg group. At T7, IOP had returned to preoperative levels in all but 3 (15%) in the Trendelenburg and 1 (5%) in the reverse Trendelenburg group. Reversible changes were observed in the MAP, HR, ETCO2, and airway pressures in both groups. Conclusions: IOP changes induced by laparoscopy are realigned after evacuation of pneumoperitoneum. A Trendelenburg tilt however produced significant changes that may require careful patient monitoring during laparoscopic procedures.
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Affiliation(s)
| | | | - Anthony T Adenekan
- Anaesthesia and Intensive Care, Obafemi Awolowo University and Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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Findlay L, Yao C, Bennett DH, Byrom R, Davies N. Non-inferiority of minimally invasive oesophagectomy: an 8-year retrospective case series. Surg Endosc 2017; 31:3681-3689. [PMID: 28078465 DOI: 10.1007/s00464-016-5406-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/21/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The trend towards laparoscopic surgery seen in other specialties has not occurred at the same pace in oesophagectomy. This stems from concerns regarding compromised oncological clearance, and complications associated with gastric tube necrosis and anastomotic failure. We present our experience of minimally invasive oesophagectomy (MIO) compared to open and hybrid surgery. We aim to ascertain non-inferiority of MIO by evaluating impact on survival, oncological clearance by resection margin and lymph node harvest and post-operative complications. METHODS Data were sourced retrospectively 2008-2015. Three approaches were studied. MIO (3-stage Mckeown), hybrid (2-stage Ivor Lewis, laparoscopy, thoracotomy) and open (2-stage Ivor Lewis). RESULTS Five-year survival was 54.2%. Surgical approach had no significant impact on survival at any stage of disease (Stage 0/I p = 0.98; stage II p = 0.2; stage III p = 0.76). There was no statistically significant difference in oncological clearance by resection margins between procedures when compared by disease stage (p = 0.49). A higher number of nodes were harvested in hybrid [median 27.5 (6-65)] and open surgeries [median 26 (4-54)] than in MIO [median 20 (7-44)] (p > 0.01). Numbers of nodes resected did not impact risk of recurrence [recurrence, median 25 (6-54), no recurrence, 26 (4-65)] (p = 0.25). Anastomotic strictures (22.4%) and potential leaks (17.9%) were more common in MIO (strictures p > 0.01, leaks p = 0.08), although associated morbidity was lower. Respiratory complications were less common in MIO (2.9%) versus hybrid (13.3%) (p = 0.02). Wound infection and chyle leak were also lower (wound 1.5% MIO 3.5% open, p = 0.6; chyle leak 1.5% MIO, 6.7% hybrid, p = 0.2). CONCLUSIONS Our results show no negative impact of MIO on survival or oncological clearance. Respiratory and wound complications are lower in MIO, but rates of anastomotic strictures and potential anastomotic leaks are increased. This may be due to the longer length of conduit and subclinical ischaemia at the anastomosis and merits further evaluation.
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Affiliation(s)
- L Findlay
- Department of Upper Gastrointestinal and Oesophago-Gastric Surgery, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, UK. .,Department of General Surgery, Salisbury District Hospital, Odstock Road, Salisbury, SP2 8BJ, UK.
