Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis

Nagpal, Kamal; Ahmed, Kamran; Vats, Amit; Yakoub, Danny; James, David; Ashrafian, Hutan; Darzi, Ara; Moorthy, Krishna; Athanasiou, Thanos

doi:10.1007/s00464-009-0822-7

Cited by 308 publications

(215 citation statements)

References 26 publications

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“…To improve outcomes, minimally invasive esophagectomy (MIE) has been gradually accepted as a reliable surgical procedure for esophageal cancer (1,2). Although the procedure is technically demanding it has been suggested that MIE can be performed with low pulmonary complication rates (1,3) and comparable longterm oncological outcomes (4,5).…”

Section: Introductionmentioning

confidence: 99%

Comparison of robot-assisted esophagectomy and thoracoscopic esophagectomy in esophageal squamous cell carcinoma

et al. 2016

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Background: The aim of the study was to compare robot-assisted esophagectomy (RE) with thoracoscopic esophagectomy (TE) for the treatment of esophageal squamous cell carcinoma (ESCC).Methods: A total of 105 patients who underwent RE (n=62) or TE (n=43) due to ESCC were included in this study. Early postoperative outcomes and long-term survivals between the two groups were compared.Results: The RE and TE groups were comparable in preoperative clinical characteristics. Total operation times were not significantly different between the two groups (490 minutes in RE vs. 458 minutes in TE; P=0.118). The total number of dissected lymph nodes was significantly greater in the RE group (37.3±17.1 vs. 28.7±11.8; P=0.003), and intergroup differences were significant for numbers of lymph nodes dissected from the upper mediastinum (10.7±9.7 in RE vs. 6.3±9.3 in TE; P=0.032) and the abdomen (12.2±8.7 in RE vs. 7.8±7.1 in TE; P=0.007). Five-year overall survival was not different between the two groups (69% in RE and 59% in TE; P=0.737).Conclusions: Better quality lymphadenectomy could be achieved in RE although survival benefit was not clear. Prospective randomized studies comparing the RE and TE are necessary.

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Section: Introductionmentioning

confidence: 99%

Comparison of robot-assisted esophagectomy and thoracoscopic esophagectomy in esophageal squamous cell carcinoma

et al. 2016

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“…Furthermore, some of these metaanalyses demonstrate a trend to reduced mortality (7) and morbidity (15,(17)(18)(19) for patients who underwent an MIE compared to those who when operated with conventional open esophagectomy. Moreover, after MIE implementation we have seen a reduction in blood loss and shorter hospital stay (15,17,19).T h e s e f a v o r a b l e f i n d i n g s a s s o c i a t e d w i t h t h e implementation of MIE are also supported by the only to date published randomized controlled trial comparing open esophagectomy to MIE. This study showed a significantly reduced risk of pulmonary complications after MIE compared to open esophagectomy (34% vs. 12% respectively) (10).…”

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confidence: 99%

Implementation of minimally invasive esophagectomy in a tertiary referral center for esophageal cancer

et al. 2017

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years, high morbidity rates are still recorded (5,6). In an effort to reduce the postoperative morbidity associated with open esophagectomy various minimally invasive esophagectomy (MIE) techniques have been introduced and developed during the recent years. MIE is believed to minimize the surgical trauma and subsequently the postoperative pain resulting in a faster mobilization and recovery with reduced postoperative complication rates and shorter hospital stay compared to the open procedure. During the last 20 years several studies have been published within the field demonstrating that MIE is a safe technique with an oncological outcome at least equal to open esophagectomy with regard to complete resection rate, number of lymph nodes harvested and postoperative survival (7-9). Moreover, there is an indication of shortterm benefits after MIE especially with regards to reduced pulmonary complications and improved health related quality of life compared to the open procedure (10,11).The aim of the current study was to present our 4.5-year experience of the gradual implementation of various MIE techniques in our tertiary referral center with special focus on the evolution of adaptive changes and refinements of our practice of the procedure over this period. Methods Our unitCenter of digestive diseases (CDD) at Karolinska University Hospital, Stockholm is one of the largest and most highly specialized centers in the Nordic countries. It is a tertiary referral center in Stockholm County with a catchment area of approximately 2,500,000 inhabitants. Furthermore, CDD receives referrals for patients with newly diagnosed esophageal and cardia cancer from neighboring counties with an additional population of 650,000. This results in an annual case volume of 40-60 esophageal and resections in the most recent years.The Unit engages three consultant surgeons (MN, ML, IR), with long laparoscopic experience within benign upper gastrointestinal (UGI) surgery as well as long previous experience in open esophageal cancer surgery. Karolinska, Stockholm. From 2009, one of the current consultant surgeons, IR, spent 3 years in a fellowship in UGI cancer surgery at Bristol Royal Infirmary, Bristol, UK with special focus in MIE. During these years he became confident in both the hybrid laparoscopic assisted esophagectomy (HLAE) technique including laparoscopic gastric mobilization and abdominal lymph node dissection followed by thoracotomy and intrathoracic anastomosis as well as with the minimal invasive McKeown (MIMK) technique, i.e., thoracolaparoscopy followed by cervical anastomosis by performing more than 70 cases. In the meantime, two other consultant surgeons (MN & ML) had the chance to visit another center with extensive In May 2012 and as a first test of transition to MIE, the first HLAE was performed safely with all consultants present. This was followed shortly by an additional procedure with satisfactory results and without any technical problems to be encountered. HLAE was chosen as the most feasible MIE in the beginning...

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“…This has been shown in several meta-analysis (18)(19)(20) and a prospective randomized controlled trial (21).…”

Section: Diversity Of Approachesmentioning

confidence: 60%

Principles of esophageal cancer surgery, including surgical approaches and optimal node dissection (2- vs. 3-field)

Nafteux¹,

Depypere²,

Veer³

et al. 2017

Ann. Cardiothorac. Surg.

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Surgery for esophageal carcinoma and carcinoma of the gastro-esophageal junction (GEJ) is considered as one of the most complex and challenging interventions on the digestive tract. This is due to the intimate relations with vital structures in the chest and the tendency of early lymphatic dissemination via a dense and complex submucosal network. This review article discusses the different aspects of surgical access routes in the light of the ever-evolving techniques, in particular the minimally invasive esophagectomy (MIE). The aspects of surgical approach are inextricably linked to the still ongoing debate on extent of lymphadenectomy, a debate that is obtaining a new dimension in view of the widely applied neoadjuvant therapy protocols as well as in view of the increasing importance of quality of life aspects after surgery. Finally, the authors provide a practical and patient tailored approach as applied in their center.

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Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis

Cited by 308 publications

References 26 publications

Comparison of robot-assisted esophagectomy and thoracoscopic esophagectomy in esophageal squamous cell carcinoma

Comparison of robot-assisted esophagectomy and thoracoscopic esophagectomy in esophageal squamous cell carcinoma

Implementation of minimally invasive esophagectomy in a tertiary referral center for esophageal cancer

Principles of esophageal cancer surgery, including surgical approaches and optimal node dissection (2- vs. 3-field)

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