Esophagectomy without thoracotomy

Orringer, Mark B.; Sloan, Herbert

doi:10.1016/s0022-5223(19)41012-x

Cited by 445 publications

(108 citation statements)

References 15 publications

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“…With regard to prior therapy, 14 patients in this series received radiotherapy preoperatively , one received chemotherapy preoperatively, four received both chemotherapy and radiotherapy preoperatively, and one had no prior treatment. All patients who received radiotherapy preoperatively were prior radiotherapy failures as planned preoperative radiotherapy is not employed at our institution.…”

Section: Resultsmentioning

confidence: 99%

Analysis of recurrence, complications, and functional results with free jejunal flaps

et al. 1994

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The medical records of 20 patients undergoing revascularized jejunal flap reconstruction of hypopharyngeal defects were retrospectively reviewed to analyze the incidence of distal marginal recurrence, complication rates, and success of early functional restoration. This report is one of few in the literature to address distal marginal recurrence in patients undergoing jejunal free flap reconstruction of hypopharyngeal defects. In 15 evaluable patients, two (13%) developed distal marginal recurrences. Both patients had tumor involving the hypopharynx at the junction of the cervical esophagus. The major complication rate was five of 20 patients (25%) and included three flap failures, one death, and one intra-abdominal hemorrhage. The minor complication rate was 35%. The median hospital stay was 15.5 days and the median time to successful swallowing was 14.5 days. The functional success rate for swallowing was 58%. Because of the aggressive nature of this disease, we feel partial esophagectomy with jejunal flap reconstruction is warranted to achieve early functional restoration in a select group of patients when a 2-cm distal margin can be obtained above the cervical esophagus with frozen-section control, and the distal esophagus is normal.

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Section: Resultsmentioning

confidence: 99%

Analysis of recurrence, complications, and functional results with free jejunal flaps

et al. 1994

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“…17 In 1978, Orringer and Sloan described the initial series of blunt transhiatal esophagectomy. 18 This operation could be suitable to those patients who are in no condition to undergo thoracotomy. The possible advantages of this transhiatal approach are that by avoiding thoracotomy, the patient's pain is minimized and certain postoperative complications, such as pneumonia and mediastinitis, may be prevented.…”

Section: Open Esophagectomymentioning

confidence: 99%

The evolution of surgical approach for esophageal cancer

Gisbertz

Hagens

Ruurda

et al. 2018

Annals of the New York Academy of Sciences

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Esophageal surgery for esophageal cancer has been performed for over a century now. Minimally invasive esophagectomy (MIE) was first described in 1992, and it is now a standard approach in many countries. However, MIE is technically difficult and requires a long learning curve. It takes >100 cases to train for MIE with gastric tube reconstruction with an intrathoracic anastomosis. A possible option to overcome several challenges of MIE might be the use of a robotic system. A robot-assisted MIE was first described in 2005, and long-term results have shown its feasibility and safety. Over the years, different approaches for esophagectomy have been established. Our review discusses these developments and recent literature on open, minimally invasive and robotic esophageal surgery.

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“…2,3 Although there are many options for esophageal resection, the two most common operations to treat the gastroesophageal junction (E-GEJ) adenocarcinoma are the Ivor-Lewis operation and the transhiatal esophagectomy popularized by Orringer. 4 The main advantage of the Ivor-Lewis esophagectomy is the improved direct exposure of the intrathoracic esophagus allowing for an en-block resection of the esophagus and surrounding structures. The disadvantages are the pain and pulmonary complications related to the thoracotomy and single-lung ventilation.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of laparoscopic-assisted transhiatal esophagectomy for adenocarcinoma of the esophagus and esophago-gastric junction

Montenovo

Chambers

Oelschlager

2011

Diseases of the Esophagus

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Esophagectomy is associated with substantial morbidity and mortality, yet it is the only modality that offers the possibility of cure for esophageal and gastroesophageal junction (E-GEJ) adenocarcinoma. Several minimally invasive techniques have been developed to decrease the morbidity of the operation, but to date, the results have not led to its wide adoption in part due to their complexity. We developed a technique of laparoscopic-assisted transhiatal esophagectomy (LA-THE) with the idea of preserving some of the advantages of the minimally invasive approach while eliminating the degree of complexity and the time required to complete the operation solely using laparoscopy. The course of all patients who underwent LA-THE for E-GEJ adenocarcinoma at the University of Washington Medical Center was determined by analysis of all hospital records to determine perioperative variables, complications, and survival. Patients were also given a follow-up survey in order to assess long-term health-related quality of life (Gastrointestinal Quality of Life Index or GIQLI). Seventy-two patients underwent LA-THE between 1995 and 2007. Median age was 64 years (range, 42-83 years), and the median body mass index was 28 (range 17-35). Twenty-eight tumors (39%) were categorized as Siewert I, 41 (57%) as Siewert II, and 3 (4%) as Siewert III. Median operative time was 299min (range, 212-700min). All the resections were R-0. The median number of lymph nodes harvested was 11 (range, 2-32). Using the Dindo-Clavien classification of surgical complication, we had a total of 48 postoperative complications in 37 patients: 26 (53%) grade I, 20 (41%) grade II, 1 (2%) grade IIIb, 1 (2%) grade IVb, and 1 (2%) grade V complications. Median length of hospital stay was 9 days (range, 7-58 days). One patient (1.4%) died within 30 days. Overall, 3- and 5-year survival (calculated Kaplan-Meier) was 68% and 63%, respectively. Forty-nine patients (90% of those still alive) answered the GIQLI survey. Median follow-up was 26 months (range, 6-144 months). The mean GIQLI score was 108 (range, 74-138) from a maximum possible value of 144. Our study shows that LA-THE is feasible, safe, and effective in the treatment of adenocarcinoma of the esophagus and GEJ and should probably be considered an alternative to open esophagectomy and other minimally invasive techniques in the treatment of this disease.

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Esophagectomy without thoracotomy

Cited by 445 publications

References 15 publications

Analysis of recurrence, complications, and functional results with free jejunal flaps

Analysis of recurrence, complications, and functional results with free jejunal flaps

The evolution of surgical approach for esophageal cancer

Outcomes of laparoscopic-assisted transhiatal esophagectomy for adenocarcinoma of the esophagus and esophago-gastric junction

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