Perioperative outcomes after transition from conventional to minimally invasive Ivor-Lewis esophagectomy in a specialized center

Hamouda, A.; Forshaw, Matthew; Tsigritis, Kostas; Jones, Greg; Noorani, Aliya S.; Rohatgi, Ashish; Botha, A

doi:10.1007/s00464-009-0679-9

Cited by 52 publications

(34 citation statements)

References 14 publications

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“…1 The published rates of early gastric tube ischaemic complications after MIO vary from 3.3% to 10.5%. 1,[3][4][5] This is in contrast to open oesophagectomies where the reported rates are 0.5-7.4%. 1,6 The consensus group for the Association of Upper Gastrointestinal Surgeons (AUGIS) stated that the learning curve for a surgeon developing his or her MIO technique is substantial, and thought to be between 20 and 50 cases.…”

contrasting

confidence: 44%

Gastric tube necrosis following minimally invasive oesophagectomy is a learning curve issue

Ramage

Deguara

Davies

et al. 2013

annals

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Introduction Gastric tube necrosis following oesophagectomy is thought to have an increased association with a minimally invasive technique. Some suggest gastric ischaemic preconditioning may reduce ischaemic complications. We discuss our series of 155 consecutive minimally invasive oesophagectomies (MIOs), including a number of cases of gastric tube ischaemia, of which 4 (2.6%) developed conduit necrosis. Methods Data were collected prospectively of MIOs carried out by a single surgeon between 2005 and 2011. Cases of gastric tube necrosis were identified. Results Overall, 155 patients were identified. The inpatient mortality rate was 2.6%. Gastric tube necrosis occurred in four patients (2.6%). An ultrasonic dissector injury to the gastroepiploic arcade had occurred in two cases. In another case, the gastric tube was strangulated in the hiatus. In the remaining case, no clear mechanical cause was identified. All 4 cases occurred within the first 73 cases. The gastric tube necrosis rate of the first 50 cases versus cases 51–155 was 4% and 2% respectively (p=0.5948). The anastomotic leak rate in these two cohorts was 18% and 7% respectively (p=0.0457). There was a significant reduction in overall gastric tube complications from 22% to 10% following the learning curve of the initial 50 cases (p=0.0447). Conclusions In our series, gastric tube necrosis appears to be a learning curve issue. Prophylactic measures such as ischaemic preconditioning become less relevant as the operating surgeon’s experience increases. Instead, meticulous attention to preserving the gastroepiploic arcade, avoidance of tension in the tube and careful positioning of the gastric conduit through an adequately sized hiatus are key factors.

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contrasting

confidence: 44%

Gastric tube necrosis following minimally invasive oesophagectomy is a learning curve issue

Ramage

Deguara

Davies

et al. 2013

annals

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“…However, it remains debatable whether thoracoscopic surgery can achieve comparable quality of lymphadenectomy to that of thoracotomy. Because of the steep learning curve, lower dissected lymph node yields in thoracoscopic surgery have been reported as compared to open surgery (15,16). The other issue regarding RLN dissection is the incidence of vocal cord paralysis which has been reported to range from 6% to 40% after thoracoscopic RLN dissection (17,18).…”

Section: Figurementioning

confidence: 98%

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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“…Prone pozisyonunda yapılan torakoskopik özofajektomide ise operatif görüntü alanının arttığı, daha rahat lenf nodu diseksiyonunun yapılabi-leceğini ve komplike sütürlerin atılabileceğini belirten çalışmalar mevcuttur (11,12). Torakoskopik serbestleştirmenin yüzüstü veya lateral dekübit pozisyonunda yapılmasına yönelik karşılaştırmalı çalışmada ise çıka-rılan lenf nodu sayısı, komplikasyonlar, hastanede kalış süresi, ameliyat sırasındaki kan kaybı açısından bir fark bulunmazken, ameliyat süresi yüzüstü pozisyonda anlamlı olarak kısa bulunmuştur (23)(24)(25)(26)(27).…”

