FA04.03: MIE VERSUS RAMIE: PROMISING RESULTS OF A SINGLE-CENTER AND SINGLE-SURGEON ANALYSIS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 8-8
Author(s):  
Peter Grimminger ◽  
Evangelos Tagkalos ◽  
Edin Hadzijusufovic ◽  
Benjamin Babic ◽  
Hauke Lang
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Demographic Data ◽  
Circular Stapler ◽  
Reconstruction Technique ◽  
Invasive Esophagectomy ◽  
Icu Stay

Abstract Background Robot assisted surgery for esophageal cancer is rapidly increasing, especially high-volume centers with access to a robot. The fully robotic minimally invasive esophagectomy using 4 robotic arms in the abdomen and thorax (RAMIE4) is performed as standard procedure in our department. In this analysis we compare the results of our first 50 RAMIE4 procedures with our last 50 fully minimally-invasive esophagectomies (MIE), which was our standard prior the robotic era. Methods Between April 2016 and March 2018, the data from 100 consecutive patients with esophageal carcinoma undergoing modified Ivor-Lewis esophagectomy, performed by the same surgeon using the identical intrathoracic anastomotic reconstruction technique (circular stapler). 50 patients were treated with MIE and the other 50 with RAMIE4. Demographic data, extracted lymph nodes and R-status were compared. Complications occurred were compered according to the Dindo-Clavien classification. Results Demographic data did not show significant differences between the groups. The overall 30- and 90- mortality rates were 1% (1/100) and 3% (3/100) respectively (P = 0.305 and P = 0.499 respectively). In the RAMIE group the median lymph node harvest was significantly higher (27 vs. 23; P = 0.045), the median hospital stay was less in the RAMIE group, however not significantly (11.5d vs 13d; P = 0.112), the median ICU stay was significantly lower in the RAMIE group compared to MIE (1d vs 2.5d; P = 0.002). The complications according to the Dindo-Calvien classification were not significantly different between the two groups (P = 0.091). Conclusion In this study we were able to demonstrate the superiority of robotic assisted lymph node dissection for esophageal cancer surgery in a highly comparable setting. In addition the perioperative parameters, especially ICU stay seem to be in favor of RAMIE. The future potential of standardized RAMIE and RAMIE4 seems to be high. Disclosure All authors have declared no conflicts of interest.

Robot-assisted minimally invasive esophagectomy (RAMIE) compared to conventional minimally invasive esophagectomy (MIE) for esophageal cancer: a propensity-matched analysis

2019 ◽  
Vol 33 (4) ◽  
Author(s):  
E Tagkalos ◽  
L Goense ◽  
M Hoppe-Lotichius ◽  
J P Ruurda ◽  
B Babic ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Propensity Score ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Minimally Invasive Esophagectomy ◽  
Reconstruction Technique ◽  
Robot Assisted ◽  
Invasive Esophagectomy ◽  
Icu Stay

SUMMARY Robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly being applied as treatment for esophageal cancer. In this study, the results of 50 RAMIE procedures were compared with 50 conventional minimally invasive esophagectomy (MIE) operations, which had been the standard treatment for esophageal cancer prior to the robotic era. Between April 2016 and March 2018, data of 100 consecutive patients with esophageal carcinoma undergoing modified Ivor Lewis esophagectomy were prospectively collected. All operations were performed by the same surgeon using an identical intrathoracic anastomotic reconstruction technique with the same perioperative management and pain control regimen. Intra-operative and postoperative complications were graded according to definitions stated by the Esophagectomy Complications Consensus Group. Data analysis was carried out with and without propensity score matching. Baseline characteristics did not show significant differences between the RAMIE and MIE group. Propensity score matching of the initial group of 100 patients resulted in two equal groups of 40 patients for each surgical approach. In the RAMIE group, the median total lymph node yield was 27 (range 13–84) compared to 23 in the MIE group (range 11–48), P = 0.053. Median intensive care unit (ICU) stay was 1 day (range 1–43) in the RAMIE group compared to 2 days (range 1–17) in the MIE group (P = 0.029). The incidence of postoperative complications was not significantly different between the two groups (P = 0.581). In this propensity-matched study comparing RAMIE to MIE, ICU stay was significantly shorter in the RAMIE group. There was a trend in improved lymphadenectomy in RAMIE.