| | - C Yao
- Department of Upper Gastrointestinal and Oesophago-Gastric Surgery, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, UK
| | - D H Bennett
- Department of Upper Gastrointestinal and Oesophago-Gastric Surgery, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, UK
| | - R Byrom
- Department of Upper Gastrointestinal and Oesophago-Gastric Surgery, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, UK
| | - N Davies
- Department of Upper Gastrointestinal and Oesophago-Gastric Surgery, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, UK
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Li KK, Wang YJ, Liu XH, Tan QY, Jiang YG, Guo W. The effect of postoperative complications on survival of patients after minimally invasive esophagectomy for esophageal cancer. Surg Endosc 2016; 31:3475-3482. [PMID: 27924395 DOI: 10.1007/s00464-016-5372-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 11/21/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Minimally invasive esophagectomy (MIE) has been shown to be a feasible technique for the treatment of esophageal cancer; however, its postoperative morbidity remains high. This retrospective study aimed to evaluate the effect of postoperative complications on long-term outcomes in patients who have undergone MIE for esophageal squamous cell carcinoma (ESCC). METHODS This retrospective study enrolled patients who had undergone MIE for ESCC between September 2009 and November 2014; all procedures were performed by a single surgical team. Relevant patient characteristics and postoperative variables were collected and evaluated. The disease-free survival (DFS) and disease-specific survival (DSS) were determined by the Kaplan-Meier method, and compared by log-rank tests. Possible predictors of survival were subjected to univariate analysis and multivariate Cox proportional hazard regression analysis. RESULTS In all, data on 214 patients with ESCC were analyzed, including 170 men and 44 women. All study subjects had undergone thoracoscopic or thoracoscopic-laparoscopic esophagectomy and cervical esophagogastric anastomosis. One hundred and thirty patients (60.7%) had postoperative complications (Grades 1-4). The overall DFS and DSS rates were 80.0 and 88.9% at 1 year, 48.6 and 54.2% at 3 years, and 43.2 and 43.5% at 5 years, respectively. Univariate analysis and multivariate Cox proportional hazard regression analysis showed that T stage, N stage, and tumor grade were independent prognostic factors for long-term survival; however, postoperative complications had no significant effect on the DFS or DSS of this patient cohort (log-rank test, p = 0.354 and 0.160, respectively). CONCLUSIONS Postoperative complications have no significant effect on long-term survival in patients who have undergone MIE for ESCC.
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Affiliation(s)
- Kun-Kun Li
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China
| | - Yin-Jian Wang
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China
| | - Xue-Hai Liu
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China
| | - Qun-You Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China
| | - Yao-Guang Jiang
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China
| | - Wei Guo
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China.
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Veronesi G, Cerfolio R, Cingolani R, Rueckert JC, Soler L, Toker A, Cariboni U, Bottoni E, Fumagalli U, Melfi F, Milli C, Novellis P, Voulaz E, Alloisio M. Report on First International Workshop on Robotic Surgery in Thoracic Oncology. Front Oncol 2016; 6:214. [PMID: 27822454 PMCID: PMC5075745 DOI: 10.3389/fonc.2016.00214] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/27/2016] [Indexed: 11/13/2022] Open
Abstract
A workshop of experts from France, Germany, Italy, and the United States took place at Humanitas Research Hospital Milan, Italy, on February 10 and 11, 2016, to examine techniques for and applications of robotic surgery to thoracic oncology. The main topics of presentation and discussion were robotic surgery for lung resection; robot-assisted thymectomy; minimally invasive surgery for esophageal cancer; new developments in computer-assisted surgery and medical applications of robots; the challenge of costs; and future clinical research in robotic thoracic surgery. The following article summarizes the main contributions to the workshop. The Workshop consensus was that since video-assisted thoracoscopic surgery (VATS) is becoming the mainstream approach to resectable lung cancer in North America and Europe, robotic surgery for thoracic oncology is likely to be embraced by an increasing numbers of thoracic surgeons, since it has technical advantages over VATS, including intuitive movements, tremor filtration, more degrees of manipulative freedom, motion scaling, and high-definition stereoscopic vision. These advantages may make robotic surgery more accessible than VATS to trainees and experienced surgeons and also lead to expanded indications. However, the high costs of robotic surgery and absence of tactile feedback remain obstacles to widespread dissemination. A prospective multicentric randomized trial (NCT02804893) to compare robotic and VATS approaches to stages I and II lung cancer will start shortly.
