Feasibility and Outcomes of an Early Extubation Policy After Esophagectomy

Lanuti, Michael; Delva, Pierre E. de; Maher, Abdulrahman; Wright, Cameron D.; Gaissert, Henning A.; Wain, John C.; Donahue, Dean M.; Mathisen, Douglas J.

doi:10.1016/j.athoracsur.2006.07.024

Cited by 60 publications

(39 citation statements)

References 15 publications

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“…During that era, the duration of postoperative ventilation and ICU stays were shorter after open transhiatal compared to transthoracic resections [3,9]. Since then, anesthesiological perioperative management has evolved and the feasibility of routine immediate extubation after radical transthoracic esophageal resections has been shown [56,57]. Today, when mediumcare units and epidural anesthesia are available, most patients should not need to stay in an ICU independently of whether the esophagectomy is performed by conventional transthoracic, transhiatal or MIE approach.…”

Section: Discussionmentioning

confidence: 97%

Minimally invasive esophagectomy for cancer☆

Decker¹,

Coosemans²,

Leyn³

et al. 2009

European Journal of Cardio-Thoracic Surgery

125

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Since 1992, various combinations of thoracoscopy (VATS), laparoscopy or hand-assisted thoracolaparoscopy have been used for 'minimally invasive' cancer esophagectomy (MIE). Despite widespread current use, indications and potential benefits of the many technical approaches remain controversial. A systematic literature search was conducted until June 2007. Out of 128 publications, 46 original series (1932 patients) met the inclusion criteria and were analyzed for surgical and oncological outcome. No prospective controlled study has compared any MIE technique to another or to open surgery. Most publications are retrospective series of highly selected patients, mostly excluding high-risk patients and locally advanced (T3) tumors. Altogether, the overall conversion rate was 5.9%, mortality 2.9% and morbidity 46%, many papers reporting only major complications. Overall, rates for pulmonary complications were 22%, leakage 8.8% and vocal cord palsy 7.1%. Fifteen tracheo-bronchial injuries or fistulas (1% of all VATS cases) were reported. Laparoscopy and VATS were combined in 11 series (609 patients, 4.7% conversions, 2.4% mortality). VATS combined with (mini)-laparotomy was reported in 14 papers (743 patients, 6.3% conversions, 2.4% mortality). Laparoscopy combined with right thoracotomy was reported in four papers (147 patients, 5.4% conversions, 2% mortality). Laparoscopic transhiatal resections were reported in 17 papers (433 patients, 7% conversions, 4.6% mortality). Overall morbidity rates for these four approaches were 43%, 47.6%, 51.6% and 46%, respectively. Data on oncological outcome are scarce. Lymph node retrieval (median of all series: 14 nodes, range 5-62) was mostly inferior to open surgery standards and follow-up too short to draw definitive conclusions regarding long-term survival. Based on the available literature, the morbidity and mortality of MIE is substantial and not inferior to radical open esophagectomy in experienced centers. Many different operative techniques for MIE have been reported without obvious superiority for any of them. The term 'minimally invasive' is not supported by hitherto reported results. Selection bias and huge variability in extent of resection and lymphadenectomy impair comparisons of different MIE techniques. Oncological outcome of MIE remains largely unknown by lack of good quality data and selection bias. MIE remains an investigational and still evolving treatment for invasive cancer.

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Section: Discussionmentioning

confidence: 97%

Minimally invasive esophagectomy for cancer☆

Decker¹,

Coosemans²,

Leyn³

et al. 2009

European Journal of Cardio-Thoracic Surgery

125

View full text Add to dashboard Cite

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“…It has been shown to reduce the incidence of respiratory complications after surgery (5,8). Moreover, it improves graft microcirculation and prevents anastomotic insufficiency (9).…”

Section: Discussionmentioning

confidence: 99%

“…Lack of round-the-clock experienced staff was a concern. The current concept of prolonged intubation is a risk factor for pneumonia and systemic inflammatory reaction (5). Whereas, early extubation may shorten or even avert intensive care stay (6), as well as circumvent the use of ventilation.…”

Section: Discussionmentioning

confidence: 99%

Expedite recovery from esophagectomy and reconstruction for esophageal squamous cell carcinoma after perioperative management protocol reinvention

et al. 2017

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Background: Surgery for esophageal cancer is invasive and challenging, and always to be followed with arduous post-operative care and recovery. This study, maybe one of the first in Asian populations, is to determine whether a reinvented protocol for perioperative management for esophageal cancer surgery which is being implemented in our department, will lead to a faster convalescence and also significantly decrease financial burdens garnered by patients during hospitalization. Results: There were 64 patients in group A, and 69 in group B. Ventilator days (P<0.001), ICU stay (P<0.001), and post-operative stay (P<0.001) were significantly shorter in group A patients. Complication rates were similar between the two groups. No hospital mortality was noted in either group. Hospital charges in group A were found to be perceptively lower, although not statistically significant (P value =0.078). Conclusions:The current protocol of perioperative care effectively ameliorated convalescence after esophagectomy and reconstruction for esophageal squamous cell carcinoma without increasing complication rate or mortality. It is also potentially more practical in future health care policies during this era of financial shortage.

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“…Die potenziellen Komplikationen, die mit mechanischer Ventilation assoziiert sind, sowie die Nebenwirkungen einer Sedierung haben zu vielen Studien geführt, die sich der Sicherheit, den Effekten und der Machbarkeit der frühen Extubation nach Öso-phagektomie widmen. Es konnte gezeigt werden, dass die frühe Extubation sicher durchführbar ist, mit einer Reduzierung der respiratorischen Komplikationen vergesellschaftet ist und somit auch zu einem verkürzten Aufenthalt auf der Intensivstation mit potenzieller Kostenreduzierung führt [30].…”

Section: Postoperative Phaseunclassified

Patientenvorbereitung sowie intra- und postoperatives Managementkonzept für die Ösophagusresektion

Bader

Frank²,

Roblick

et al. 2011

Viszeralmedizin

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Trotz der Reduzierung der Mortalität nach Ösophagusresektion an Zentren auf unter 5% ist die Chirurgie des Ösophagus nach wie vor durch hohe perioperative Morbidität gekennzeichnet. Die chirurgischen Komplikationen, wie z.B. die Anastomoseninsuffizienz, sind mittlerweile konservativ gut beherrschbar. Demgegenüber steht die hohe Rate an postoperativen Pneumonien – insbesondere bei neoadjuvant vorbestrahlten Patienten –, die für etwa 50% der Gesamtmortalität verantwortlich sind. Dies macht die Notwendigkeit einer kritischen Patientenselektion und ausgedehnten präoperativen Befunderhebung deutlich. Nur in enger interdisziplinärer Zusammenarbeit von Internisten und Intensivmedizinern sowie von Anästhesisten und Chirurgen wird es möglich sein, Patienten bereits präoperativ nach entsprechender Risikoklassifizierung so vorzubereiten, dass sie einem ausgedehnten thorakoabdominalen Eingriff mit vertretbarer Morbidität und Mortalität gewachsen sind. Nur so kann eine weitere Reduzierung von Morbidität und Mortalität erreicht werden.

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Feasibility and Outcomes of an Early Extubation Policy After Esophagectomy

Cited by 60 publications

References 15 publications

Minimally invasive esophagectomy for cancer☆

Minimally invasive esophagectomy for cancer☆

Expedite recovery from esophagectomy and reconstruction for esophageal squamous cell carcinoma after perioperative management protocol reinvention

Patientenvorbereitung sowie intra- und postoperatives Managementkonzept für die Ösophagusresektion

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