Minimally invasive esophagectomy: Lateral decubitus vs. prone positioning; systematic review and pooled analysis

Markar, Sheraz R.; Wiggins, Tom; Antonowicz, Stefan; Zacharakis, Emmanouil; Hanna, George B.

doi:10.1016/j.suronc.2015.06.001

Cited by 67 publications

(39 citation statements)

References 30 publications

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“…Also, the prone position allows better ventilation and oxygenation of the ipsilateral lung, which is blocked in the lateral decubitus position. The outcome of this study has been confirmed by other studies (17,18). Atelectasis could be promoted in the collapsed lung, which is a major contribution to post-operative respiratory infection (19).…”

Section: Logistic Regression For Pulmonary Morbiditysupporting

confidence: 83%

Predictive factors for post-operative respiratory infections after esophagectomy for esophageal cancer: outcome of randomized trial

et al. 2017

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Section: Logistic Regression For Pulmonary Morbiditysupporting

confidence: 83%

Predictive factors for post-operative respiratory infections after esophagectomy for esophageal cancer: outcome of randomized trial

et al. 2017

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“…Se incluyeron en el estudio 33 pacientes (hombres 24; edad 69 [41-78] años; IMC 24 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]) que se sometieron a una EMI, lo cual representa el 78% de las esofagectomías realizadas por cáncer esofágico en el período de estudio (Tabla 1).…”

Section: Resultsunclassified

Experiencia inicial con esofagectomia mínimamente invasiva transtorácica en posición semiprono por cáncer esofágico

et al. 2018

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Introduction: Surgical treatment of esophageal cancer is associated with high morbidity and mortality. The minimally invasive approach has been introduced with the aim of reducing postoperative morbidity. Aim: To describe the surgical technique and the results of transthoracic minimally invasive esophagectomy (MIE) in semiprone position. Material and Methods: Descriptive cohort study. Patients with an elective MIE for cancer were included between April 2013 and May 2017. Demographic, perioperative, pathology and survival variables were recorded. Results: We included 33 patients (24 men, age 69 years, 91% with comorbidities). The predominant location of the tumor was in the middle and lower thirds of the esophagus (90%). Fifteen (45%) patients received neoadjuvant treatment. There were no cases of conversion to thoracotomy. The reconstruction was performed with stomach in 93%. Cervical anastomosis was performed in 66% and thoracic anastomosis in 30%. The operative time was 420 (330-570) minutes and bleeding 200 (20-700) cc. The 90-day mortality rate was 0%. Overall morbidity was 78%, there was a 15% occurrence of pneumonia and 9% required a reoperation. The hospital stay was 23 (11-81) days. The histology was squamous carcinoma in 51% and adenocarcinoma in 45%. Margins were RO at 87%. The lymph node count reached 30 (9-45) lymph nodes. Overall 2-year survival is 68%. Conclusion: The preliminary results of this technique are favorable, without any case of postoperative mortality. The oncological results demonstrate a high percentage of RO surgery and adequate lymph node count.Introducción: El tratamiento quirúrgico del cáncer esofágico se asocia a una alta morbimortalidad. El abordaje mínimamente invasivo se ha introducido con el objetivo de disminuir la morbilidad postoperatoria. Objetivo: Describir la técnica y los resultados de la esofagectomía mínimamente invasiva (EMI) transtorácica en posición semiprono. Métodos: Estudio de cohorte descriptivo. Se incluyeron pacientes con una EMI electiva por cáncer entre abril de 2013 y mayo de 2017. Se registraron variables demográficas, perioperatorias, anatomía patológica y la sobrevida. Resultados: Incluimos 33 pacientes (24 hombres, edad 69 años, 91% con comorbilidades). La ubicación predominante del tumor fue en los tercios medio e inferior del esófago (90%). Quince (45%) pacientes recibieron neoadyuvancia. No existieron casos de conversión a toracotomías. La reconstrucción se realizó con estómago en un 93%. Se realizó anastomosis cervical en 66% y torácica en 30%. El tiempo operatorio fue de 420 (330-570) minutos y el sangrado de 200 (20-700) cc. La mortalidad a 90 días fue de 0%. La morbilidad global fue de 78%, se registró un 15% de neumonía y un 9% requirió una reoperación. La estadía hospitalaria fue de 23 (11-81) días. La histología fue carcinoma escamoso en 51% y adenocarcinoma en 45%. Los márgenes fueron RO en 87%. El recuento ganglionar alcanzó 30 (9-45) ganglios. La sobrevida global a 2 años es 68%. Conclusión: Los resultados preliminares de esta técnica son ...