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Affiliation(s)
- Giulia Veronesi
- Thoracic Surgery, Humanitas Research Hospital, Rozzano , Milan , Italy
| | - Robert Cerfolio
- Thoracic Surgery, University of Alabama at Birmingham , Birmingham , USA
| | | | - Jens C Rueckert
- Universitätsmedizin Berlin - Charité Campus Mitte , Berlin , Germany
| | | | - Alper Toker
- Department of Thoracic Surgery, Istanbul Bilim University , Istanbul , Turkey
| | - Umberto Cariboni
- Thoracic Surgery, Humanitas Research Hospital, Rozzano , Milan , Italy
| | - Edoardo Bottoni
- Thoracic Surgery, Humanitas Research Hospital, Rozzano , Milan , Italy
| | - Uberto Fumagalli
- General Surgery, Humanitas Research Hospital, Rozzano , Milan , Italy
| | - Franca Melfi
- Chirurgia Toracica, Ospedale Cisanello , Pisa , Italy
| | - Carlo Milli
- Direzione amministrativa, Azienda Ospedaliera Cisanello , Pisa , Italy
| | | | - Emanuele Voulaz
- Thoracic Surgery, Humanitas Research Hospital, Rozzano , Milan , Italy
| | - Marco Alloisio
- Thoracic Surgery, Humanitas Research Hospital, Rozzano , Milan , Italy
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Cuesta MA, van der Wielen N, Straatman J, van der Peet DL. Video-assisted thoracoscopic esophagectomy: keynote lecture. Gen Thorac Cardiovasc Surg 2016; 64:380-5. [PMID: 27130186 PMCID: PMC4916188 DOI: 10.1007/s11748-016-0650-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/06/2016] [Indexed: 12/30/2022]
Abstract
Minimally invasive esophagectomy (MIE) by thoracoscopy after neoadjuvant therapy results in significant short-term advantages such as a lower incidence of pulmonary infections and a better quality of life (QoL) with the same completeness of resection. After 1 year, a better QoL is still observed for MIE in comparison with the open approach, while having the same survival. Seven issues about implementation of MIE for cancer require discussion: (1) choice of the extension of esophageal resection and use of neoadjuvant therapy; (2) reasons to approach the esophageal cancer by MIE; (3) determining the best minimally invasive approach for gastro-esophageal junction cancers; (4) implementation of evidence-based MIE; (5) standardization of the surgical anatomy of the esophagus based on MIE; (6) future lines of research of MIE; and (7) learning process. In the time of imaging-integrated surgery it is clear that the MIE approach should be increasingly implemented in all centers worldwide having an adequate volume of patients and expertise.
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Affiliation(s)
- Miguel A Cuesta
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1018 HV, Amsterdam, The Netherlands.
| | - Nicole van der Wielen
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1018 HV, Amsterdam, The Netherlands
| | - Jennifer Straatman
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1018 HV, Amsterdam, The Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1018 HV, Amsterdam, The Netherlands
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Gurusamy KS, Pallari E, Midya S, Mughal M. Laparoscopic versus open transhiatal oesophagectomy for oesophageal cancer. Cochrane Database Syst Rev 2016; 3:CD011390. [PMID: 27030301 PMCID: PMC7086382 DOI: 10.1002/14651858.cd011390.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Surgery is the preferred treatment for resectable oesophageal cancers, and can be performed in different ways. Transhiatal oesophagectomy (oesophagectomy without thoracotomy, with a cervical anastomosis) is one way to resect oesophageal cancers. It can be performed laparoscopically or by open method. With other organs, laparoscopic surgery has been shown to reduce complications and length of hospital stay compared to open surgery. However, concerns remain about the safety of laparoscopic transhiatal oesophagectomy in terms of post-operative complications and oncological clearance compared with open transhiatal oesophagectomy. OBJECTIVES To assess the benefits and harms of laparoscopic versus open oesophagectomy for people with oesophageal cancer undergoing transhiatal oesophagectomy. SEARCH METHODS We electronically searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and trials registers until August 2015. We also searched the references of included trials to identify