Conversion to open surgery during minimally invasive esophagectomy portends worse short-term outcomes: an analysis of the National Cancer Database

2019 ◽  
Vol 34 (8) ◽  
pp. 3470-3478
Author(s):  
Alison L. Halpern ◽  
Chloe Friedman ◽  
Robert J. Torphy ◽  
Mohammed H. Al-Musawi ◽  
John D. Mitchell ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Open Surgery ◽  
Minimally Invasive Esophagectomy ◽  
National Cancer Database ◽  
Short Term ◽  
Conversion To Open Surgery ◽  
Invasive Esophagectomy

Minimally invasive esophagectomy is associated with superior survival, lymphadenectomy and surgical margins: propensity matched analysis of the National Cancer Database

2020 ◽  
Vol 33 (10) ◽  
Author(s):  
Stephanie G Worrell ◽  
Katelynn C Bachman ◽  
Anuja L Sarode ◽  
Yaron Perry ◽  
Philip A Linden ◽  
...  
Keyword(s):  
Overall Survival ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Rank Test ◽  
National Cancer Database ◽  
Long Term Outcomes ◽  
Short Term ◽  
Invasive Esophagectomy ◽  
Open Esophagectomy

Abstract Despite excellent short-term outcomes of minimally invasive esophagectomy (MIE), there is minimal data on long-term outcomes compared to open esophagectomy. MIE’s superior visualization may have improved lymphadenectomy and complete resection rate and therefore improved long-term outcomes. We hypothesized that MIE would have superior long-term survival. Patients undergoing an esophagectomy for cancer between 2010 and 2016 were identified in the National Cancer Database. MIE included laparoscopic/robotic approach, and conversions were categorized as open. A 1:1 propensity match was performed. Lymphadenectomy and margin status were compared between MIE and open using Stuart Maxwell marginal homogeneity and Wilcoxon matched-pair signed-rank test. Survival was compared using log-rank test. 13,083 patients were identified: 8,906 (68%) open and 4,177 (32%) MIE. Propensity matching identified 3,659 ‘pairs’ of MIE and open esophagectomy patients. Among them, MIE was associated with higher number lymph nodes examined (16 vs. 14, P < 0.001) and similar number of positive lymph nodes (0 vs. 0, P = 0.33). MIE had higher rate of negative pathologic margin (95 vs. 93.5%, P < 0.001). MIE was also associated with shorter hospitalization (9 vs. 10 days, P < 0.001). Survival was improved among MIE patients (46.6 vs. 41.4 months for open, P = 0.003) and among pathologic node-negative patients (71.4 vs. 61.5 months, P = 0.005). These data suggest that MIE has improved short-term outcomes (improved lymphadenectomy, pathologic margins, and length of stay) and also associated improved overall survival. The etiology of superior overall survival is likely secondary to many factors related and unrelated to surgical approach.

384 SHORT-TERM OUTCOMES OF INTRA-THORACIC ESOPHAGO-GASTRIC ANASTOMOSES UNDER MINIMALLY INVASIVE ESOPHAGECTOMY VIA A PRONE POSITION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Shinji Mine ◽  
Masayuki Watanabe ◽  
Atushi Kanamori ◽  
Yu Imamura ◽  
Akihiko Okamura ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Stricture ◽  
Minimally Invasive Esophagectomy ◽  
Anterior Wall ◽  
Gastric Conduit ◽  
Linear Stapler ◽  
Short Term ◽  
Invasive Esophagectomy ◽  
Operative Complications ◽  
Gastric Anastomosis

Abstract   Although minimally invasive esophagectomy (MIE) has been performed for esophageal cancer worldwide, intra-thoracic anastomosis under prone positions is still challenging. In this retrospective study, we reviewed our short-term results of this anastomotic technique in our institution. Methods From November 2016 to December 2019, we performed 319 esophagectomies. Of these patients, 28 patients (9%) underwent intra-thoracic esophago-gastric anastomosis under MIE. Procedures The left side of an esophageal stump which had been closed using a linear stapler was opened for anastomosis. Then, the anterior wall of a gastric conduit, around 5 cm below the tip, was opened for anastomosis. Linear staplers were inserted in both esophageal stump and gastric conduit and side-to-side anastomosis was performed. The opening for insertion was closed using a hand-sewn anastomosis in 2 layers. Results Five patients (18%) suffered anastomotic leakage with Clavien-Dindo 2 and 3a, and all of them recovered by conservative treatments. Two patients (2/19, 11%) showed anastomotic stricture which improved by several endoscopic dilatations. Six patients (6/19, 32%) showed the reflux esophagitis of Grade C. Conclusion Although we have not experienced severe or critical post-operative complications, the short-term results of intra-thoracic anastomosis under MIE were not sufficient. Additional progresses in techniques are required.

