Results of the Combination of Open Transthoracic Esophagectomy with Laparoscopic Gastric Tube Formation for Esophageal Cancer

Cense, Huib A.; Busch, Olivier R.; Bemelman, W. A.; Obertop, H.; Lanschot, J. Jan B. van

doi:10.1159/000094350

Cited by 13 publications

(11 citation statements)

References 39 publications

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“…Within each type of surgical approaches, the extent of esophageal resection also varied from segmental to subtotal or total resection of the thoracic esophagus and the extent of lymph node dissection ranged from the lack of any formal lymphadenectomy (majority of papers) to an extended mediastinal and abdominal lymph node dissection in a few others [18,[34][35][36][37][38][39].…”

Section: Resultsmentioning

confidence: 99%

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Minimally invasive esophagectomy for cancer☆

Decker¹,

Coosemans²,

Leyn³

et al. 2009

European Journal of Cardio-Thoracic Surgery

125

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Since 1992, various combinations of thoracoscopy (VATS), laparoscopy or hand-assisted thoracolaparoscopy have been used for 'minimally invasive' cancer esophagectomy (MIE). Despite widespread current use, indications and potential benefits of the many technical approaches remain controversial. A systematic literature search was conducted until June 2007. Out of 128 publications, 46 original series (1932 patients) met the inclusion criteria and were analyzed for surgical and oncological outcome. No prospective controlled study has compared any MIE technique to another or to open surgery. Most publications are retrospective series of highly selected patients, mostly excluding high-risk patients and locally advanced (T3) tumors. Altogether, the overall conversion rate was 5.9%, mortality 2.9% and morbidity 46%, many papers reporting only major complications. Overall, rates for pulmonary complications were 22%, leakage 8.8% and vocal cord palsy 7.1%. Fifteen tracheo-bronchial injuries or fistulas (1% of all VATS cases) were reported. Laparoscopy and VATS were combined in 11 series (609 patients, 4.7% conversions, 2.4% mortality). VATS combined with (mini)-laparotomy was reported in 14 papers (743 patients, 6.3% conversions, 2.4% mortality). Laparoscopy combined with right thoracotomy was reported in four papers (147 patients, 5.4% conversions, 2% mortality). Laparoscopic transhiatal resections were reported in 17 papers (433 patients, 7% conversions, 4.6% mortality). Overall morbidity rates for these four approaches were 43%, 47.6%, 51.6% and 46%, respectively. Data on oncological outcome are scarce. Lymph node retrieval (median of all series: 14 nodes, range 5-62) was mostly inferior to open surgery standards and follow-up too short to draw definitive conclusions regarding long-term survival. Based on the available literature, the morbidity and mortality of MIE is substantial and not inferior to radical open esophagectomy in experienced centers. Many different operative techniques for MIE have been reported without obvious superiority for any of them. The term 'minimally invasive' is not supported by hitherto reported results. Selection bias and huge variability in extent of resection and lymphadenectomy impair comparisons of different MIE techniques. Oncological outcome of MIE remains largely unknown by lack of good quality data and selection bias. MIE remains an investigational and still evolving treatment for invasive cancer.

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Section: Resultsmentioning

confidence: 99%

“…Other series of MIE however still rely on systematic postoperative ventilation [8,30,31,39,40,47] and prolonged ICU stays after MIE [20,39,40,44]. All these parameters however are influenced by many factors other than the mere operative approach, e.g.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive esophagectomy for cancer☆

Decker¹,

Coosemans²,

Leyn³

et al. 2009

European Journal of Cardio-Thoracic Surgery

125

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“…A recent study described the use of thoracoscopic esophagectomy for EC, and a laparoscopic approach was used to prepare the reconstructive gastric tube and dissect the abdominal lymph nodes [13] . The use of a video-assisted maneuver might also prevent injury to the parietal pleura during blunt dissection of the retrosternal space.…”

Section: Discussionmentioning

confidence: 99%

Clinical Impact of Intrathoracic Herniation of Gastric Tube Pull-Up via the Retrosternal Route following Esophagectomy

Uemura

Kawakami

et al. 2017

Dig Surg

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Background: Intrathoracic herniation of gastric tube (IHGT) pull-up via the retrosternal route is a rare complication following esophagectomy, which is caused due to an injury in the parietal pleura during a blunt dissection of the retrosternal space. However, little is known regarding the clinical impact of IHGT pull-up via the retrosternal route. Patients and Methods: Clinical data of 231 patients receiving gastric tube reconstruction via the retrosternal route following esophagectomy were collected from medical charts. Results: Of the 231 patients, 19 (8%) developed IHGT. Vocal cord palsy, particularly with delayed onset, developed at a significantly high frequency in the group of patients with IHGT. There were no significant differences in the frequency of other surgical complications. Conclusion: This is the first report to examine the clinical impact of IHGT pull-up via the retrosternal route. Vocal cord palsy, particularly with delayed onset, developed in the group of patients with IHGT. Therefore, when reconstruction is performed via the retrosternal route, it is very important that blunt and blind dissection of the retrosternal space be performed with extreme care to prevent pleural injury.

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“…Recently, thoracoscopic esophagectomy has been performed for esophageal cancer 6 and a laparoscopic approach has been used to prepare the reconstructive gastric tube and dissect the abdominal lymph nodes. 7 Performing this technique using video-assisted surgery made full visualization possible. During esophagectomy, the dissected retrosternal space can be seen through the videoscope.…”

Section: Discussionmentioning

confidence: 99%

Intrathoracic hernia of a retrosternal colonic graft after esophagectomy: Report of a case

et al. 2011

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We report a case of intrathoracic herniation of the colonic interposition pulled up through the retrosternal space after subtotal esophagectomy for esophageal cancer. The patient, a 68-year-old man, presented with progressive dysphagia about 1 year after this operation. We performed left thoracotomy and laparotomy, which revealed the reconstructed colon herniating into the left thoracic cavity through a large defect in the left mediastinal pleura. The redundant colon was resected, and the colonic graft was shortened and straightened. We concluded that the defect in the mediastinal pleura and colonic redundancy had permitted the colonic graft to herniate into the left thoracic cavity.

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Results of the Combination of Open Transthoracic Esophagectomy with Laparoscopic Gastric Tube Formation for Esophageal Cancer

Cited by 13 publications

References 39 publications

Minimally invasive esophagectomy for cancer☆

Minimally invasive esophagectomy for cancer☆

Clinical Impact of Intrathoracic Herniation of Gastric Tube Pull-Up via the Retrosternal Route following Esophagectomy

Intrathoracic hernia of a retrosternal colonic graft after esophagectomy: Report of a case

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