further trials. SELECTION CRITERIA We considered randomised controlled trials and non-randomised studies comparing laparoscopic with open transhiatal oesophagectomy in patients with resectable oesophageal cancer, regardless of language, blinding, or publication status for the review. DATA COLLECTION AND ANALYSIS Three review authors independently identified trials, assessed risk of bias and extracted data. We calculated the risk ratio (RR) or hazard ratio (HR) with 95% confidence intervals (CI), using both fixed-effect and random-effects models, with RevMan 5, based on intention-to-treat analyses. MAIN RESULTS We found no randomised controlled trials on this topic. We included six non-randomised studies (five retrospective) that compared laparoscopic versus open transhiatal oesophagectomy (334 patients: laparoscopic = 154 patients; open = 180 patients); five studies (326 patients: laparoscopic = 151 patients; open = 175 patients) provided information for one or more outcomes. Most studies included a mixture of adenocarcinoma and squamous cell carcinoma and different stages of oesophageal cancer, without metastases. All the studies were at unclear or high risk of bias; the overall quality of evidence was very low for all the outcomes.The differences between laparoscopic and open transhiatal oesophagectomy were imprecise for short-term mortality (laparoscopic = 0/151 (adjusted proportion based on meta-analysis estimate: 0.5%) versus open = 2/175 (1.1%); RR 0.44; 95% CI 0.05 to 4.09; participants = 326; studies = 5; I² = 0%); long-term mortality (HR 0.97; 95% CI 0.81 to 1.16; participants = 193; studies = 2; I² = 0%); anastomotic stenosis (laparoscopic = 4/36 (11.1%) versus open = 3/37 (8.1%); RR 1.37; 95% CI 0.33 to 5.70; participants = 73; studies = 1); short-term recurrence (laparoscopic = 1/16 (6.3%) versus open = 0/4 (0%); RR 0.88; 95% CI 0.04 to 18.47; participants = 20; studies = 1); long-term recurrence (HR 1.00; 95% CI 0.84 to 1.18; participants = 173; studies = 2); proportion of people who required blood transfusion (laparoscopic = 0/36 (0%) versus open = 6/37 (16.2%); RR 0.08; 95% CI 0.00 to 1.35; participants = 73; studies = 1); proportion of people with positive resection margins (laparoscopic = 15/102 (15.8%) versus open = 27/111 (24.3%); RR 0.65; 95% CI 0.37 to 1.12; participants = 213; studies = 3; I² = 0%); and the number of lymph nodes harvested during surgery (median difference between the groups varied from 12 less to 3 more lymph nodes in the laparoscopic compared to the open group; participants = 326; studies = 5).The proportion of patients with serious adverse events was lower in the laparoscopic group (10/99, (10.3%) compared to the open group = 24/114 (21.1%); RR 0.49; 95% CI 0.24 to 0.99; participants = 213; studies = 3; I² = 0%); as it was for adverse events in the laparoscopic group = 37/99 (39.9%) versus the open group = 71/114 (62.3%); RR 0.64; 95% CI 0.48 to 0.86; participants = 213; studies = 3; I² = 0%); and the median lengths of hospital stay were significantly less in the laparoscopic group than the open group (three days less in all three studies that reported this outcome; number of participants = 266). There was lack of clarity as to whether the median difference in the quantity of blood transfused was statistically significant favouring laparoscopic oesophagectomy in the only study that reported this information. None of the studies reported post-operative dysphagia, health-related quality of life, time-to-return to normal activity (return to pre-operative mobility without caregiver support), or time-to-return to work. AUTHORS' CONCLUSIONS There are currently no randomised controlled trials comparing laparoscopic with open transhiatal oesophagectomy for patients with oesophageal cancers. In observational studies, laparoscopic transhiatal oesophagectomy is associated with fewer overall complications and shorter hospital stays than open transhiatal oesophagectomy. However, this association is unlikely to be causal. There is currently no information to determine a causal association in the differences between the two surgical approaches. Randomised controlled trials comparing laparoscopic transhiatal oesophagectomy with other methods of oesophagectomy are required to determine the optimal method of oesophagectomy.
