Short-term outcomes following total minimally invasive oesophagectomy

Berrisford, R. G.; Wajed, S; Sanders, David J.; Rucklidge, M. W. M.

doi:10.1002/bjs.6054

Cited by 67 publications

(66 citation statements)

References 44 publications

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“…One potential benefit of laparoscopic surgery shown by this study was the decrease in initial transfusion requirements for a significant proportion of patients as well as a significant decrease in the median length of postoperative ventilation. Similar results have been reported with minimally invasive esophagectomy for 77 patients, who had a median intraoperative blood loss of 425 ml and a median blood transfusion requirement during the hospital stay of 0 units (range, 0-8 units) [14]. Although postoperative ventilation time was not reported in this study, the median intensive care unit (ICU) length of stay was 6.5 days [14].…”

Section: Discussionsupporting

confidence: 86%

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

et al. 2009

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Section: Discussionsupporting

confidence: 86%

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

et al. 2009

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“…1 In a case series by Berrisford et al, the authors reported on 70 MIOs, with 9 patients (12.9%) suffering gastric conduit complications. 17 Several authors have tried to solve the problem of gastric tube ischaemia after laparoscopic oesophagectomy. In an experimental study in pigs, significant improvement in gastric tube blood flow was found following intravenous administration of unmodified prostaglandin E 1 (PGE1) and lipo-PGE1 (p<0.01).…”

mentioning

confidence: 99%

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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“…18 In addition, it seems clear that MIO is associated with complications very rarely seen in open oesophagectomy, including gastric conduit necrosis. 19 Guidelines published by the National Institute for Health and Clinical Excellence and by professional associations in the UK concluded that there was no convincing evidence that MIO was superior to open oesophagectomy.…”

Section: Surgical Approachmentioning

confidence: 99%

A personal perspective on controversies in the surgical management of oesophageal cancer

Manson

Beasley

2014

annals

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Significant disagreement and debate persist regarding several aspects of the optimal surgical management of oesophageal cancer. We address some of these issues based on our consecutive series of 165 patients undergoing oesophageal resection (reported in full elsewhere) and the available literature. The areas considered are controversial but we argue in favour of a 'traditional' two-stage open approach (Ivor-Lewis), leaving the pylorus alone, making no attempt to perform a radical lymphadenectomy and fashioning a hand sewn anastomosis. KEYWORDSOesophagectomy -Ivor-Lewis -Oesophageal cancer -Gastro-oesophageal anastomosisPyloroplasty -Lymphadenectomy The aim of this paper is to outline and justify the approach we favour for oesophageal resection in malignant disease. In order to accomplish this aim, we draw on our own experience 1 and review of the relevant literature. Surgical approachPerhaps because the oesophagus is present in the neck, the thorax and the abdomen, multiple surgical approaches (and combination of approaches) to oesophageal resection are described. Inevitably, there is controversy over the optimal approach. We favour a laparotomy and right lateral thoracotomy. This is preferred to other approaches such as a threestage, transhiatal or minimally invasive oesophagectomy (MIO).In the three-stage (McKeown) approach, gastro-oesophagectomy is followed by a further cervical incision and an anastomosis fashioned in the neck. We are unable to identify any compelling argument to support this approach. It is claimed that anastomosis is technically easier in the neck than in the chest. In south Wales, the majority of patients with oesophageal cancer are overweight with a barrel chest and a short neck. In our experience, no matter how high in the chest it located, an intrathoracic anastomosis is unarguably technically easier than in the neck.It is also argued that anastomotic leakage following cervical anastomosis is less dangerous than in the chest. Not all oesophageal surgeons accept this. There is evidence that a cervical anastomosis often comes to lie in the upper part of the thoracic cavity.2 Since our rate of anastomotic leakage is, fortunately, very low (overall leak rate 1.2%, clinical leak rate 0.6%), this is not an issue in our practice.A further potential argument in favour of the three-stage approach is a greater proximal resection margin; the advantage has been estimated at 1cm.2 No patient in our series had an involved proximal margin, which suggests that adequate clearance can be obtained with an intrathoracic approach. The majority of the available evidence suggests that the rate of benign anastomotic stricture is significantly lower in intrathoracic than in cervical anastomoses.3-5 (See 'Anastomotic technique' section below.) We can identify no advantages to a three-stage procedure. In our series of 165 patients, access to the neck was needed in only two patients who developed significant complications. It is claimed that a transhiatal approach to oesophageal resection is associated wi...

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Short-term outcomes following total minimally invasive oesophagectomy

Cited by 67 publications

References 44 publications

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

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

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

A personal perspective on controversies in the surgical management of oesophageal cancer

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