Comparative Perioperative Outcomes by Esophagectomy Surgical Technique

Meredith, Kenneth; Maramara, Taylor; Blinn, Paige; Lee, Daniel; Huston, Jamie; Shridhar, Ravi

doi:10.1007/s11605-019-04269-y

Cited by 24 publications

(71 citation statements)

References 41 publications

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“…The incidence of postoperative complications observed within our series was comparable to the results obtained in aforementioned studies describing RAMIE (Ivor Lewis). [23][24][25]27,28 Our results show that the results of RAMIE4 with an intrathoracic anastomosis as performed in Europe nowadays were comparable to the highest international standards worldwide. 21,27,28 Therefore, RAMIE4 is a valuable therapeutic option for patients with resectable esophageal cancer.…”

Section: Discussionsupporting

confidence: 65%

“…21 Furthermore, postoperative results were also comparable to 2 studies from the United States w h i c h c o m p a r e d R A M I E ( I v o r L e w i s ) t o o p e n esophagectomy. 27,28 In both studies, RAMIE (Ivor Lewis) demonstrated substantial benefits in postoperative complications compared to open esophagectomy. The incidence of postoperative complications observed within our series was comparable to the results obtained in aforementioned studies describing RAMIE (Ivor Lewis).…”

Section: Discussionmentioning

confidence: 99%

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Robot-Assisted Minimally Invasive Esophagectomy with Intrathoracic Anastomosis (Ivor Lewis): Promising Results in 100 Consecutive Patients (the European Experience)

Sluis

Tagkalos

Hadzijusufoviç

et al. 2021

Journal of Gastrointestinal Surgery

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Background Robot-assisted minimally invasive esophagectomy (RAMIE) with intrathoracic anastomosis is gaining popularity as a treatment for esophageal cancer. The aim of this study was to describe postoperative complications and short-term oncologic outcomes for RAMIE procedures using the da Vinci Xi robotic system 4-arm technique. Methods Data of 100 consecutive patients with esophageal or gastro-esophageal junction carcinoma undergoing modified Ivor Lewis esophagectomy were prospectively collected. All operations were performed by the same surgeon using an identical intrathoracic anastomotic reconstruction technique with the same perioperative management. Intraoperative and postoperative complications were graded according to Esophagectomy Complications Consensus Group (ECCG) definitions. Results Mean duration was 416 min (±80); 70% of patients had an uncomplicated postoperative recovery. Pulmonary complications were observed in 17% of patients. Anastomotic leakage was observed in 8% of patients. Median ICU stay was 1 day and median overall postoperative hospital stay was 11 days. The 30-day mortality was 1%; 90-day mortality was 3%. A R0 resection was reached in 92% of patients with a median number of 29 dissected lymph nodes. All patients had at least 7 months of followup with a median follow-up of 17 months. Median overall survival was not reached yet. Conclusion RAMIE with intrathoracic anastomosis (Ivor Lewis) for esophageal or gastro-esophageal junction cancer was technically feasible and safe. Postoperative complications and short-term oncologic results were comparable to the highest international standards nowadays. Keywords Esophageal cancer. Minimally invasive. MIE. RAMIE. Ivor Lewis Synopsis RAMIE with intrathoracic anastomosis (Ivor Lewis) for esophageal or gastro-esophageal junction cancer is technically feasible and safe. Postoperative complications and shortterm oncologic results were comparable to the highest international standards nowadays.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Robot-Assisted Minimally Invasive Esophagectomy with Intrathoracic Anastomosis (Ivor Lewis): Promising Results in 100 Consecutive Patients (the European Experience)

Sluis

Tagkalos

Hadzijusufoviç

et al. 2021

Journal of Gastrointestinal Surgery

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“…Furthermore, though the mechanism is unclear, there may be intrinsic therapeutic value to not just the presence of more benign lymph nodes but also their resection. Another potential confounder of these results is that there are differences in lymph node harvest after trans‐thoracic esophagectomy (including McKeown) as compared to trans‐hiatal esophagectomy 21,22 . Though many studies have failed to show a difference in survival, there may be a complex association between the technique of the resection, lymph node presence, and survival.…”