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Affiliation(s)
- Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | - Elena Pallari
- University College LondonDepartment of General Surgery4th Floor, Rockefeller Building21 University StreetLondonUKWC1E 6DE
- King's College London School of MedicineDivision of Cancer Studies, Cancer Epidemiology GroupGuy's Hospital, Great Maze PondResearch OncologyLondonUKSE1 6RT
| | - Sumit Midya
- Royal Berkshire HospitalDepartment of General SurgeryReadingUKRG1 5AN
- University College LondonDivision of Surgery and Interventional ScienceLondonUK
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Rodríguez-Sanjuán JC, Gómez-Ruiz M, Trugeda-Carrera S, Manuel-Palazuelos C, López-Useros A, Gómez-Fleitas M. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions. World J Gastroenterol 2016; 22:1975-2004. [PMID: 26877605 PMCID: PMC4726673 DOI: 10.3748/wjg.v22.i6.1975] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/20/2015] [Accepted: 11/30/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated.
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Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: A qualified systematic review. World J Methodol 2015; 5:238-254. [PMID: 26713285 PMCID: PMC4686422 DOI: 10.5662/wjm.v5.i4.238] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To review current applications of the laparoscopic surgery while highlighting the standard procedures across different fields.
METHODS: A comprehensive search was undertaken using the PubMed Advanced Search Builder. A total of 321 articles were found in this search. The following criteria had to be met for the publication to be selected: Review article, randomized controlled trials, or meta-analyses discussing the subject of laparoscopic surgery. In addition, publications were hand-searched in the Cochrane database and the high-impact journals. A total of 82 of the findings were included according to matching the inclusion criteria. Overall, 403 full-text articles were reviewed. Of these, 218 were excluded due to not matching the inclusion criteria.
RESULTS: A total of 185 relevant articles were identified matching the search criteria for an overview of the current literature on the laparoscopic surgery. Articles covered the period from the first laparoscopic application through its tremendous advancement over the last several years. Overall, the biggest advantage of the procedure has been minimizing trauma to the abdominal wall compared with open surgery. In the case of cholecystectomy, fundoplication, and adrenalectomy, the procedure has become the gold standard without being proven as a superior technique over the open surgery in randomized controlled trials. Faster recovery, reduced hospital stay, and a quicker return to normal activities are the most evident advantages of the laparoscopic surgery. Positive outcomes, efficiency, a lower rate of wound infections, and reduction in the perioperative morbidity of minimally invasive procedures have been shown in most indications.
CONCLUSION: Improvements in surgical training and developments in instruments, imaging, and surgical techniques have greatly increased safety and feasibility of the laparoscopic surgical procedures.
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Mu JW, Gao SG, Xue Q, Mao YS, Wang DL, Zhao J, Gao YS, Huang JF, He J. Updated experiences with minimally invasive McKeown esophagectomy for esophageal cancer. World J Gastroenterol 2015; 21:12873-12881. [PMID: 26668512 PMCID: PMC4671043 DOI: 10.3748/wjg.v21.i45.12873] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 11/09/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To update our experiences with minimally invasive McKeown esophagectomy for esophageal cancer.
METHODS: We retrospectively reviewed the medical records of 445 consecutive patients who underwent minimally invasive McKeown esophagectomy between January 2009 and July 2015 at the Cancer Hospital of Chinese Academy of Medical Sciences and used 103 patients who underwent open McKeown esophagectomy in the same period as controls. Among 375 patients who underwent total minimally invasive McKeown esophagectomy, 180 in the early period were chosen for the study of learning curve of total minimally invasive McKeown esophagectomy. These 180 minimally invasive McKeown esophagectomies performed by five surgeons were divided into three groups according to time sequence as group 1 (n = 60), group 2 (n = 60) and group 3 (n = 60).
