The use of a tailored surgical technique for minimally invasive esophagectomy

Abstract

Objective: Uncertainty exists among surgeons as to whether minimally invasive esophagectomy (MIE) is a comparable operation to open esophagectomy (OE). The surgical technique and oncologic dissection should not be degraded when using a minimally invasive approach.Methods: We reviewed a single hospital's experience with both OE and MIE. From 2000 to 2010, 257 patients underwent esophagectomy by 1 of 3 surgical techniques: transhiatal, Ivor Lewis, or 3-hole.Results: Of the 257 patients (median age, 67 years; range, 58-74), 92 underwent MIE. Both groups were comparable in terms of gender, age, comorbidities, surgical technique, and induction chemotherapy and radiotherapy. The overall median follow-up was 29.5 months (range, 9.9-61.5). The MIE group had a significantly shorter operative time (MIE vs OE, 330 vs 365 minutes, P ¼ .04), length of stay (MIE vs OE, 9 vs 12 days, P <.01), intensive care unit admission rate (MIE vs OE, 55% vs 81%, P<.01), intensive care unit length of stay (MIE vs OE, 1 vs 2 days, P<.01), and estimated blood loss (MIE vs OE, 100 vs 400 mL, P <.01). More lymph nodes were harvested in the MIE group than in the OE group (17 vs 11 nodes, P<.01). There were insignificant differences in 30-day mortality (MIE vs OE, 2.2% vs 3.0%; P ¼ .93) and overall survival (P ¼ .19), as well as in the rates of all complications, except pneumonia (MIE vs OE, 2% vs 13%; P ¼ .01).Conclusions: A thoracic surgeon can safely tailor the MIE to a patient's anatomy and oncologic demands while maintaining equivalent survival.

Superiority of Minimally Invasive Oesophagectomy in Reducing In-Hospital Mortality of Patients with Resectable Oesophageal Cancer: A Meta-Analysis

“…Of the 48 studies, only 1 was a randomized controlled trial (RCT) [ 4 ]. Eight studies [ 54 , 56 , 58 , 59 , 72 , 76 , 79 , 80 , 85 ] were done in the United Kingdom (UN), 8 in the USA [ 21 , 44 , 52 , 55 , 64 , 73 , 74 , 88 ],11 in Japan [ 6 , 45 , 46 , 50 , 66 , 68 , 70 , 75 , 77 , 78 , 81 ], 7 in China [ 43 , 63 , 65 , 82 , 84 , 86 , 87 ], 4 in Australia [ 3 , 57 , 60 , 67 ],3 in Netherlands [ 4 , 47 , 71 ], and 2 in Italy [ 49 , 51 ], and the remaining studies were conducted in Germany [ 61 ], France [ 69 ], Chile [ 48 ], and Finland [ 83 ]. Key methodological characteristics are shown in Table 1 .…”

Is minimally invasive esophagectomy effective for preventing anastomotic leakages after esophagectomy for cancer? A systematic review and meta-analysis

“…The selected trials included a total of 43 studies and 5537 patients (Table 1 ). Among the included 43 studies, 19 were retrospective studies [ 15 , 24 – 41 ], 13 were prospective ones [ 14 , 42 – 53 ], and only 1 was randomized controlled trial (RCT) [ 13 ]. Ten studies were done in Japan [ 25 , 28 , 29 , 35 , 43 , 44 , 50 , 52 , 54 , 55 ], 9 in USA [ 14 , 24 , 27 , 33 , 41 , 46 , 51 , 56 , 57 ], 7 in China [ 31 , 36 , 38 – 40 , 58 , 59 ], 5 in the UK [ 47 , 49 , 53 , 60 , 61 ], 3 in Netherlands [ 15 , 34 , 62 ], 3 in Australia [ 42 , 48 , 63 ], 2 in Italy [ 45 , 64 ], and the remaining were conducted in Germany [ 30 ], Chile [ 26 ], Belgium [ 32 ], and Finland [ 37 ].…”

Minimally Invasive Ivor Lewis Esophagectomy

“…This is likely secondary to the significantly shorter hospital stay and our preference to delay oral intake until the patient is home. [1][2][3][4][5][6][7] Figure 13 When completed, the anastomosis lies well above the transected azygos vein. To avoid problems with postoperative gastric emptying, the conduit should not be redundant and should have a "straight" alignment in the esophageal bed.…”