P-OGC16 Minimally Invasive Oesophagectomy: Technique and learning curve over 10 years

Abstract Background The use of minimally invasive oesophagectomy (MIO) in the treatment of patients with oesophageal malignancy has developed since its first description by Cuschieri in 1992, although mainstream uptake of this technique has not been forthcoming. Oncological resection margins were not compromised in MIO, whilst complications and two-year mortality rates improved in MIO compared to open oesophagectomy. The advantages of MIO compared to open surgery include the speed of recovery, improved return to baseline quality of life, better physical function and less pain. We present our experience of MIO including operative technique, tips, and learning curve. Methods 160 patients underwent MIO at Portsmouth Hospitals University NHS Trust between August 2010 and December 2019. After June 2016 there was a significant change in surgical technique and pathway as outlined below and this time point has been interrogated. Primary outcomes were operative duration (minutes) and both 30-day and in-hospital mortality. Secondary outcomes were length of in hospital stay (days), ITU stay, conversion to open surgery and complications. We undertake laparoscopic abdominal phase and thoracoscopic or robotic assisted thoracic phase oeasophagectomy. Dual consultant operating is standard; and we work consistently with the same group of anaesthetists and theatre staff. Results 82.5% of our 160 patients were male, median age was 67 years. Operative duration showed a steep learning curve over the first 10 cases followed by stabilisation to case 56 and then improvement. CUSUM analysis of the anastomotic leaks showed a change point at 53 cases - 30.8% vs 16.7% (p = 0.05). 30-day mortality is 1.88% and median length of stay 12 days (IQR12.75). Complications of Clavien-Dindo ≥III occurred in 35% and “perfect” outcomes in 21.25%. Conversion to open in 5.6% of cases but only 1 in the last 100 patients. Conclusions There is a learning curve associated with the adoption of a new technique. MIO can be performed safely and cost effectively with equivalent oncological outcomes with the advantage of improved quality of life. Oesophageal cancer is still poorly understood and we therefore must spend more thought on how best to give our patients good quality disease free life. Our outcome data is within existing published data and our prospectively collected data is thorough and meticulous. Though some complications are inevitable, small changes lead to marginal gains and add up to better outcomes.

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485 MINIMALLY INVASIVE EN-BLOC OESOPHAGECTOMY: ANALYSIS OF THE OUTCOMES ALONG A LEARNING CURVE

Diseases of the Esophagus ◽

10.1093/dote/doaa087.124 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

F Di Maggio ◽

A Lee ◽

Z Vrakopoulou ◽

H Deere ◽

A Botha

Keyword(s):

Survival Rate ◽

Minimally Invasive ◽

Learning Curve ◽

Hospital Stay ◽

Open Surgery ◽

En Bloc Resection ◽

Bloc Resection ◽

Resection Margins ◽

En Bloc ◽

Minimally Invasive Oesophagectomy

Abstract Minimally invasive oesophagectomy is technically demanding but benefits perioperative morbidity and intra-hospital mortality. We previously described open total adventitial resection of the cardia (TARC) as an optimal anatomical resection technique for lower oesophageal and gastro-esophageal junction cancers. We wanted to investigate whether the peri-operative benefits of minimally invasive techniques, along with en-bloc resection of the primary tumour, translate into long term survival benefit in a specialized high volume center along a surgeon learning curve. Methods Data from 198 consecutive patients undergoing oesophagectomy by a single surgeon was collected prospectively. Patient stratification was made to chronologically reflect four main stages of our learning curve: open surgery, Laparoscopic Ivor Lewis, laparoscopy/thoracoscopy with mini-thoracotomy and laparoscopic TARC. Primary outcomes included five-year survival rate, operating time, hospital stay, specimen lymphnodes. Peri-operative complications and mortality are also described. 45 patients had open surgery; laparoscopy (n = 50) was initiated after two years, and thoracoscopy (n = 56) introduced after case 94. MIO was performed for the last 47 patients. Patients in all groups had similar demographics, histological diagnosis, preoperative and pathological staging. Results 158 patients were male (79.8%); age was 63 +/− 10 years. Overall five-year survival rate was 45%; perioperative mortality rate was 1.5% (n = 3); 13 patients were returned to theatre. Hospital stay was 22+/−23 days. Specimen lymph nodes were 21+/− 8. Resection margins were negative (ACP) in 193 cases (97.4%). Five-year survival rates during the 4 phases were 38.6%, 44.9%, 42.8% and 59% respectively, showing a benefit trend towards the end of the learning curve (p = 0.03). Specimen lymph nodes were: open = 20.5+/−9.5; Lap = 19.5+/− 7; mini-tho = 19.9+/− 7; MIO = 25+/− 10 (p = 0.027). Resection margins were > 1 mm in 68.1%(open), 67.3%(lap), 64.2%(mini-tho) and 79.5(MIO). Conclusion Laparoscopic en-bloc resection of cancers of the OGJ requires a long learning curve. Proficiency gains along this learning curve affects oncological quality of oesophageal resectional surgery and benefits patients survival after minimally invasive oesophagectomy.

