Minimally Invasive McKeown Esophagectomy

2021 ◽  
pp. 11-17
Author(s):  
Matthew L. Inra ◽  
Shanda H. Blackmon
Keyword(s):  
Minimally Invasive ◽  
Mckeown Esophagectomy

scholarly journals European consensus on essential steps of Minimally Invasive Ivor Lewis and McKeown Esophagectomy through Delphi methodology

2021 ◽  
Author(s):  
Yassin Eddahchouri ◽  
◽  
Frans van Workum ◽  
Frits J. H. van den Wildenberg ◽  
Mark I. van Berge Henegouwen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Expert Panel ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Round Table Discussion ◽  
Ivor Lewis ◽  
Delphi Methodology ◽  
Invasive Esophagectomy ◽  
European Consensus ◽  
Mckeown Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure with a long learning curve, which is associated with increased morbidity and mortality. To master MIE, training in essential steps is crucial. Yet, no consensus on essential steps of MIE is available. The aim of this study was to achieve expert consensus on essential steps in Ivor Lewis and McKeown MIE through Delphi methodology. Methods Based on expert opinion and peer-reviewed literature, essential steps were defined for Ivor Lewis (IL) and McKeown (McK) MIE. In a round table discussion, experts finalized the lists of steps and an online Delphi questionnaire was sent to an international expert panel (7 European countries) of minimally invasive upper GI surgeons. Based on replies and comments, steps were adjusted and rephrased and sent in iterative fashion until consensus was achieved. Results Two Delphi rounds were conducted and response rates were 74% (23 out of 31 experts) for the first and 81% (27 out of 33 experts) for the second round. Consensus was achieved on 106 essential steps for both the IL and McK approach. Cronbach’s alpha in the first round was 0.78 (IL) and 0.78 (McK) and in the second round 0.92 (IL) and 0.88 (McK). Conclusions Consensus among European experts was achieved on essential surgical steps for both Ivor Lewis and McKeown minimally invasive esophagectomy.

scholarly journals Feasibility of enhanced recovery protocol in minimally invasive McKeown esophagectomy

Esophagus ◽  
2021 ◽  
Author(s):  
Yuichiro Tanishima ◽  
Katsunori Nishikawa ◽  
Masami Yuda ◽  
Yoshitaka Ishikawa ◽  
Keita Takahashi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Enhanced Recovery ◽  
Enhanced Recovery Protocol ◽  
Mckeown Esophagectomy

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

2020 ◽  
Vol 271 (1) ◽  
pp. 128-133 ◽  
Author(s):  
Frans van Workum ◽  
Annelijn E. Slaman ◽  
Mark I. van Berge Henegouwen ◽  
Suzanne S. Gisbertz ◽  
Ewout A. Kouwenhoven ◽  
...  
Keyword(s):  
Propensity Score ◽  
Minimally Invasive ◽  
Ivor Lewis ◽  
Mckeown Esophagectomy

scholarly journals Minimal invasive versus open esophagectomy for patients with esophageal squamous cell carcinoma after neoadjuvant treatments

2020 ◽  
Author(s):  
Dongni Chen ◽  
Weidong Wang ◽  
Junxian Mo ◽  
Qiannan Ren ◽  
Huikai Miao ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Neoadjuvant Treatment ◽  
Surgical Approaches ◽  
Open Esophagectomy ◽  
Short And Long Term ◽  
Mckeown Esophagectomy

Abstract Background Although previous studies have discussed whether the minimally invasive esophagectomy (MIE) is superior to open surgery, the data concerning esophageal squamous cell carcinoma (ESCC) patients underwent neoadjuvant treatment followed by radical resection is limited. The purpose of our study was to compare the short- and long-term clinical outcomes of the two surgical approaches in treating ESCC patients. Methods Between January 2010 and December 2016, ESCC patients who had received neoadjuvant therapy and underwent Mckeown esophagectomy at our institute were eligible. The baseline characteristics, pathological data, short-and long-term outcomes of these patients were collected and compared based on the surgical approach. Results A total of 195 patients was included in the current study. Compared to patients underwent open surgery, patients underwent MIE had shorter operative time and less intraoperative bleeding (390 min vs 330 min, P = 0.001; 204 ml vs 167 ml, P = 0.021). In addition, the risk of anastomotic leakage was decreased in MIE group (20.0% vs 3.3%, P < 0.001), while the occurrence of other complications did not have statistical significance between two groups. Overall survival (OS) and disease-free survival (DFS) was no difference in patients received neoadjuvant chemotherapy between the two approaches. For the patients underwent neoadjuvant chemoradiotherapy, OS was significantly better in the MIE group (log rank = 6.197; P = 0.013). Conclusion Minimally invasive Mckeown esophagectomy is safe and feasible for ESCC patients who underwent neoadjuvant therapy. MIE approach presented better perioperative results than open esophagectomy. The effect of surgical approaches on survival was depending on the scheme of neoadjuvant treatment.

