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.

P113 ESOPHAGECTOMY-SPECIFIC OBJECTIVE STRUCTURED ASSESSMENT OF TECHNICAL SKILL (E-OSATS): CONSENSUS ON ESSENTIAL IVOR-LEWIS AND MCKEOWN STEPS TROUGH DELPHI METHODOLOGY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Yassin Eddahchouri ◽  
Workum Frans van ◽  
Bastiaan Klarenbeek ◽  
den Wildenberg Frits van ◽  
Berge Henegouwen Mark van ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Learning Curve ◽  
Assessment Tool ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Cervical Anastomosis ◽  
International Consensus ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Specific Objective

Abstract Aim The objective of this study was to determine expert consensus on essential steps in MIE to develop an ‘Esophagectomy-specific Objective Structured Assessment of Technical Skills’ tool (E-OSATS). Background & Methods Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure. Studies have shown that MIE has a long learning curve which is associated with increased morbidity and mortality. To master MIE training of procedural steps is crucial. Yet, no consensus regarding the essential steps nor a structured way of assessment of MIE are available. Essential steps were defined for both Ivor-Lewis (IL) and McKeown (MCK) approach, based on expert opinion and peer-reviewed literature. In round table discussions experts finalized the list, 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 94 and 98 steps for the IL and MCK approach respectively. Cronbach’s alpha in the first round was 0,77 (IL) and 0,77 (MCK), and in the second round 0,91 (IL) and 0,87 (MCK). Conclusion International consensus on essential surgical steps for MIE with both intrathoracic- and cervical anastomosis was achieved. Validation of the assessment tool allows for specific and structured feedback and will potentially shorten the learning curve and decrease learning associated morbidity consequently.

PS01.246: ESOPHAGECTOMY-SPECIFIC OBJECTIVE STRUCTURED ASSESSMENT OF TECHNICAL SKILL (E-OSATS): CONSENSUS ON ESSENTIAL STEPS THROUGH DELPHI METHODOLOGY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 119-119
Author(s):  
Yassin Eddahchouri ◽  
Suzanne Gisbertz ◽  
Mark I Van Berge Henegouwen ◽  
Bastiaan Klarenbeek ◽  
Camiel Rosman
Keyword(s):  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Round Table Discussion ◽  
Cervical Anastomosis ◽  
Invasive Esophagectomy ◽  
Delphi Round ◽  
Specific Objective ◽  
International Experts

Abstract Background Minimally invasive esophagectomy (MIE) is a technically demanding procedure, but without consensus regarding essential steps and assessment of surgical technique. The objective of this study was to determine expert consensus on essential steps in MIE as a first step in the development of an ‘esophagectomy-specific objective structured assessment of technical skills’ tool (E-OSATS). Methods Essential steps were defined for both MIE with intrathoracic- and cervical anastomosis, based on local expert opinion, peer-reviewed literature and surgical textbooks. In round table discussion disparities between experts were resolved, and an online Delphi questionnaire was sent to an international expert panel of minimally invasive upper GI surgeons. Based on replies and comments steps were adjusted and resent in iterative fashion. Results A total of 137 and 138 essential steps were identified for the MIE with intrathoracic- and cervical anastomosis respectively. After the first Delphi round 24 out of 36 (67%) invited international experts replied, and consensus was reached in 99 out of 137 (72%) and 95 out of 138 steps for both procedures respectively. Conclusion A Delphi method seems feasible in determining essential steps as a first step in the development of an E-OSATS for both MIE with intrathoracic- and cervical anastomosis. The second Delphi round is currently pending. Disclosure All authors have declared no conflicts of interest.

scholarly journals Robotic assisted minimally invasive esophagectomy: Ivor-Lewis approach

2021 ◽  
Vol 5 ◽  
pp. 21-21
Author(s):  
Kelsey Musgrove ◽  
Charlotte R. Spear ◽  
Jahnavi Kakuturu ◽  
Britney R. Harris ◽  
Fazil Abbas ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Invasive Esophagectomy

scholarly journals Totally minimally invasive esophagectomy versus hybrid minimally invasive esophagectomy: systematic review and meta-analysis

2020 ◽  
Vol 33 (8) ◽  
Author(s):  
Frans van Workum ◽  
Bastiaan R Klarenbeek ◽  
Nikolaj Baranov ◽  
Maroeska M Rovers ◽  
Camiel Rosman
Keyword(s):  
Sensitivity Analysis ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Meta Analysis ◽  
Leakage Rate ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Lymph Node Count ◽  
Randomized Controlled ◽  
Node Count

