Propensity Score–Matched Analysis Comparing Minimally Invasive Ivor Lewis Versus Minimally Invasive Mckeown Esophagectomy

Workum, Frans van; Slaman, Annelijn E.; Henegouwen, Mark I. van Berge; Gisbertz, Suzanne S.; Kouwenhoven, Ewout A.; Det, Marc J. van; Wildenberg, Frits J. H. van den; Polat, Fatih; Luyer, Misha; Nieuwenhuijzen, Grard A. P.; Rosman, Camiel

doi:10.1097/sla.0000000000002982

Cited by 66 publications

(63 citation statements)

References 20 publications

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“…The incidence of postoperative complications observed within our series was comparable to the results obtained in aforementioned studies describing RAMIE (Ivor Lewis). [23][24][25]27,28 Our results show that the results of RAMIE4 with an intrathoracic anastomosis as performed in Europe nowadays were comparable to the highest international standards worldwide. 21,27,28 Therefore, RAMIE4 is a valuable therapeutic option for patients with resectable esophageal cancer.…”

Section: Discussionsupporting

confidence: 66%

“…[22][23][24] These data might suggest that an (circularly stapled) Ivor Lewis anastomosis might reduce anastomotic insufficiency in patients with esophageal cancer compared to a McKeown procedure, which is in concordance with recent literature. 25 A randomized controlled trial is currently being performed to answer the question whether a McKeown or Ivor Lewis procedure should be preferred in patients undergoing MIE. 26 Fig.…”

Section: Discussionmentioning

confidence: 99%

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Robot-Assisted Minimally Invasive Esophagectomy with Intrathoracic Anastomosis (Ivor Lewis): Promising Results in 100 Consecutive Patients (the European Experience)

Sluis

Tagkalos

Hadzijusufoviç

et al. 2021

Journal of Gastrointestinal Surgery

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Background Robot-assisted minimally invasive esophagectomy (RAMIE) with intrathoracic anastomosis is gaining popularity as a treatment for esophageal cancer. The aim of this study was to describe postoperative complications and short-term oncologic outcomes for RAMIE procedures using the da Vinci Xi robotic system 4-arm technique. Methods Data of 100 consecutive patients with esophageal or gastro-esophageal junction carcinoma undergoing modified Ivor Lewis esophagectomy were prospectively collected. All operations were performed by the same surgeon using an identical intrathoracic anastomotic reconstruction technique with the same perioperative management. Intraoperative and postoperative complications were graded according to Esophagectomy Complications Consensus Group (ECCG) definitions. Results Mean duration was 416 min (±80); 70% of patients had an uncomplicated postoperative recovery. Pulmonary complications were observed in 17% of patients. Anastomotic leakage was observed in 8% of patients. Median ICU stay was 1 day and median overall postoperative hospital stay was 11 days. The 30-day mortality was 1%; 90-day mortality was 3%. A R0 resection was reached in 92% of patients with a median number of 29 dissected lymph nodes. All patients had at least 7 months of followup with a median follow-up of 17 months. Median overall survival was not reached yet. Conclusion RAMIE with intrathoracic anastomosis (Ivor Lewis) for esophageal or gastro-esophageal junction cancer was technically feasible and safe. Postoperative complications and short-term oncologic results were comparable to the highest international standards nowadays. Keywords Esophageal cancer. Minimally invasive. MIE. RAMIE. Ivor Lewis Synopsis RAMIE with intrathoracic anastomosis (Ivor Lewis) for esophageal or gastro-esophageal junction cancer is technically feasible and safe. Postoperative complications and shortterm oncologic results were comparable to the highest international standards nowadays.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Robot-Assisted Minimally Invasive Esophagectomy with Intrathoracic Anastomosis (Ivor Lewis): Promising Results in 100 Consecutive Patients (the European Experience)

Sluis

Tagkalos

Hadzijusufoviç

et al. 2021

Journal of Gastrointestinal Surgery

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“…However, there is a certain technical skill required to close the remaining defect after stapling the linear anastomosis, which increases the technical difficulty of the operation. Due to this difficulty, a side‐to‐side liner stapled anastomosis is mainly used for McKeown or open Ivor Lewis procedure . In addition, the retention of a gastric conduit stump increases the incidence of an ischemic anastomotic fistula forming.…”

Section: Discussionmentioning

confidence: 99%

“…Due to this difficulty, a side-to-side liner stapled anastomosis is mainly used for McKeown or open Ivor Lewis procedure. 27 In addition, the retention of a gastric conduit stump increases the incidence of an ischemic anastomotic fistula forming. The advantages mentioned above with an intrathoracic side-to-side anastomosis may therefore outweigh other options.…”