RESULTS: Patients who underwent total minimally invasive McKeown esophagectomy had significantly less intraoperative blood loss than patients who underwent hybrid minimally invasive McKeown esophagectomy or open McKeown esophagectomy (100 mL vs 300 mL vs 200 mL, P = 0.001). However, there were no significant differences in operation time, number of harvested lymph nodes, or postoperative morbidity including incidence of pulmonary complication and anastomotic leak between total minimally invasive McKeown esophagectomy, hybrid minimally invasive McKeown esophagectomy and open McKeown esophagectomy groups. There were no significant differences in 5-year survival between these three groups (60.5% vs 47.9% vs 35.6%, P = 0.735). Patients in group 1 had significantly longer duration of operation than those in groups 2 and 3. There were no significant differences in intraoperative blood loss, number of harvested lymph nodes, or postoperative morbidity including incidence of pulmonary complication and anastomotic leak between groups 1, 2 and 3.
CONCLUSION: Total minimally invasive McKeown esophagectomy was associated with reduced intraoperative blood loss and comparable short term and long term survival compared with hybrid minimally invasive McKeown esophagectomy or open Mckeown esophagectomy. At least 12 cases are needed to master total minimally invasive McKeown esophagectomy in a high volume center.
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Wee JO. Minimally invasive oesophagectomy: the Ivor Lewis approach. Multimed Man Cardiothorac Surg 2015; 2015:mmv034. [PMID: 26489990 DOI: 10.1093/mmcts/mmv034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/26/2015] [Indexed: 06/05/2023]
Abstract
Oesophagectomy is a challenging operation involving multiple body cavities. The traditional open approach has several described techniques. The Ivor Lewis approach is one of the most commonly utilized approaches and includes a laparotomy and a thoracotomy. Traditionally, this has resulted in some morbidity. This article describes a stepwise approach to a minimally invasive Ivor Lewis oesophagectomy including laparoscopic mobilization of the stomach, formation of the gastric conduit, placement of a feeding jejunostomy tube, thoracoscopic oesophageal mobilization and resection and a stapled oesophago-gastric anastomosis. Common pitfalls and technical insights will be presented.
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Affiliation(s)
- Jon O Wee
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Wullstein C, Ro-Papanikolaou HY, Klingebiel C, Ersahin K, Carolus R. Minimally Invasive Techniques and Hybrid Operations for Esophageal Cancer. VISZERALMEDIZIN 2015; 31:331-6. [PMID: 26989388 PMCID: PMC4789912 DOI: 10.1159/000438661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Minimally invasive esophagectomy (MIE) is slowly gaining acceptance due to advantages in short-term outcome. While evidence is slowly increasing, the discussion about MIE is still controversial. Methods A literature review was performed to compare MIE with open esophagectomy (OE). Current studies are summarized in view of short- and long-term outcome as well as oncological accuracy. Results The majority of studies show that MIE is associated with a significant reduction of pulmonary complications, blood loss, and shorter length of stay on the intensive care unit. Pulmonary complications are reduced by 14-65%. MIE shows an improved quality of life 6 weeks after surgery. There is some evidence that the endoscopic reintervention rate may be higher after MIE than after OE. Mortality rates do not differ. Regarding oncological results, the rate of R0 resections is comparable between MIE and OE, as is the number of retrieved lymph nodes. Long-term survival seems to be comparable. A few single center trials suggest oncological advantages of MIE over OE concerning the number of lymph nodes, R0 resection rate, and 1-year survival. Conclusion Current evidence supports that MIE has advantages over OE in the short-term outcome. Oncological results are comparable to those achieved by OE. As a result, MIE has already been included in current guidelines for the treatment of esophageal cancer.