Summary Minimally invasive esophagectomy is increasingly performed for the treatment of esophageal cancer, but it is unclear whether hybrid minimally invasive esophagectomy (HMIE) or totally minimally invasive esophagectomy (TMIE) should be preferred. The objective of this study was to perform a meta-analysis of studies comparing HMIE with TMIE. A systematic literature search was performed in MEDLINE, Embase, and the Cochrane Library. Articles comparing HMIE and TMIE were included. The Newcastle–Ottawa scale was used for critical appraisal of methodological quality. The primary outcome was pneumonia. Sensitivity analysis was performed by analyzing outcome for open chest hybrid MIE versus total TMIE and open abdomen MIE versus TMIE separately. Therefore, subgroup analysis was performed for laparoscopy-assisted HMIE versus TMIE, thoracoscopy-assisted HMIE versus TMIE, Ivor Lewis HMIE versus Ivor Lewis TMIE, and McKeown HMIE versus McKeown TMIE. There were no randomized controlled trials. Twenty-nine studies with a total of 3732 patients were included. Studies had a low to moderate risk of bias. In the main analysis, the pooled incidence of pneumonia was 19.0% after HMIE and 9.8% after TMIE which was not significantly different between the groups (RR: 1.46, 95% CI: 0.97–2.20). TMIE was associated with a lower incidence of wound infections (RR: 1.81, 95% CI: 1.13–2.90) and less blood loss (SMD: 0.78, 95% CI: 0.34–1.22) but with longer operative time (SMD:-0.33, 95% CI: −0.59—-0.08). In subgroup analysis, laparoscopy-assisted HMIE was associated with a higher lymph node count than TMIE, and Ivor Lewis HMIE was associated with a lower anastomotic leakage rate than Ivor Lewis TMIE. In general, TMIE was associated with moderately lower morbidity compared to HMIE, but randomized controlled evidence is lacking. The higher leakage rate and lower lymph node count that was found after TMIE in sensitivity analysis indicate that TMIE can also have disadvantages. The findings of this meta-analysis should be considered carefully by surgeons when moving from HMIE to TMIE.

Intraoperative Lipid-Rich Nutrition in the Detection of Chylothorax in Minimally Invasive Ivor Lewis Esophagectomy

2019 ◽  
Vol 26 (5) ◽  
pp. 545-550
Author(s):  
Merel Lubbers ◽  
Marc J. van Det ◽  
Ewout A. Kouwenhoven
Keyword(s):  
Minimally Invasive ◽  
Thoracic Duct ◽  
Minimally Invasive Esophagectomy ◽  
Control Group ◽  
Historical Cohort ◽  
Feeding Jejunostomy ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Rich Solution ◽  
Group A

Background. Chylothorax is a rare but severe complication after esophagectomy with an incidence of 1.9% to 8.9%. The aim of this study was to evaluate the efficacy of intraoperative lipid-rich feeding in reducing the incidence of post-esophagectomy chylothorax. Methods. A retrospective cohort study was performed among patients who underwent totally minimally invasive esophagectomy with intrathoracic anastomosis (tMIE Ivor Lewis) from February 2015 until December 2016. In this group, a lipid-rich solution was administered intraoperatively via a feeding jejunostomy. A historical cohort of identical patients operated in the period December 2012 to February 2015 did not receive intraoperative feeding and was used as a control. Results. In total, 133 patients underwent tMIE Ivor Lewis, of whom 59 patients (44%) received lipid-rich solution intraoperatively. The administered median total volume was 800 mL. During thoracic dissection, the thoracic duct was clearly visible in 37 patients (63%). With the help of lipid-rich feeding, intraoperative unintended duct damage was detected in 3 patients and treated. Postoperatively, 1 out of 59 patients (1.7%) developed chylothorax that was managed nonoperatively. In the control group, chylothorax was seen in 3 out of 74 patients (4.1%), P = .629. Conclusions. Intraoperative lipid-rich solution through a feeding jejunostomy helps identify thoracic duct damage during tMIE and may reduce postoperative chylothorax.

Relationship of drain amylase and anastomotic leak after esophagectomy.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 118-118 ◽  
Author(s):  
Joshua S. Hill ◽  
Erin Marie Hanna ◽  
Susie C. Hurley ◽  
Mark Reames ◽  
Jonathan C. Salo
Keyword(s):  
Minimally Invasive ◽  
Radiation Exposure ◽  
Anastomotic Leak ◽  
Minimally Invasive Esophagectomy ◽  
Locally Advanced ◽  
Chi Square ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Drain Amylase ◽  
Relationship Of

118 Background: Esophagectomy is considered the only curative approach in patients with esophageal cancers without locally advanced or metastasis. Anastomotic leak can lead to significant morbidity and mortality. CT esophagram (CTE) is a sensitive method of evaluating for leak; however this test carries with it financial cost and radiation exposure. This study evaluates the utility of drain amylase in the prediction of anastomotic leak. Methods: Fifty-nine patients underwent esophagectomy between 3/10 and 8/12; serial drain amylases and CTE were obtained in 50. Leak was defined by extravasation of contrast or the presence of empyema on CTE. Elevated drain amylase was defined as any level > 400 IU/L. Chi-square and descriptive statistics were performed and the sensitivity of drain amylase >400 IU/L in predicting leak was calculated. Results: A minimally invasive esophagectomy was performed in 47, and an open Ivor-Lewis in 2 and a minimally invasive Ivor-Lewis in 1. Stapled intra-thoracic anastomoses were performed in 47, 3 had a cervical anastomoses. Average age was 61 years and 84% were males. Leak occurred in 6 patients (12.5%). One patient with a late leak was excluded from analysis as they did not have concurrent drain amylase values. This patient had low amylase levels and a normal CTE, though later presented with leak. The overall peri-operative mortality rate was 4.2% (2/48). Mortality in the non-leak and leak cohorts were 0% & 33%. Drain amylase was an accurate marker of anastomotic leak. Of 6 patients with an elevated drain amylase, 5 had an anastomotic leak (sensitivity 83.3%). 40/41 patients with low drain amylase had no leak. Using a cut-off value of 400 IU/L, the negative predictive value of drain amylase in predicting leak after esophagectomy was 97.6% (95%CI; 85.6, 99.9). Conclusions: Drain amylase is a simple and inexpensive test that has excellent sensitivity and negative prediction for the detection of anastomotic leak after esophagectomy. To our knowledge, this is the first study to demonstrate this finding. Routine evaluation of drain amylase may safely replace CTE in the management of patients after esophagectomy, thus reducing radiation exposure and overall cost.

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