Minimally invasive esophagectomy is becoming the routine procedure for resectable esophageal cancer. The aim of this retrospective study is to analyze the oncologic adequacy of these two procedures at our Centre. Out of 1252 registered esophageal cancer patients at our institute from 2006 to 2015, 206 patients who underwent a surgical resection with curative intent and a complete medical record were retrospectively evaluated thru hospital medical record system (HIS). Patients were allocated into the conventional open OE, and minimally invasive MIE and Hybrid esophagectomy groups. Primary outcomes are tumor recurrence and disease-free survival over a minimum follow-up of 1 year along with assessment of adequacy of pathological specimen in terms of lymph nodes harvested and clear longitudinal <1 cm and circumferential (≥1 mm) resection margins for patients with post-neo-adjuvant residual disease. Secondary endpoint is to look for trends in the adequacy of oncologic clearance in each group over the study period. Overall, there was no statistically significant difference (p > 0.05) between groups (OE vs. MIE vs. Hybrid) for median number of lymph nodes retrieved (13 vs.14 vs.15), resection margin positive disease (55.8 vs. 35.7 vs. 44 % of patients with any residual disease N = 103,50 %), or tumor recurrence (45.2 vs. 37.3 vs. 25 %). Disease-free survival over a mean follow-up of 2.3 years was higher in the conventional group (13.8 months vs. 9.7MIE and 11.8hybrid) without any statistical significance. Learning curve for MIE to achieve a comparable mean lymph nodes harvest to OE was 1 year, while pathological complete resection stayed persistently better with minimally invasive approach. Minimally invasive esophagectomy is found to be oncologically adequate and gives results matching their conventional analogue with an increasing experience.

BACKGROUND:There has been an increasing inclination towards minimally invasive esophagectomies (MIEs) at our institute recently for resectable oesophageal cancer.OBJECTIVES:The purpose of the present study is to report peri-operative and long-term procedure specific outcomes of the two groups and analyse their changing pattern at our institute.METHODS:All adult patients with a diagnosis of oesophageal cancer managed at our institute from 2005 to 2015 were included in this retrospective study. Patients’ demographic and clinical characteristics were recorded through our hospital information system. The cohort of esophagectomies was allocated into two groups, conventional open esophagectomy (OE) or total laparoscopic MIE; hybrid esophagectomies were taken as a separate group. The short-term outcome measures are an operative time in minutes, length of hospital and Intensive Care Unit (ICU) stay in days, post-operative complications and 30 days in-hospital mortality. Complications are graded according to the Clavien-Dindo classification system. Long-term outcomes are long-term procedure related complications over a minimum follow-up of 1 year. Trends were analysed by visually inspecting the graphic plots for mean number of events in each group each year.RESULTS:Our results showed no difference in mortality, length of hospital and ICU stays and incidence of major complications between three groups on uni- and multi-variate analysis (P > 0.05). The operative time was significantly longer in MIE group (odds ratio [OR]: 1.66, confidence interval [CI]: 2.4–11.5). The incidence of long-term complication was low for MIE (OR: 1.0, CI: 133–1.017). However, all post-operative surgical outcomes trended to improve in both groups over the course of this study and stayed better for MIE group except for the operative time.CONCLUSION:MIE has overall comparable surgical outcomes to its conventional counterpart. Furthermore, the peri-operative outcomes tend to improve in our centre with the maturation of program and experience.

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Introduction: Aberrant hepatic arterial anatomy poses a challenge for surgeon during pancreaticoduodenectomy (PD). These anomalies are best picked up on preoperative imaging in order to avoid inadvertent injury to the aberrant vasculature. Damage to aberrant vasculature may lead to liver ischaemia and also biliary-enteric anastomotic failure. We present our experience of dealing with aberrant hepatic vessels during PD.Methods: All patients who underwent PD between September 2014 and August 2015 were studied and those with aberrant hepatic vascular anatomy identified on preoperative imaging or intraoperatively were included. We used artery first technique for dissection in expected cases and aberrations were classed according to Hiatt classification. Results: A total of 23 PD were performed between September 2014 and August 2015, of which 10 cases (43%) of aberrant arterial anatomy were identified (Table 1). These aberrant vessels were recognized and preserved in 9 cases. In one patient, the replaced right hepatic artery arising from SMA was coursing through pancreatic parenchyma needing resection and reconstruction of the vessel with uneventful postoperative recovery. We also identified one replaced right hepatic artery arising from SMA coursing lateral to CBD and entering liver parenchyma in gallbladder fossa. Conclusions: Aberrant hepatic arterial anomalies are common and should ideally be picked up by preoperative imaging. It is possible to preserve these vessels in most cases with careful surgical dissection using artery first technique. Surgeons performing pancreaticoduodenectomy should be well versed with the aberrant vascular anatomy to minimize any inadvertent damage.