Section: Complications Description Valuementioning

confidence: 99%

Totally mechanical linear stapled anastomosis for minimally invasive Ivor Lewis esophagectomy: Operative technique and short‐term outcomes

Gao

Pan

et al. 2020

Thoracic Cancer

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Background Anastomosis is one of the important factors affecting anastomotic complications after esophagectomy, and multiple reports have compared anastomotic complications among various techniques. However, there is insufficient evidence in the literature to definitively recommend one anastomotic technique over another. Method We retrospectively evaluated 34 consecutive patients who underwent an improved totally mechanical side‐to‐side: posterior‐to‐posterior linear stapled (TM‐STS) technique for minimally invasive Ivor Lewis esophagogastric anastomosis, performed by a single surgeon between February 2015 to November 2017. The operative techniques and short‐term outcomes are analyzed in this study. Results There were no conversions to an open approach and a complete resection was achieved in all patients undergoing this improved procedure. During the first half of the series, the median operation time was 355 minutes, ranging from 257 to 480 minutes. Over the second half of this series, the median operation time was reduced to 256 minutes. There were no mortalities or serious postoperative complications. Only one patient (2.9%) had an anastomotic leak, which resolved without intervention. Another patient (2.9%) experienced transient, delayed conduit emptying which upper gastrointestinal radiography determined was due to a mechanical obstruction caused by an abnormally long gastric tube in the chest cavity. Conclusions The results of our study suggest that this improved TM‐STS technique is safe and effective for minimally invasive Ivor Lewis esophagectomy, and can be considered as one of the alternative procedure for patients with lower esophageal as well as Siewert types I/II gastroesophageal junction carcinoma.

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“…In addition, the number of retrieved lymph nodes was significantly higher in the Ivor Lewis procedure (26 versus 21, P < 0.001). 12 Given the above mentioned reports indicating that supraclavicular lymph node dissection does not add a survival benefit for patients with thoracic esophageal cancer (at least for patients with no suspicion of metastatic cervical lymph nodes), threefield lymphadenectomy remains controversial. This is further supported by several studies reporting an increase in postoperative complications after threefield lymphadenectomy.…”

Section: Surgical Standards Of Thoracic Esophageal Cancermentioning

confidence: 99%

Current surgical treatment standards for esophageal and esophagogastric junction cancer

Jung

Schmidt

Chevallay

et al. 2020

Annals of the New York Academy of Sciences

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A number of different surgical techniques for the treatment of cancer of the esophagus and the esophagogastric junction have been proposed. Guidelines generally recommend a transthoracic approach for esophageal cancer, including Siewert type I tumors. In tumors of the proximal esophageal third, transthoracic esophagectomy may be extended to a three-field approach, including resection of cervical lymph nodes. However, the choice between transthoracic esophagectomy with intrathoracic anastomosis (Ivor Lewis esophagectomy) and the three-incision approach with cervical esophago-gastrostomy (McKeown esophagectomy) remains controversial, with guidelines varying among different countries. Furthermore, it is commonly accepted that Siewert type III tumors should be treated by extended total gastrectomy with transhiatal resection of the lower esophagus, whereas currently no consensus exists regarding the optimal surgical approach for the treatment of Siewert type II adenocarcinoma. Likewise, there is a major controversy regarding palliative and potentially curative treatment modalities in oligometastatic disease. This review deals with current surgical treatment standards for cancer of the esophagus and the eosphagogastric junction, including discussion of ongoing trials.

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Propensity Score–Matched Analysis Comparing Minimally Invasive Ivor Lewis Versus Minimally Invasive Mckeown Esophagectomy

Abstract: Ivor Lewis TMIE is associated with a lower incidence of anastomotic leakage, 90-day mortality and other postoperative morbidity compared to McKeown TMIE in patients in whom both procedures are oncologically feasible.

Cited by 66 publications

References 20 publications

Robot-Assisted Minimally Invasive Esophagectomy with Intrathoracic Anastomosis (Ivor Lewis): Promising Results in 100 Consecutive Patients (the European Experience)

Robot-Assisted Minimally Invasive Esophagectomy with Intrathoracic Anastomosis (Ivor Lewis): Promising Results in 100 Consecutive Patients (the European Experience)

Totally mechanical linear stapled anastomosis for minimally invasive Ivor Lewis esophagectomy: Operative technique and short‐term outcomes

Current surgical treatment standards for esophageal and esophagogastric junction cancer

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