scholarly journals Application of intraoperative nerve monitoring for recurrent laryngeal nerves in minimally invasive McKeown esophagectomy

2021 ◽  
Author(s):  
Luo Zhao ◽  
Jia He ◽  
Yingzhi Qin ◽  
Hongsheng Liu ◽  
Shanqing Li ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pulmonary Complications ◽  
Control Group ◽  
Postoperative Pulmonary Complications ◽  
Nerve Monitoring ◽  
Mediastinal Lymphadenectomy ◽  
Significant Difference ◽  
Recurrent Laryngeal Nerves ◽  
Intraoperative Nerve Monitoring ◽  
Mckeown Esophagectomy

Abstract Background Mediastinal lymphadenectomy is of great importance during esophagectomy for esophageal squamous cell carcinoma. However, recurrent laryngeal nerve (RLN) injury is a severe complication caused by lymphadenectomy along the RLN. Intraoperative nerve monitoring (IONM) can effectively identify the RLN and reduce the incidence of postoperative vocal cord paralysis (VCP). Here, we describe the feasibility and effectiveness of IONM in minimally invasive McKeown esophagectomy. Methods A total of 150 patients who underwent minimally invasive McKeown esophagectomy from 2016 to 2020 were enrolled in this study. We divided the patients into two groups: a neuromonitoring group (IONM, n = 70) and a control group (control, n = 80). Clinical data, surgical variables, and postoperative complications were retrospectively analyzed and compared. Results There was no significant difference in baseline data between the two groups. Postoperative VCP occurred in six cases (8.6%) in the IONM group, which was lower than that in the control group (21.3%, P = 0.032). Postoperative pulmonary complications were found in five cases (7.1%) and 14 in the control group (18.8%, P = 0.037). The postoperative hospital stay in the IONM group was significantly shorter than that in the control group (8 vs. 12, median, P &lt; 0.001). The number of RLN lymph nodes harvested in the IONM group was higher than that in the control group (13.74 ± 5.77 vs. 11.03 ± 5.78, P = 0.005). The sensitivity and specificity of IONM monitoring VCP were 83.8% and 100%, respectively. A total of 66.7% of patients with a reduction in signal showed transient VCP, whereas 100% with a loss of signal showed permanent VCP. Conclusion IONM is feasible in minimally invasive McKeown esophagectomy. It showed advantages for distinguishing RLN and achieving thorough mediastinal lymphadenectomy with less RLN injury. Abnormal IONM signals can provide an accurate prediction of postoperative VCP incidence.

scholarly journals Minimal invasive versus open esophagectomy for patients with esophageal squamous cell carcinoma after neoadjuvant treatments

2020 ◽  
Author(s):  
Dongni Chen ◽  
Weidong Wang ◽  
Junxian Mo ◽  
Qiannan Ren ◽  
Huikai Miao ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Neoadjuvant Treatment ◽  
Surgical Approaches ◽  
Open Esophagectomy ◽  
Short And Long Term ◽  
Mckeown Esophagectomy

Abstract Background Although previous studies have discussed whether the minimally invasive esophagectomy (MIE) is superior to open surgery, the data concerning esophageal squamous cell carcinoma (ESCC) patients underwent neoadjuvant treatment followed by radical resection is limited. The purpose of our study was to compare the short- and long-term clinical outcomes of the two surgical approaches in treating ESCC patients.MethodsBetween January 2010 and December 2016, ESCC patients who had received neoadjuvant therapy and underwent Mckeown esophagectomy at our institute were eligible. The baseline characteristics, pathological data, short-and long-term outcomes of these patients were collected and compared based on the surgical approach. ResultsA total of 195 patients was included in the current study. Compared to patients underwent open surgery, patients underwent MIE had shorter operative time and less intraoperative bleeding (390 min vs 330 min, P=0.001; 204 ml vs 167 ml, P=0.021). In addition, the risk of anastomotic leakage was decreased in MIE group (20.0% vs 3.3%, P<0.001), while the occurrence of other complications did not have statistical significance between two groups. Overall survival (OS) and disease-free survival (DFS) was no difference in patients received neoadjuvant chemotherapy between the two approaches. For the patients underwent neoadjuvant chemoradiotherapy, OS was significantly better in the MIE group (log rank=6.197; P=0.013). ConclusionMinimally invasive Mckeown esophagectomy is safe and feasible for ESCC patients who underwent neoadjuvant therapy. MIE approach presented better perioperative results than open esophagectomy. The effect of surgical approaches on survival was depending on the scheme of neoadjuvant treatment.

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