Hybrid minimally invasive esophagectomy for cancer: impact on postoperative inflammatory and nutritional status

Abstract

The purpose of this case-control study was to evaluate the impact of hybrid minimally invasive esophagectomy for cancer on surgical stress response and nutritional status. All 34 consecutive patients undergoing hybrid minimally invasive esophagectomy for cancer at our surgical unit between 2008 and 2013 were retrospectively compared with 34 patients undergoing esophagectomy with open gastric tubulization (open), matched for neoadjuvant therapy, pathological stage, gender and age. Demographic data, tumor features and postoperative course (including quality of life and systemic inflammatory and nutritional status) were compared. Postoperative course was similar in terms of complication rate. Length of stay in intensive care unit was shorter in patients undergoing hybrid minimally invasive esophagectomy (P = 0.002). In the first postoperative day, patients undergoing hybrid minimally invasive esophagectomy had lower C-reactive protein levels (P = 0.001) and white cell blood count (P = 0.05), and higher albumin serum level (P = 0.001). In this group, albumin remained higher also at third (P = 0.06) and seventh (P = 0.008) postoperative day, and C-reactive protein resulted lower at third post day (P = 0.04). Hybrid minimally invasive esophagectomy significantly improved the systemic inflammatory and catabolic response to surgical trauma, contributing to a shorter length of stay in intensive care unit.

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

“…Preoperative albumin concentration is a well known prognostic marker; however, fewer studies have assessed the prognostic value of postoperative albumin. Although a decrease in albumin after surgery probably reflects the systemic inflammatory response to surgery and was associated with higher‐grade complications, decreased albumin levels have been shown to be associated with other adverse outcomes and were independently predictive of survival in multivariable analysis in the present study.…”

Postoperative short‐term outcomes of minimally invasive versus open esophagectomy for patients with esophageal cancer: An updated systematic review and meta‐analysis

“…A total of 24 studies with 7117 patients were involved in the analysis of all‐cause RCs. Figure a shows that the patients who underwent MIE experienced less postoperative RCs as compared to those who underwent OE (OR = 0.56; 95% CI = 0.41, 0.78; P = <0.001).…”

“…A total of 22 studies with 6925 patients were included in the analysis of all‐cause AL, which showed low level of heterogeneity ( P = 0.08, I 2 = 32%) and no statistical difference between MIE versus OE (OR = 1.08; 95% CI = 0.92, 1.26; P = 0.35) (Figs b, S2c). Data for all‐cause CCs was reported in 13 studies with 2302 patients and showed neither heterogeneity ( P = 0.99, I 2 = 0%), nor statistically significant difference between MIE or OE (OR = 0.97; 95% CI = 0.74, 1.26; P = 0.81) (Figs a, S2d).…”

“…Evaluation of data for total length of in‐hospital stay from 21 studies with 3265 patients showed that patients who underwent MIE got to experience less in‐hospital duration compared with those who underwent OE (SMD = −0.51; 95% CI = −0.78, −0.24; P = <0.001) (Fig. b).…”

Squamous cell carcinoma antigen 1 is associated to poor prognosis in esophageal cancer through immune surveillance impairment and reduced chemosensitivity

“…Details concerning surgical techniques have been published elsewhere . Briefly, esophagectomy was carried out using an Ivor Lewis procedure, by laparotomy or laparoscopy, and right thoracotomy for tumors of the mid‐lower esophagus and the gastric cardia . During surgical procedures, biopsies of periesophageal adipose tissue and of tumoral and nontumoral mucosa were collected for each patient.…”