Section: Cerrahi̇ Sonuçlarunclassified

“…'larının (24) İngitere'den yaptıkları bir çalışmada son 12 yılda özofagus kanseri için yapı-lan özofajektomileri retrospektif olarak değerlendirmiş-ler ve 1996/1997 döneminde minimal invaziv özofa-jektominin oranı %0,6 iken 2007/2008 döneminde bu oranın %16'a çıktığını bulmuşlardır. Minimal invaziv özofajektomi yapılan hastalarla açık cerrahi teknikle yapılan hastaları karşılaştırdıklarında mortalite ve hastanede kalış süresi açısından fark bulunmazken 1 yıllık sağ-kalımın minimal invaziv özofajektomi yapılan hastalarda daha iyi olduğunu tespit etmişlerdir (24)(25)(26)(27)(28)(29).…”

Section: Cerrahi̇ Sonuçlarunclassified

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Mınımally Invasıve Esophagectomy

Kaplan¹,

Han²

2016

Toraks Cer Bult

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ÖzetTüm dünyada özofagus kanseri, kansere bağlı ölümlerin en sık altıncı nedenidir. Özofagus kanseri için tedavinin temeli halen özofagus rezeksiyonudur. Özofajektomi sonrası operatif mortalite son yıllarda azalırken, postoperatif morbidite hala önemli bir sorundur. Günümüzde özofajektomiler laparoskopik ve/veya torakoskopik yöntemler ile daha sık yapıl-maya başlanmıştır. Bu prosedürlerin amacı geleneksel açık teknikle yapılan özofagus rezeksiyonu sonrası yüksek olan genel morbiditeyi azaltmaktır. Açık özofajektomi tekniklerinin tümü başarılı bir şekilde minimal invaziv cerrahide yapılabil-mektedir. Minimal invaziv özofajektomi açık cerrahi prosedürlere göre daha hızlı iyileşme sağlayıp, postoperatif ağrı ve solunum komplikasyonlarını azaltan ilgi cekici bir konsept haline gelmiştir. Minimal invaziv özofajektomi gerek solunum komplikasyonlarının azlığı, gerekse ameliyat süresinin kısalı-ğı açısından tercih edilen bir teknik olup açık cerrahi serilerle karşılaştırılabilir sonuçları mevcuttur. Günümüzde özofagus kanserinin cerrahi tedavisinde torakoskopik ve laparoskopik girişimler gittikçe daha yaygın kullanılmaya başlanmış olup minimal invaziv cerrahinin açık cerrahiye olan üstünlüğünün büyük ölçekli randomize kontrollü çalışmalar ile desteklenmesi gerekmektedir. Anahtar kelimeler: Özofagus kanseri, videotorakoskopi, laparoskopi AbstractEsophageal carcinoma is the sixth most common cause of cancer deaths worldwide. Surgical resection of the esophagus remains the primary treatment for this type of cancer. While operative mortality after esophagectomy has decreased in recent years, postoperative morbidity is still a significant problem. Currently, more esophagectomies are being performed by laparoscopic and/or thoracoscopic methods. The goal of these procedures is to decrease the high overall morbidity of traditional open esophageal resections. All current esophagectomy techniques have been successfully performed using minimally invasive procedures. Minimally invasive esophagectomy is an attractive alternative because it reduces postoperative pain and pulmonary complications, leading to more rapid recovery than open surgery allows. Minimally invasive esophagectomy is technically feasible, with a low incidence of respiratory complications and reduced operation time. It provides comparable outcomes with other techniques of most open surgeries. Nowadays, thoracoscopic and laparoscopic procedures have become more common in the surgical treatment of esophageal cancer, but the superiority of minimally invasive procedures as compared to open surgery needs to be confirmed in large-scale, randomized, controlled trials.

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Perioperative outcomes after transition from conventional to minimally invasive Ivor-Lewis esophagectomy in a specialized center

Abstract: This study shows that laparoscopic Ivor-Lewis esophagectomy is associated with a reduced need for blood transfusion, a shorter operative time, and an adequate lymph node harvest. Oncologic principles are not compromised during the transition phase from open to laparoscopic esophagectomy.

Cited by 52 publications

References 14 publications

Gastric tube necrosis following minimally invasive oesophagectomy is a learning curve issue

Gastric tube necrosis following minimally invasive oesophagectomy is a learning curve issue

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

Mınımally Invasıve Esophagectomy

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