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Health-related quality of life after minimally invasive oesophagectomy

British Journal of Surgery ◽

10.1002/bjs.6908 ◽

2010 ◽

Vol 97 (4) ◽

pp. 525-531 ◽

Cited By ~ 64

Author(s):

R. Parameswaran ◽

J. M. Blazeby ◽

R. Hughes ◽

K. Mitchell ◽

R. G. Berrisford ◽

...

Keyword(s):

Quality Of Life ◽

Minimally Invasive ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Minimally Invasive Oesophagectomy

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compare of outcomes of minimally invasive and open surgical techniques in patients with symptomatic lumbar spine stenosis on the background of scoliotic deformity

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17116/vto201904133 ◽

2019 ◽

Vol 26 (4) ◽

pp. 33-42

Author(s):

S. G Mlyavykh ◽

A. E Bokov ◽

A. Ya Aleynik ◽

K. S Yashin

Keyword(s):

Quality Of Life ◽

Lumbar Spine ◽

Blood Loss ◽

Minimally Invasive ◽

Open Surgery ◽

Intraoperative Complications ◽

Scoliotic Deformity ◽

Group 2 ◽

Group 1

Objective: to compare the results of minimally invasive and open surgery in the treatment of the patients with combined symptomatic degenerative stenosis and scoliotic deformity of the lumbar spine. Patients and methods. A retrospective comparative analysis of the long-term results of 54 patients was performed. The patients were devided in two groups: open surgery (group 1, n=39) and minimally invasive surgery (group 2, n=15). Different approaches were used based on the type of deformity (according to Berzhano and Lamartine), localization and extent of lumbar stenosis. The evaluation of volume of decompression, blood loss, time of surgery and postoperative treatment, intraoperative complications, pain and patients condition were measured using clinical scales ODI, ZCQ, SF-12 was performed. Results. No differences in the type of deformity, the severity of stenosis and clinical manifestations between groups were discovered before treatment. All characteristics of the surgery (except the intraoperative complications) - blood loss, duration of surgery, and hospital stay - were significantly less in the minimally invasive group. Postoperative assessment has shown in group 1 greater regression of axial pain syndrome (p=0.03), in group 2 greater regression of radicular syndrome (p=0.03). Assessment of quality of life based on questionnaires after 2 years has revealed no differences between groups. Conclusion. Using of minimally-invasive decompression and decompression-stabilizing surgical technologies in patients with combined stenosis and deformity of the lumbar spine allow to eliminate the syndromes of neural compression, provide sufficient correction of segmental relationships and improve the quality of life.

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O184 MINIMALLY INVASIVE OESOPHAGECTOMY: A LONG LEARNING CURVE FOR BETTER ONCOLOGICAL RESECTION AND IMPROVED SURVIVAL OUTCOME

Diseases of the Esophagus ◽

10.1093/dote/doz092.184 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Francesco Di Maggio ◽

Ai Ru Lee ◽

Harriet Deere ◽

Zoi Vrakopoulou ◽

Abrie Botha

Keyword(s):

