The evolution of surgical approach for esophageal cancer

Gisbertz, Suzanne S.; Hagens, Eliza; Ruurda, Jelle P.; Schneider, Paul M.; Tan, Li; Домрачев, С. А.; Hoeppner, Jens; Henegouwen, Mark I. van Berge

doi:10.1111/nyas.13957

Cited by 38 publications

(27 citation statements)

References 47 publications

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“…1 Currently, most esophagectomies are performed via a minimally invasive approach. 2 Transthoracic esophagectomy is a painful procedure due to muscular and intercostal nerve damage during surgery, and effective pain relief is important for reduction of postoperative (pulmonary) complications, including chronic postsurgical pain (CPSP), and for enhancement of patient comfort. [3][4][5] With the introduction of minimally invasive esophagectomy, the complication rate has decreased.…”

Section: Discussionmentioning

confidence: 99%

Optimal Perioperative Pain Management in Esophageal Surgery: An Evaluation of Paravertebral Analgesia

et al. 2021

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Background For esophagectomy, thoracic epidural analgesia (TEA) is the standard of care for perioperative pain management. Although effective, TEA is associated with moderate to serious adverse events such as hypotension and neurologic complications. Paravertebral analgesia (PVA) may be a safe alternative. The authors hypothesized that TEA and PVA are similar in efficacy for pain treatment in thoracolaparoscopic Ivor Lewis esophagectomy. Methods This retrospective cohort study compared TEA with PVA in two consecutive series of 25 thoracolaparoscopic Ivor Lewis esophagectomies. In this study, TEA consisted of continuous epidural bupivacaine and sufentanil infusion with a patient-controlled bolus function. In PVA, the catheter was inserted by the surgeon under thoracoscopic vision during surgery. Administration of PVA consisted of continuous paravertebral bupivacaine infusion after a bolus combined with patient-controlled analgesia using intravenous morphine. The primary outcome was the median highest recorded Numeric Pain Rating Scale (NRS) during the 3 days after surgery. The secondary outcomes were vasopressor consumption, fluid administration, and length of hospital stay. Results In both groups, the median highest recorded NRS was 4 or lower during the first three postoperative days. The patients with PVA had a higher overall NRS (mean difference, 0.75; 95% confidence interval 0.49–1.44). No differences were observed in any of the other secondary outcomes. Conclusion For the patients undergoing thoracolaparoscopic Ivor Lewis esophagectomy, TEA was superior to PVA, as measured by NRS during the first three postoperative days. However, both modes provided adequate analgesia, with a median highest recorded NRS of 4 or lower. These results could form the basis for a randomized controlled trial.

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Section: Discussionmentioning

confidence: 99%

Optimal Perioperative Pain Management in Esophageal Surgery: An Evaluation of Paravertebral Analgesia

et al. 2021

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“…Totally minimally invasive esophagectomy is technically difficult and requires a long learning curve. For the esophagectomy through the three-stage approach thoracoscopic, laparoscopic and cervical, at least 35 surgeries should be performed to overcome the learning curve and more than 100 surgical interventions for the two-stage approach laparoscopic and thoracoscopic with gastric tube reconstruction (22,23). Experience in open esophageal surgery and advanced technical skills in minimally invasive surgery reduce the learning curve (we benefited from this aspect).…”

Section: Short History Of Esophageal Reconstruction With Stomachmentioning

confidence: 99%

Use of the Stomach in Esophageal Reconstructive Surgery in Era of Minimally Invasive Approach

Constantinoiu¹,

Achim²,

Constantin³

2018

chr

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Esophagectomy is standard indication for surgical treatment of resectable esophageal cancer, but it can also be performed for the management of benign conditions. Esophagectomy is followed by esophageal reconstruction using other parts of the digestive tract and is associated with increased postoperative morbidity and mortality. Gastric interposition with intrathoracic or cervical esophago-gastric anastomosis is currently the preferred technique for reconstruction after esophagectomy. The incidence of esophagectomy performed by the minimal invasive approach has increased in recent years due to the advanced technology of endoscopic surgery and image enhancement that provides a better estimate of anatomical plans, facilitates access to narrow spaces and more precise dissection with less tissue trauma. Randomized clinical trials have found a significant reduction in postoperative respiratory complications, decreased hospital stay and equivalent oncological results to open esophagectomy. We present the operative technique of minimally invasive esophagectomy performed in our clinic by three-stage modified McKeown approach thoracoscopic, laparoscopic and cervical with esophageal reconstruction with stomach.

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“…However, this operation is a complex surgical procedure and associated to higher rates of post-operative complications and morbidities. With the advent of minimally access surgery, IL has rapidly evolved towards totally minimally invasive (laparoscopy and thoracoscopy) approach [2] to minimize surgical trauma and reduce perioperative complications (particularly pulmonary infections), decrease length of hospital-stay and improve quality of life compared to open esophagectomy [3][4][5]. However, outcomes of minimally invasive esophagectomy (MIE) have been often discordant when considering the incidence of anastomotic leakage (AL) [6][7][8][9][10] probably as a consequence of the technical difficulty of intra-thoracic anastomosis and a long proficiency gain curve for MIE.…”

Section: Introductionmentioning

confidence: 99%

Side-to-side esophagogastric anastomosis for minimally invasive Ivor-Lewis esophagectomy: operative technique and short-term outcomes

et al. 2021

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Totally minimally invasive Ivor-Lewis esophagectomy (TMIIL) is associated to lower rate of post-operative complication, decreases length of hospital stay and improves quality of life compared to open approach. Nevertheless, adaptation of TMIIL still proceeds at slow pace, mainly due to the difficulty to perform the intra-thoracic anastomosis and heterogeneity of surgical techniques. We present our experience with TMIIL utilizing a stapled side-to-side anastomosis. We retrospectively evaluated 36 patients who underwent a planned TMIIL from January 2017 to September 2020. Esophagogastric anastomoses were performed using a 3-cm linear-stapled side-to-side technique. General features, operative techniques, pathology data and short-term outcomes were analyzed. The median operative time was 365 min (ranging from 240 to 480 min) with a median blood loss of 100 ml (50–1000 ml). The median overall length of stay was 13 (7–64) days and in-hospital mortality rate was 2.8%. Two patients (5.6%) had an anastomotic leak, without need for operative intervention and another patient developed an anastomotic stricture, resolved with a single endoscopic dilation. Chylothorax occurred in three patients; two of these required a surgical intervention. Pulmonary complications occurred in six patients (16.7%). Based on Comprehensive Complications Index (CCI), median values of complications were 27.9 (ranging from 20.9 to 100). The results of our study suggest that TMIIL with a 3-cm linear-stapled anastomosis seems to be safe and effective, with low rates of post-operative anastomotic leak and stricture.

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The evolution of surgical approach for esophageal cancer

Cited by 38 publications

References 47 publications

Optimal Perioperative Pain Management in Esophageal Surgery: An Evaluation of Paravertebral Analgesia

Optimal Perioperative Pain Management in Esophageal Surgery: An Evaluation of Paravertebral Analgesia

Use of the Stomach in Esophageal Reconstructive Surgery in Era of Minimally Invasive Approach

Side-to-side esophagogastric anastomosis for minimally invasive Ivor-Lewis esophagectomy: operative technique and short-term outcomes

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