Standardizing procedures improves and homogenizes short-term outcomes after minimally invasive esophagectomy

2018 ◽  
Vol 403 (2) ◽  
pp. 221-234 ◽  
Author(s):  
Taro Oshikiri ◽  
Tetsu Nakamura ◽  
Hiroshi Hasegawa ◽  
Masashi Yamamoto ◽  
Shingo Kanaji ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Short Term ◽  
Invasive Esophagectomy

Esophageal Position Affects Short-Term Outcomes After Minimally Invasive Esophagectomy: A Retrospective Multicenter Study

2019 ◽  
Vol 44 (3) ◽  
pp. 831-837 ◽  
Author(s):  
Tomoyuki Uchihara ◽  
Naoya Yoshida ◽  
Yoshifumi Baba ◽  
Yuichiro Nakashima ◽  
Yasue Kimura ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Multicenter Study ◽  
Minimally Invasive Esophagectomy ◽  
Short Term ◽  
Invasive Esophagectomy ◽  
Retrospective Multicenter Study

Extracorporeal Gastric Stapling Reduces the Incidence of Gastric Conduit Failure after Minimally Invasive Esophagectomy

2010 ◽  
Vol 76 (8) ◽  
pp. 823-828 ◽  
Author(s):  
Gregory D. Crenshaw ◽  
Suven S. Shankar ◽  
Russell E. Brown ◽  
Abbas E. Abbas ◽  
John S. Bolton
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Operative Mortality ◽  
Minimally Invasive Esophagectomy ◽  
Gastric Conduit ◽  
Short Term ◽  
Simple Modification ◽  
Invasive Esophagectomy ◽  
Clinic Foundation ◽  
Significant Difference

Esophageal cancer resection is associated with significant morbidity and mortality. To date, no standardized technique exists. In this study, we analyze our short-term results in 92 minimally invasive resections performed over the past 10 years in an attempt to identify technical factors, which contribute to improved short-term outcomes. A retrospective review of 92 minimally invasive esophagectomies was performed at the Ochsner Clinic Foundation from 1999 through 2009. Data collected included preoperative stage, whether or not preoperative chemoradiation was used, technique of minimally-invasive resection, technique of esophagogastric anastomosis, margin status, anastomotic leak, conduit necrosis, gastric conduit failure of any type, and operative mortality. Gastric stapling was done either laparoscopically (intracorporeal) or through a minilaparotomy (extracorporeal). Ninety-two patients met criteria for this study. There was a significant difference in the incidence of positive gastric margins ( P = 0.04), anastomotic leak ( P = 0.045), conduit necrosis ( P = 0.03), and any gastric conduit failure ( P = 0.02) favoring the extracorporeal group. The overall short-term morbidity and operative mortality with minimally invasive esophagectomy is comparable to the results obtained with open techniques. A relatively simple modification of the operative technique—performing extracorporeal stapling of the gastric conduit—led to a significant reduction in the incidence of gastric conduit failures when compared with the intracorporeal stapling technique.

125. Minimally Invasive Esophagectomy (MIE) – adequacy and short term perioperative outcomes – our experience

2014 ◽  
Vol 40 (11) ◽  
pp. S58
Author(s):  
K. Rehmani ◽  
K.V.V.N. Raju ◽  
S. Patnaik ◽  
V. Naik ◽  
R. Rajagopalan ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Perioperative Outcomes ◽  
Short Term ◽  
Invasive Esophagectomy

Does staged surgical training for minimally invasive esophagectomy have an impact on short-term outcomes?

2020 ◽  
Author(s):  
Koshiro Ishiyama ◽  
Takeo Fujita ◽  
Hisashi Fujiwara ◽  
Daisuke Kurita ◽  
Junya Oguma ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Training ◽  
Minimally Invasive Esophagectomy ◽  
Short Term ◽  
Invasive Esophagectomy
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