Section: Discussionmentioning

confidence: 99%

Higher lymph node harvest in patients with a pathologic complete response after neoadjuvant therapy for esophageal cancer is associated with improved survival

Lutfi

Martinez‐Meehan

Dhupar

et al. 2020

Journal of Surgical Oncology

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Background and Objectives Lymph node harvest during esophagectomy has been associated with improved survival for esophageal cancer but the value of enhanced lymph node harvest following complete pathologic response (pCR) is debated. This study investigated if increasing lymph node harvest in esophageal cancer patients with a pCR after neoadjuvant therapy and esophagectomy is associated with improved survival. Methods We queried the National Cancer Data Base for patients with esophageal cancer between 2004 and 2014 who underwent neoadjuvant chemotherapy or chemoradiation therapy followed by esophagectomy found to have pCR. Multivariable Cox modeling was utilized to evaluate the impact of increasing lymph node counts on overall survival (OS). Results A total of 1373 patients met inclusion criteria. A National Comprehensive Cancer Network compliant lymphadenectomy of ≥15 nodes was associated with improved survival (66.7% vs 51.1%; P < .001). Cox modeling showed that the first node cutoff to demonstrate a statistically significant improvement in OS was ≥7 nodes (hazard ratio [HR], 95% confidence interval [CI]: 0.81, 0.68‐0.97; 5‐year OS: 54.2%) with a trend of decreasing and statistically significant HRs until ≥25 nodes (HR, 95% CI: 0.52, 0.37‐0.72; 5‐year OS: 68.4%). Conclusions High negative node counts after neoadjuvant therapy and esophagectomy are associated with improved survival in patients with pCR.

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“…With developments in minimally invasive technology, MIE has gradually become the preferred method for the treatment of esophageal cancer. Although MIE has considerable advantages over traditional open esophagectomy, such as less bleeding, larger lymph node dissection area, fewer postoperative complications, and better postoperative recovery, 8 , 9 perioperative morbidity and mortality rates are high. 10 By reducing surgical trauma and perioperative risk, it should be possible to reduce the perioperative morbidity and mortality rates.…”

Section: Discussionmentioning

confidence: 99%

Perioperative safety and short-term efficacy of functional minimally invasive esophagectomy

et al. 2021

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Background Standard minimally invasive McKeown three-field esophagectomy (SMIE) results in high perioperative risk and poor postoperative quality of life owing to considerable surgical damage and numerous postoperative complications. We created a modified procedure, functional minimally invasive esophagectomy (FMIE), which preserves the azygos arch, bronchial artery, pulmonary branch of the vagus nerve, and the mediastinal pleura. Our aim was to evaluate the efficacy and safety of FMIE and to determine whether it has limited invasiveness. Methods Between 2018 and 2020, FMIE was performed for 48 patients who were compared with 76 SMIE cases; 44 paired cases were matched using propensity score matching. Results Operation time, extubation time, and postoperative hospital stay were significantly lower in the FMIE group. FMIE was also associated with fewer pulmonary infections. Postoperative drainage volume on postoperative day (POD) 1 and POD 2, and white blood cell counts on POD 2 and POD 4 were also significantly lower in the FMIE group. There was no statistically significant difference in the number of dissected lymph nodes, short-term recurrence, metastasis rates, or survival rate between the two groups. Conclusions FMIE is a less invasive procedure and may be a suitable alternative for lower and early middle esophageal carcinoma.

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Comparative Perioperative Outcomes by Esophagectomy Surgical Technique

Cited by 24 publications

References 41 publications

Robot-Assisted Minimally Invasive Esophagectomy with Intrathoracic Anastomosis (Ivor Lewis): Promising Results in 100 Consecutive Patients (the European Experience)

Robot-Assisted Minimally Invasive Esophagectomy with Intrathoracic Anastomosis (Ivor Lewis): Promising Results in 100 Consecutive Patients (the European Experience)

Higher lymph node harvest in patients with a pathologic complete response after neoadjuvant therapy for esophageal cancer is associated with improved survival

Perioperative safety and short-term efficacy of functional minimally invasive esophagectomy

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