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“…A transhiatal approach has been suggested for patients with significant pulmonary co‐morbidity, owing to a reduced incidence of postoperative pulmonary complications and because the need for single‐lung ventilation in obviated, and the present data may inform such discussions. However, minimally invasive approaches may produce similar benefits for patients with significant baseline pulmonary co‐morbidity, while producing favourable oncological outcomes even compared with open transthoracic resection.…”

Section: Discussionmentioning

confidence: 99%

Effect of neoadjuvant chemoradiation on preoperative pulmonary physiology, postoperative respiratory complications and quality of life in patients with oesophageal cancer

Elliott

O’Byrne

Foley

et al. 2019

British Journal of Surgery

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Background It remains controversial whether neoadjuvant chemoradiation (nCRT) for oesophageal cancer influences operative morbidity, in particular pulmonary, and quality of life. This study combined clinical outcome data with systematic evaluation of pulmonary physiology to determine the impact of nCRT on pulmonary physiology and clinical outcomes in locally advanced oesophageal cancer. Methods Consecutive patients treated between 2010 and 2016 were included. Three‐dimensional conformal radiation was standard, with a lung dose–volume histogram of V20 less than 25 per cent, and total radiation between 40 and 41·4 Gy. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) were assessed at baseline and 1 month after nCRT. Radiation‐induced lung injury (grade 2 or greater), comprehensive complications index (CCI) and pulmonary complications were monitored prospectively. Health‐related quality of life was assessed among disease‐free patients in survivorship. Results Some 228 patients were studied. Comparing pulmonary physiology values before with those after nCRT, FEV1 decreased from mean(s.d.) 96·8(17·7) to 91·5(20·4) per cent (–3·6(10·6) per cent; P < 0·001), FVC from 104·9(15·6) to 98·1(19·8) per cent (–3·2(11·9) per cent; P = 0·005) and DLCO from 97·6(20·7) to 82·2(20·4) per cent (–14·8(14·0) per cent; P < 0·001). Five patients (2·2 per cent) developed radiation‐induced lung injury precluding surgical resection. Smoking (P = 0·005) and increased age (P < 0·001) independently predicted percentage change in DLCO. Carboplatin and paclitaxel with 41·4 Gy resulted in a greater DLCO decline than cisplatin and 5‐fluorouracil with 40 Gy (P = 0·001). On multivariable analysis, post‐treatment DLCO predicted CCI (P = 0·006), respiratory failure (P = 0·020) and reduced physical function in survivorship (P = 0·047). Conclusion These data indicate that modern nCRT alters pulmonary physiology, in particular diffusion capacity, which is linked to short‐ and longer‐term clinical consequences, highlighting a potentially modifiable index of risk.

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Minimally invasive esophagectomy: Lateral decubitus vs. prone positioning; systematic review and pooled analysis

Cited by 67 publications

References 30 publications

Predictive factors for post-operative respiratory infections after esophagectomy for esophageal cancer: outcome of randomized trial

Predictive factors for post-operative respiratory infections after esophagectomy for esophageal cancer: outcome of randomized trial

Experiencia inicial con esofagectomia mínimamente invasiva transtorácica en posición semiprono por cáncer esofágico

Effect of neoadjuvant chemoradiation on preoperative pulmonary physiology, postoperative respiratory complications and quality of life in patients with oesophageal cancer

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