VS01.02: MEDIASTINAL LYMPH NODE DISSECTION DURING MINIMAL INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 44-44
Author(s):  
Hirokazu Noshiro ◽  
Yukie Yoda
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Minimally Invasive ◽  
Prone Position ◽  
Lymph Node Dissection ◽  
Conflicts Of Interest ◽  
Mediastinal Lymph Node ◽  
Mediastinal Lymph Node Dissection ◽  
Node Dissection ◽  
Invasive Esophagectomy

Abstract Description As esophageal cancer reveals aggressive characteristics of lymph node metastasis, esophagectomy with extensive lymph node dissection is required as the optimal management in most cases. In spite of improvements in the survival rate, however, the procedure is still associated with significant postoperative morbidity and mortality. As minimally invasive surgery reduces both pain and the systemic inflammatory response, minimally invasive esophagectomy has been developed in an obvious attempt to reduce the incidence of postoperative complications. In addition, the magnified and clear views by thoracoscopy accelerate recognition for the fine and minute surgical anatomy of the mediastinum. Thoracoscopic mobilization of the esophagus and mediastinal lymph node dissection as part of a three-stage procedure was reported in the early 1990s. Recently, thoracoscopic esophageal mobilization and mediastinal dissection in the prone position has been developed. Enhanced visualization and improved ergonomics for surgeons in the prone position provide higher-quality mobilization and lymphadenectomy and contribute to enhancement of the learning curve. Especially, it is favorable during the procedures of upper mediastinal lymph node dissection which are the most complicated ones. During this lymph node dissection, the concept of lymphatic flow is very important. Now, it takes 3 hours and 15 minutes for the thoracic procedure, but the blood loss is less than 100 ml in our recent series. In the presentation, the surgical procedures of thoracoscopic or robotically-assisted esophagectomy in the prone position for esophageal cancer will be demonstrated and our surgical results of over 300 cases will be shown. Disclosure All authors have declared no conflicts of interest.

PS01.220: COMPARISON OF SHORT-TERM OUTCOMES BETWEEN RAMIE AND VAMIE IN TREATMENT MIDDLE THORACIC ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 112-112
Author(s):  
Yidan Lin ◽  
Hanyu Deng
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Operation Time ◽  
Short Term ◽  
Thoracic Esophageal Cancer ◽  
Comparable Rate ◽  
Invasive Esophagectomy

Abstract Background Whether robot-assisted minimally invasive esophagectomy (RAMIE) has any advantages over video-assisted minimally invasive esophagectomy (VAMIE) remains controversial. In this study, we tried to compare the short-term outcomes of RAMIE with that of VAMIE in treating middle thoracic esophageal cancer from a single medical center. Methods Consecutive patients undergoing RAMIE or VAMIE for middle thoracic esophageal cancer from April 2016 to April 2017 were prospectively included for analysis. Baseline data and pathological findings as well as short-term outcomes of these two group (RAMIE group and VAMIE group) patients were collected and compared. A total of 84 patients (RAMIE group: 42 patients, VAMIE group: 42 patients) were included for analysis. Results The baseline characteristics between the two groups were comparable. RAMIE yielded significantly larger numbers of total dissected lymph nodes (21.9 and 17.8, respectively; P = 0.042) and right recurrent laryngeal nerve (RLN) lymph nodes (2.1 and 1.2, respectively; P = 0.033) as well as abdominal lymph nodes (10.8 and 7.7, respectively; P = 0.041) than VAMIE. Even though RAMIE may consume more overall operation time, it could significant decrease total blood loss compared to VAMIE (97 and 161 ml, respectively; P = 0.015). Postoperatively, no difference of the risk of major complications or hospital stay was observed between the two groups. Conclusion RAMIE had significant advantage of lymphadenectomy especially for dissecting RLN lymph nodes over VAMIE with comparable rate of postoperative complications. Further randomized controlled trials are badly needed to confirm and update our conclusions. Disclosure All authors have declared no conflicts of interest.