Minimally Invasive ◽

Learning Curve ◽

Resection Margins ◽

Anatomical Resection ◽

Term Survival ◽

Ivor Lewis ◽

Long Term Survival ◽

Neo Adjuvant Chemotherapy ◽

Minimally Invasive Oesophagectomy

Abstract Aim We wanted to investigate whether the established perioperative benefits of minimally invasive techniques, along with defined anatomical resection of the primary tumour (TARC), translate into long term survival benefit in a specialized high volume center. Background & Methods Minimally invasive oesophagectomy is technically demanding but benefits perioperative morbidity and intra-hospital mortality. We previously described open total adventitial resection of the cardia (TARC) as an optimal anatomical resection technique for lower oesophageal and gastro-esophageal junction cancers1. Long-term survival outcomes across our learning curve in adopting laparoscopic TARC are hereby assessed. Data from 198 consecutive patients undergoing oesophagectomy by a single surgeon across two institutions was collected prospectively. Patient stratification was made to chronologically reflect four main stages of our learning curve: open surgery, Laparoscopic Ivor Lewis, laparoscopy/thoracoscopy with mini-thoracotomy and laparoscopic TARC. Primary outcomes included five-year survival rate, operating time, hospital stay, specimen lymphnodes. Peri-operative complications and mortality are also described. Results 158 patients were male (79.8%); age was 63 +/- 10 years. 159 (78%) patients had neo-adjuvant chemotherapy. Overall five-year survival rate was 45%; peri-operative mortality rate was 1.5% (n=3). 13 patients were returned to theatre for surgical complications. Hospital stay was 22+/-23 days. Pathological specimen lymphnodes were 21+/- 8 (median: 20). Resection margins were negative (ACP) in 193 cases (97.4%); further than 1mm (RCPath) in 138 cases (69.7%). The first 45 patients had open TARC surgery (26 Ivor Lewis, 17 trans-hiatal, one three-stage and one left thoracotomy). Laparoscopy (n=50) was initiated after two years, and thoracoscopic dissection (n=56) was introduced after case 94. Laparoscopic TARC was performed for the last 47 patients. Patients in the four groups had similar demographics, histological diagnosis, pre-operative and pathological staging, although the ones in the lap TARC group had a lower uptake of neo-adjuvant chemotherapy (64% versus 83%), mainly due to patient choice and co-morbidities. Specimen lymph nodes for the four groups were: open = 20.5 +/-9.5; Lap = 19.5+/- 7; mini-tho = 19.9 +/- 7; lap TARC = 25 +/- 10 (p = 0.027). Resection margins were >1mm in 68.1% (open), 67.3% (lap), 64.2 (mini-tho) and 79.5% (lap TARC). Patients five-year survival rates during the 4 phases of the learning curve were 38.6%, 44.9%, 42.8% and 59% respectively, showing a benefit trend towards the end of the learning curve (p=0.03, log Rank Test). Conclusion Laparoscopic Anatomical resection of cancers of the OGJ requires a long learning curve. The evolution of performance and surgical technique through open and minimally invasive learning phases, along with the progress in oncological science, result in improved long-term survival.

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W1030 Minimally Invasive Oesophagectomy for Cancer Leads to Early Recovery of Health-Related Quality of Life

Gastroenterology ◽

10.1016/s0016-5085(08)62888-7 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-618 ◽

Cited By ~ 2

Author(s):

Rajeev Parameswaran ◽

Jane M. Blazeby ◽

Keith Mitchell ◽

Richard G. Berrisford ◽

Saj Wajed

Keyword(s):

Quality Of Life ◽

Minimally Invasive ◽

Health Related Quality ◽

Early Recovery ◽

Related Quality ◽

Health Related ◽

Minimally Invasive Oesophagectomy

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Colorectal resection in endometriosis patients: correlation between histopathological findings and postoperative outcome

European Journal of Medical Research ◽

10.1186/s40001-021-00484-z ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Peter Tschann ◽

Nikola Vitlarov ◽

Martin Hufschmidt ◽

Daniel Lechner ◽

Paolo N. C. Girotti ◽

...

Keyword(s):

Quality Of Life ◽

Colorectal Resection ◽

Postoperative Outcome ◽

Resection Margins ◽

Pain Level ◽

Histopathological Findings ◽

Vas Score ◽

Reduction Of Pain

Abstract Introduction Endometriosis is associated with a high number of chronic pelvic pain and reduced quality of life. Colorectal resections in case of bowel involvement of endometriosis are associated with an unneglectable morbidity in young and healthy patients. There is no linear correlation established between the degree of symptoms and stage of endometriosis. The aim of this study was to correlate the histological findings to preoperative pain scores in colorectal resected patients with endometriosis. Methods Twenty-five patients who underwent laparoscopic colorectal resection for endometriosis between 2014 and 2019 were included in this retrospective study. Pain level was assessed preoperatively and postoperatively via phone call in May 2020. Histopathology was correlated to preoperative symptoms and postoperative outcome. Results Average follow-up time was 38.68 months (± 19.92). Preoperative VAS-score was 8.32 (± 1.70). We observed a significant reduction of pain level in all patients after surgery (p ≤ 0.005). Pain levels were equal regarding the presence of satellite spots and various degrees of infiltration depth. The resection margins were clear in all patients. Postoperative complications occurred in 6 cases (24%) and anastomotic leakage was observed in 3 patients (12%). Average VAS-score at time of follow-up was 1.70 (± 2.54). Conclusion Our data demonstrate that adequate colorectal resection leads to reduction of pain and an increase of quality of life irrespective of histopathological findings. An experienced team is necessary to improve intraoperative outcome and to reduce postoperative morbidity in case of complication.

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