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Affiliation(s)
- Christoph Wullstein
- Department of General, Visceral and Minimal Invasive Surgery, HELIOS Hospital, Krefeld, Germany
| | | | - Christoph Klingebiel
- Department of General, Visceral and Minimal Invasive Surgery, HELIOS Hospital, Krefeld, Germany
| | - Koray Ersahin
- Department of General, Visceral and Minimal Invasive Surgery, HELIOS Hospital, Krefeld, Germany
| | - Rene Carolus
- Department of General, Visceral and Minimal Invasive Surgery, HELIOS Hospital, Krefeld, Germany
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Zhao L, Ge J, Li W, Luo Y, Chai Y. Minimally invasive esophageal resection and intrathoracic anastomosis for lower thoracic esophageal cancer with single position. J Thorac Dis 2015; 7:1486-8. [PMID: 26380776 DOI: 10.3978/j.issn.2072-1439.2015.08.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 07/31/2015] [Indexed: 12/18/2022]
Abstract
There are various esophagectomy approaches for lower thoracic esophageal cancer, and the minimally invasive esophagectomy (MIE) approach shows the advantages of less discomfort, shorter length of stay and a faster recovery to baseline status than open approaches. The current study reports a case of lower thoracic esophageal cancer was treated using a single-position, minimally invasive surgical technique with laparoscopy and thoracoscopy. A 68-year-old man, whose gastroscopy identified the esophageal carcinoma, came to our medical center due to dysphagia for over 1 year. The patient underwent tumor radical resection and intrathoracic anastomosis by laparoscopy and thoracoscopy with single position. The patient has recovered well after the surgery.
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Affiliation(s)
- Lufeng Zhao
- Department of Thoracic Surgery, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Jianjun Ge
- Department of Thoracic Surgery, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Wenshan Li
- Department of Thoracic Surgery, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yaping Luo
- Department of Thoracic Surgery, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Ying Chai
- Department of Thoracic Surgery, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, China
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Superiority of Minimally Invasive Oesophagectomy in Reducing In-Hospital Mortality of Patients with Resectable Oesophageal Cancer: A Meta-Analysis. PLoS One 2015. [PMID: 26196135 PMCID: PMC4509855 DOI: 10.1371/journal.pone.0132889] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Compared with open oesophagectomy (OE), minimally invasive oesophagectomy (MIO) proves to have benefits in reducing the risk of pulmonary complications for patients with resectable oesophageal cancer. However, it is unknown whether MIO has superiority in reducing the occurrence of in-hospital mortality (IHM). Objective The objective of this meta-analysis was to explore the effect of MIO vs. OE on the occurrence of in-hospital mortality (IHM). Data Sources Sources such as Medline (through December 31, 2014), Embase (through December 31, 2014), Wiley Online Library (through December 31, 2014), and the Cochrane Library (through December 31, 2014) were searched. Study Selection Data of randomized and non-randomized clinical trials related to MIO versus OE were included. Interventions Eligible studies were those that reported patients who underwent MIO procedure. The control group included patients undergoing conventional OE. Study Appraisal and Synthesis Methods Fixed or random -effects models were used to calculate summary odds ratios (ORs) or relative risks (RRs) for quantification of associations. Heterogeneity among studies was evaluated by using Cochran’s Q and I2 statistics. Results A total of 48 studies involving 14,311 cases of resectable oesophageal cancer were included in the meta-analysis. Compared to patients undergoing OE, patients undergoing MIO had statistically reduced occurrence of IHM (OR=0.69, 95%CI =0.55 -0.86). Patients undergoing MIO also had significantly reduced incidence of pulmonary complications (PCs) (RR=0.73, 95%CI = 0.63-0.86), pulmonary embolism (PE) (OR=0.71, 95%CI= 0.51-0.99) and arrhythmia (OR=0.79, 95%CI = 0.68-0.92). Non-significant reductions were observed among the included studies in the occurrence of anastomotic leak (AL) (OR=0.93, 95%CI =0.78-1.11), or Gastric Tip Necrosis (GTN) (OR=0.89, 95%CI =0.54-1.49). Limitation Most of the included studies were non-randomized case-control studies, with a diversity of study designs, demographics of participants and surgical intervention. Conclusions Minimally invasive oesophagectomy (MIO) has superiority over open oesophagectomy (OE) in terms of the occurrence of in-hospital mortality (IHM) and should be the first-choice surgical procedure in esophageal surgery.