PS02.018: MINIMALLY INVASIVE ESOPHAGECTOMY (MIE): FROM HYBRID, TO FULLY MINIMALLY-INVASIVE (MIE) AND TO ROBOTIC ASSISTED MIE (RAMIE): A SINGLE SURGEON ANALYSIS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 125-125
Author(s):  
Evangelos Tagkalos ◽  
Edin Hadzijusufovic ◽  
Florian Matthias Corvinus ◽  
Benjamin Babic ◽  
Hauke Lang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Lymph Nodes ◽  
Esophageal Carcinoma ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Demographic Data ◽  
Tumor Stage ◽  
Western World ◽  
Robotic Assisted ◽  
Invasive Esophagectomy

Abstract Background The incidence of esophageal carcinoma is increasing in the western world and esophageal resection is the essential therapy depending on the tumor stage. Several studies report advantages of minimally invasive esophagectomies (MIE) versus conventional open procedures. The use of totally MIE (thoraco- and laparoscopic) or robotic assisted MIE (RAMIE) compared to the hybrid approaches remain unclear. Methods Between July 2015 and August 2017, the data of 75 patients with esophageal carcinoma were prospectively registered. 25 were treated with a hybrid MIE (hybrid), another 25 with a totally MIE (MIE) and another 25 with a robotic assisted MIE (RAMIE). All patients were operated by the same specialized surgeon in our center. Demographic data), duration of total hospital- and intensive-care-stay (ICU), number of remote lymph nodes and histopathological R-status, as well as operating times were compared. The complications were assessed according to the Dindo-Clavien classification. Results The overall 30- and 90-day mortality rate were 0% and 1.33% (1/75) respectively. Hospital stay (P = 0.262), ICU stay (P = 0.079), number of resected lymph nodes (P = 0.863) and R status (P = 0.132) did not differ significantly between the groups. However more pneumonias and wound infections (P = 0.046 and P = 0.003 respectively) were found in the hybrid group when compared to the minimally invasive group (MIE und RAMIE). Conclusion Although the MIE as well as the RAMIE group contained the first 25 patients treated in this clinic with this procedures, comparable results with regard to oncological outcomes and morbidity could be achieved. Additionally the minimally invasive approaches seem to be assosiated with low occurence of pneumonia and wound infects. Disclosure All authors have declared no conflicts of interest.

PS01.225: SINGLE HOLE PNEUMOPERITONEUM COMBINED WITH LAPAROSCOPIC RADICAL MASTECTOMY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 114-114
Author(s):  
Hua Tang ◽  
Kenan Huang ◽  
Xinyu Ding ◽  
Bin Wu ◽  
Zhifei Xu
Keyword(s):  
Esophageal Cancer ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Operative Time ◽  
Conflicts Of Interest ◽  
Single Port ◽  
Minimally Invasive Esophagectomy ◽  
Radical Mastectomy ◽  
Invasive Esophagectomy ◽  
Laparoscopic Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) has been an alternative treatment for esophageal cancer. The objective of this study is to evaluate the safety and feasibility of single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy for esophageal cancer. Methods Retrospective analysis of clinical data was performed on 12 patients with esophageal cancer who underwent a single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy by one surgical team in Shanghai Changzheng hospital. Recorded outcome measures included operative time, blood loss, length of hospital stay, and perioperative complications. Results No perioperative mortality, pulmonary infection, arrhythmia, recurrent laryngeal nerve (RLN) palsy and thoracic duct injury was observed in all patients. The operative time, intraoperative blood loss and pressure of CO2 was (219 ± 9.3)min, (26.3 ± 2.7)ml and (50.5 ± 4.6)mmHg. The mean number of dissected thoracic lymph nodes was 19 ± 1.5. One patient was converted to open surgery because of massive bleeding intraoperation. Two patients occurred postoperative anastomotic leakage. Conclusion A single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy provides safe and feasible approach to minimally invasive esophagectomy for patients with early esophageal cancer. Disclosure All authors have declared no conflicts of interest.

