Variation in the Standard of Minimally Invasive Esophagectomy for Cancer—Systematic Review

Abstract The thoracic phase of minimally invasive esophagectomy was initially performed in the lateral decubitus position (LDP); however, many experts have gradually transitioned to a prone position (PP) approach. The aim of the present systematic review and meta-analysis is to quantitatively compare the two approaches. A systematic literature search of the MEDLINE, Embase, Google Scholar, Web of Knowledge, China National Knowledge Infrastructure and ClinicalTrials.gov databases was undertaken for studies comparing outcomes between patients undergoing minimally invasive esophageal surgery in the PP versus the LDP. In total, 15 studies with 1454 patients (PP; n = 710 vs. LDP; n = 744) were included. Minimally invasive esophagectomy in the PP provides statistically significant reduction in postoperative respiratory complications (Risk ratios 0.5, 95% confidence intervals [CI] 0.34–0.76, P < 0.001), blood loss (weighted mean differences [WMD] –108.97, 95% CI –166.35 to −51.59 mL, P < 0.001), ICU stay (WMD –0.96, 95% CI –1.7 to −0.21 days, P = 0.01) and total hospital stay (WMD –2.96, 95% CI –5.14 to −0.78 days, P = 0.008). In addition, prone positioning increases the overall yield of chest lymph node dissection (WMD 2.94, 95% CI 1.54–4.34 lymph nodes, P < 0.001). No statistically significant difference in regards to anastomotic leak rate, mortality and 5-year overall survival was encountered. Subgroup analysis revealed that the protective effect of prone positioning against pulmonary complications was more pronounced for patients undergoing single-lumen tracheal intubation. A head to head comparison of minimally invasive esophagectomy in the prone versus the LDP reveals superiority of the former method, with emphasis on the reduction of postoperative respiratory complications and reduced length of hospitalization. Long-term oncologic outcomes appear equivalent, although validation through prospective studies and randomized controlled trials is still necessary.

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Learning curves in minimally invasive esophagectomy: A systematic review and evaluation of benchmarking parameters

Surgery ◽

10.1016/j.surg.2021.10.050 ◽

2021 ◽

Author(s):

Pooja Prasad ◽

Lauren Wallace ◽

Maziar Navidi ◽

Alexander W. Phillips

Keyword(s):

Systematic Review ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Learning Curves ◽

Invasive Esophagectomy

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Micronutrient Deficiencies Following Minimally Invasive Esophagectomy for Cancer

Nutrients ◽

10.3390/nu12030778 ◽

2020 ◽

Vol 12 (3) ◽

pp. 778

Author(s):

Henricus J.B. Janssen ◽

Laura F.C. Fransen ◽

Jeroen E.H. Ponten ◽

Grard A.P. Nieuwenhuijzen ◽

Misha D.P. Luyer

Keyword(s):

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Survival Rates ◽

Micronutrient Deficiencies ◽

Postoperative Evaluation ◽

Invasive Esophagectomy ◽

Resectable Esophageal ◽

Resectable Esophageal Cancer ◽

Esophagectomy For Cancer

Over the past decades, survival rates for patients with resectable esophageal cancer have improved significantly. Consequently, the sequelae of having a gastric conduit, such as development of micronutrient deficiencies, become increasingly apparent. This study investigated postoperative micronutrient trends in the follow-up of patients following a minimally invasive esophagectomy (MIE) for cancer. Patients were included if they had at least one postoperative evaluation of iron, ferritin, vitamins B1, B6, B12, D, folate or methylmalonic acid. Data were available in 83 of 95 patients. Of these, 78.3% (65/83) had at least one and 37.3% (31/83) had more than one micronutrient deficiency at a median of 6.1 months (interquartile range (IQR) 5.4–7.5) of follow-up. Similar to the results found in previous studies, most common deficiencies identified were: iron, vitamin B12 and vitamin D. In addition, folate deficiency and anemia were detected in a substantial amount of patients in this cohort. At 24.8 months (IQR 19.4–33.1) of follow-up, micronutrient deficiencies were still common, however, most deficiencies normalized following supplementation on indication. In conclusion, patients undergoing a MIE are at risk of developing micronutrient deficiencies as early as 6 up to 24 months after surgery and should therefore be routinely checked and supplemented when needed.

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