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Understanding Complete Pathologic Response in Oesophageal Cancer: Implications for Management and Survival. Gastroenterol Res Pract 2015; 2015:518281. [PMID: 26246803 PMCID: PMC4515501 DOI: 10.1155/2015/518281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/28/2015] [Accepted: 06/25/2015] [Indexed: 12/18/2022] Open
Abstract
Despite significant improvement over recent decades, oesophageal cancer survival rates remain poor. Neoadjuvant chemoradiotherapy followed by oesophageal resection is mainstay of therapy for resectable oesophageal tumours. Operative morbidity and mortality associated with oesophagectomy remain high and complications arise in up to 60% of patients. Management strategies have moved towards definitive chemoradiotherapy for a number of tumour sites (head and neck, cervical, and rectal) particularly for squamous pathology. We undertook to perform a review of the current status of morbidity and mortality associated with oesophagectomy, grading systems determining pathologic response, and data from clinical trials managing patients with definitive chemoradiotherapy to inform a discussion on the topic.
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Palazzo F, Rosato EL, Chaudhary A, Evans NR, Sendecki JA, Keith S, Chojnacki KA, Yeo CJ, Berger AC. Minimally invasive esophagectomy provides significant survival advantage compared with open or hybrid esophagectomy for patients with cancers of the esophagus and gastroesophageal junction. J Am Coll Surg 2014; 220:672-9. [PMID: 25667145 DOI: 10.1016/j.jamcollsurg.2014.12.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 12/15/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Minimally invasive esophagectomy (MIE) is increasingly being used to treat patients with cancer of the esophagus and gastroesophageal junction. We previously reported that oncologic efficacy may be improved with MIE compared with open or hybrid esophagectomy (OHE). We compared survival of patients undergoing MIE and OHE. STUDY DESIGN Our contemporary series of patients who underwent MIE (2008 to 2013) was compared with a cohort undergoing OHE (3-hole [n = 39], Ivor Lewis [n = 16], hybrid [n = 13], 2000 to 2013). Summary statistics were calculated by operation type; Kaplan-Meier methods were used to compare survival. Cox regression was used to assess the impact of operation type (MIE vs OHE) on mortality, adjusting for age, sex, total lymph nodes, lymph node ratio (LNR), neoadjuvant chemoradiotherapy (CRT), and stage. RESULTS The MIE (n = 104) and OHE (n = 68) groups were similar with respect to age and sex. The MIE group tended to have higher BMI, earlier stage disease, and was less likely to receive CRT. The MIE group experienced lower operative mortality (3.9% vs 8.8%, p = 0.35) and significantly fewer major complications. Five-year survival between groups was significantly different (MIE, 64%, OHE, 35%, p < 0.001). Multivariate analysis demonstrated that patients undergoing OHE had a significantly worse survival compared with MIE independent of age, LNR, CRT, and pathologic stage (hazard ratio 2.00, p = 0.019). CONCLUSIONS This study supports MIE for EC as a superior procedure with respect to overall survival, perioperative mortality, and severity of postoperative complications. Several biases may have affected these results: earlier stage in the MIE group and disparity in timing of the procedures. These results will need to be confirmed in future prospective studies with longer follow-up.
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Affiliation(s)
- Francesco Palazzo
- The Jefferson Gastro-Esophageal Center, the Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
| | - Ernest L Rosato
- The Jefferson Gastro-Esophageal Center, the Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Asadulla Chaudhary
- The Jefferson Gastro-Esophageal Center, the Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Nathaniel R Evans
- The Jefferson Gastro-Esophageal Center, the Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Jocelyn A Sendecki
- Division of Biostatistics, Department of Clinical Pharmacology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Scott Keith
- Division of Biostatistics, Department of Clinical Pharmacology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Karen A Chojnacki
- The Jefferson Gastro-Esophageal Center, the Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Charles J Yeo
- The Jefferson Gastro-Esophageal Center, the Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Adam C Berger
- The Jefferson Gastro-Esophageal Center, the Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
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