VS01.01: STEP BY STEP INSTRUCTIONAL VIDEO OF MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER FOR SURGEONS-IN-TRAINING IN A SINGAPORE INSTITUTION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 44-44
Author(s):  
Aung Myint Oo
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Postgraduate Training ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Instructional Video ◽  
Instructional Videos ◽  
Invasive Esophagectomy ◽  
Residency Programme

Abstract Description Tan Tock Seng Hospital is second largest hospital in Singapore. It is affiliated to two medical schools in Singapore and it is a training hospital for both undergraduate and postgraduate training. Minimally Invasive Esophagectomy for esophageal cancer is more and more popular nowadays. In our department, all the residents have to view the step by step instructional videos of mininally invasive surgeries before they can assist in the cases. The viewing of the instructional videos help them with better understanding of the procedures. The viewing of videos help them with the importance of steps, standardization of steps. With the help of instructional video, they can not only assist better in the surgery but also reduce the learning curve when they start doing the procedure themselves after the graduation from the residency programme. This is the step by step instructional video of minimally invasive esophagectomy for surgeons-in-training rotated to our department. To view the video please follow this link: https://www.dropbox.com/sh/3azfkz37x7zh6z8/AABXRSxJUhhtWlEA0Eo2p599a?dl=0 Disclosure All authors have declared no conflicts of interest.

VS03.08: ANASTOMOTIC TECHNIQUES FOR MINIMALLY INVASIVE TRANSTHORACIC ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 49-49
Author(s):  
Daniele Bernardi ◽  
Emanuele Asti ◽  
Luigi Bonavina
Keyword(s):  
Minimally Invasive ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Circular Stapler ◽  
Linear Stapler ◽  
Invasive Esophagectomy ◽  
Orotracheal Tube ◽  
Wound Retractor ◽  
Mini Thoracotomy

Abstract Description Minimally invasive esophagectomy has the potential to reduce the incidence of pulmonary complications and postoperative pain. This video shows two safe and reproducible technical variants for thoracoscopic stapled anastomosis. The patient is placed in a left semi-prone position after induction of anesthesia with a single lumen orotracheal tube. Triportal access and low-pressure pneumothorax (8 mmHg) are used for the procedure. Once circumferential mobilization of the esophagus is completed, intraoperative ultrasonography is performed to identify a previously placed endoscopic metal clip marking the upper tumor level. The esophagus is safely transected above this level. An end-to-side intra-corporeal esophagogastric anastomosis is performed. Technique A. The esophagus is stapled with a 60 mm cartridge (EndoGIA™ Tri-Staple™ purple). The anvil of a 25 mm circular stapler (OrVil™) is inserted transorally and retrieved through a small hole in the esophageal stump. Technique B. The 25 mm anvil is inserted through a transverse esophagotomy with a 7 cm long 2–0 polypropylene suture attached to the sharp tip. The suture is passed from inside to outside of the esophageal lumen. The esophagus is then divided distal to the anvil with an linear stapler. At this point, the anvil is pulled out with a gentle traction close to the stapled line. In both techniques, the circular stapler is introduced into the chest cavity through a mini-thoracotomy at the level of lowermost trocar and a wound retractor (Alexis™) is used. The head of the circular stapler, sealed with a surgical glove cutted at the middle finger, is then introduced into the gastric tube through a small gastrotomy on the lesser curvature. The tip of the gastric tube is perforated close to the greater curvature and engage the esophageal anvil. After checking the doughnut, transection of the remnant gastric tube is completed with a linear stapler and the specimen is retrieved through the mini-thoracotomy. Disclosure All authors have declared no conflicts of interest.

scholarly journals Does Circular Stapler Size in Surgical Management of Esophageal Cancer Affect Anastomotic Leak Rate? 4-Year Experience of a European High-Volume Center

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3474
Author(s):  
Dolores T. Müller ◽  
Benjamin Babic ◽  
Veronika Herbst ◽  
Florian Gebauer ◽  
Hans Schlößer ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Minimally Invasive Esophagectomy ◽  
Circular Stapler ◽  
High Volume ◽  
Time Frame ◽  
Invasive Esophagectomy ◽  
Quality Of Surgery ◽  
The Individual

Anastomotic leak is one of the most severe postoperative complications and is therefore considered a benchmark for the quality of surgery for esophageal cancer. There is substantial debate on which anastomotic technique is the best for patients undergoing Ivor Lewis esophagectomy. Our standardized technique is a circular stapled anastomosis with either a 25 or 28 mm anvil. The aim of this study was to retrospectively analyze whether the stapler diameter had an impact on postoperative anastomotic leak rates during a 4-year time frame from 2016 to 2020. A total of 632 patients (open, hybrid, and totally minimally invasive esophagectomy) met the inclusion criteria. A total of 214 patients underwent an anastomosis with a 25 mm stapler vs. 418 patients with a 28 mm stapler. Anastomotic leak rates were 15.4% vs. 10.8%, respectively (p = 0.0925). Stapler size should be chosen according to the individual anatomical situation of the patient. Stapler size may be of higher relevance in patients undergoing totally minimally invasive reconstruction.

PS02.023: SINGLE-INCISION MINIMALLY INVASIVE ESOPHAGECTOMY FOR TREATING ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 126-126
Author(s):  
Jang-Ming Lee ◽  
Sunn-Mao Yang ◽  
Pei-Ming Huang
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Single Incision ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Vocal Cord Palsy ◽  
Pulmonary Complications ◽  
Invasive Esophagectomy ◽  
Matched Comparison

Abstract Background Single-incision throacoscopic and laparoscopic procedure has been applied to treating various diseases. In the current study, we applied this novel surgical technique in the minimally invasive esophagectomy for esophageal cancer. Methods Minimally invasive esophagectomy (MIE) with single-port approach in the thoracoscopic and laparoscopic procedures was attempted for patients with esophageal cancer. Patients with esophageal cancer who underwent MIE from 2006 to 2016 were evaluated. A 3–4 cm incision was created both in the thoracoscopic and the laparoscopic phases during the single-incision MIE procedures. A propensity-matched comparison was made between the two groups of patients with single-incision and multi-incision MIE. Results We analyzed a total of 48 pairs of patients with propensity-matched from the cohort of 360 patients undergoing MIE during 2006–2015. There were 12 patients having postoperative complications (25%), including 4 (8.3%) of anastomotic leakage one (2.1%) of pulmonary complications and 3 (6.3%) with vocal cord palsy in the patients undergoing single-incision MIE (SIMIE). There is no statistical difference in terms of postoperative ICU and hospital stay, number of dissected lymph nodes and presence of major surgical complications (anastomotic leakage and pulmonary complications) between the two groups of patients. The pain score one week after surgery was significantly lower in the single-incision group (P < 0.05). There was no surgical mortality in the single-incision MIE group. Conclusion Minimally invasive esophogectomy performed with a single-incision approach is feasible for treating patients with esophageal cancer, with a comparable perioperative outcome with that of multi-incision approaches. The postoperative pain one week after surgery was significantly reduced in patients undergoing single-incision MIE. Disclosure All authors have declared no conflicts of interest.

Short- and long-term outcomes in patients operated with total minimally invasive esophagectomy for esophageal cancer

2021 ◽  
Author(s):  
Tobias Hauge ◽  
Dag T Førland ◽  
Hans-Olaf Johannessen ◽  
Egil Johnson
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
University Hospital ◽  
Long Term Results ◽  
Resection Margins ◽  
Invasive Esophagectomy ◽  
Short And Long Term

Summary At our hospital, the main treatment for resectable esophageal cancer (EC) has since 2013 been total minimally invasive esophagectomy (TMIE). The aim of this study was to present the short- and long-term results in patients operated with TMIE. This cross-sectional study includes all patients scheduled for TMIE from June 2013 to January 2016 at Oslo University Hospital. Data on morbidity, mortality, and survival were retrospectively collected from the patient administration system and the Norwegian Cause of Death Registry. Long-term postoperative health-related quality of life (HRQL) and level of dysphagia were assessed by patients completing the following questionaries: EORTC QLQ-OG25, QLQ-C30, and the Ogilvie grading scale. A total of 123 patients were included in this study with a median follow-up time of 58 months (1–88 months). 85% had adenocarcinoma, 15% squamous cell carcinoma. Seventeen patients (14%) had T1N0M0, 68 (55%) T2-T3N0M0, or T1-T2N1M0 and 38 (31%) had either T3N1M0 or T4anyNM0. Ninety-eight patients (80%) received neoadjuvant (radio)chemotherapy and 104 (85%) had R0 resection. Anastomotic leak rate and 90-days mortality were 14% and 2%, respectively. The 5-year overall survival was 53%. Patients with tumor free resection margins of &gt;1 mm (R0) had a 5-year survival of 57%. Median 60 months (range 49–80) postoperatively the main symptoms reducing HRQL were anxiety, chough, insomnia, and reflux. Median Ogilvie score was 0 (0–1). In this study, we report relatively low mortality and good overall survival after TMIE for EC. Moreover, key symptoms reducing long-term HRQL were identified.

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