FA04.04: IMPORTANT STEPS AND FIRST RESULTS OF FULLY ROBOTIC IVOR-LEWIS ESOPHAGEAL RESECTION (RAMIE4) FOR ESOPHAGEAL AND ESOPHAGOGASTRIC JUNCTION CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 8-9
Author(s):  
Peter Grimminger ◽  
Edin Hadzijusufovic ◽  
Benjamin Babic ◽  
Florian Matthias Corvinus ◽  
Hauke Lang
Keyword(s):  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
High Volume ◽  
Esophageal Resection ◽  
Minimal Invasive ◽  
Robotic Arms ◽  
Invasive Esophagectomy ◽  
Advantages And Disadvantages ◽  
First Results ◽  
Future Potential

Abstract Background Robotic-assisted surgery is increasing, especially in general tumor surgery. Minimal-invasive esophagectomy (MIE) is commonly the standard operation procedure in high-volume centers. Also the fully robotic minimally invasive esophagectomy using 4 robotic arms in the abdomen and thorax (RAMIE4) is performed more frequent. The advantages of RAMIE4 as well as advantages and disadvantages of special steps in the procedure and reconstruction are not clear so far and are under comparison with other MIE techniques. Methods Form January 2017 until March 2018 we prospectively collect the first 50 fully robotic RAMIE4 cases performed by one specialized surgeon and additionally the 50 MIE cases performed by the same surgeon between 2016 and 2017. Results At the meeting we will present our RAMIE4 results of the first 50 cases operated by one specialized surgeon and compare those results with the 50 MIE cases of the same surgeon. Additionally essential steps of the RAMIE4 procedure will be presented. Conclusion In our opinion RAMIE4 is feasible and offers great potential, especially for lymph node dissection, surgical precision, future potential, teaching and advanced ergonomics. The overall advantages have to be proven in randomized trials by specialized surgeons in MIE and RAMIE. Disclosure All authors have declared no conflicts of interest.

PS02.234: POSTOPERATIVE PNEUMONIA AFTER ESOPHAGEAL RESECTION: DO WE NEED PROPHYLCATIC ANTIBIOTICS FOR PREVENTION?

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 188-188
Author(s):  
Tina Maghsoudi ◽  
Anke Wilhelm ◽  
Michael Beumer ◽  
Karl Oldhafer
Keyword(s):  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Prophylactic Antibiotic ◽  
Esophageal Resection ◽  
Minimal Invasive ◽  
Pulmonary Complications ◽  
Postoperative Pneumonia ◽  
Single Shot ◽  
Invasive Esophagectomy

Abstract Background Postoperative pulmonary complications are a common course of serious morbidity after esophageal resection. In literature rates of pneumonia are quoted up to 38%. Recent studies showed that minimally invasive esophagectomy could reduce this to 9 to 15%, but is this the only approach to lower the incidence of postoperative pneumonia? Methods We analysed our data from esophagectomies performed in our department between 2014 to 2017. Only procedures with thoracotomy due to malignancies were included. All patients received a single shot dose of piperacillin/tazobactam repeated after 4 hours during operation. Bronchoscopy was performed intraoperatively with bronchial toilet. Patients at risk (COPD or viscous secretion) recieved antibiotics for further 7 days. If postoperatively elevation of CRP or leucocytes ocurred, thorax CT scan was performed. Only when pulmonary infiltrates were visible pneumonia was diagnosed. Results 151 operations due to esophageal cancer were performed. Extended gastrectomies, minimal invasive esophagectomies with thoracoscopy and transhiatal resections were excluded. Only Ivor-Lewis resectios (108), McKeown resections (8) and colon interpositions (2) were analysed. The all over pneumonia rate was 13,6% (16 patients). The 30 day mortality was 2,5%. None of the patients died due to pneumonia. Conclusion To reduce postoperative pneumonia rates is an important aim in esophageal surgery. Latest data showed that minimally invasive surgery is adequate to achieve this. But not every patient is suitable for this procedure. From our single center experience we could show that also intraopereative bronchial toilet together with prophylactic antibiotic therapy could achieve good results. Disclosure All authors have declared no conflicts of interest.

PS02.012: AN IMPORTANT COMPLICATION OF MINIMALLY INVASIVE ESOPHAGECTOMIES: HIATAL HERNIA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 123-123
Author(s):  
Atila Eroglu ◽  
Yener Aydin ◽  
Ali Ulas ◽  
Coskun Daharli
Keyword(s):  
Minimally Invasive ◽  
Hospital Stay ◽  
Hiatal Hernia ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Length Of Hospital Stay ◽  
Esophageal Resection ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
The Mean

Abstract Background Development of hiatal hernia after esophageal resection is a known complication. However, due to the spread of minimally invasive esophagectomy, complications of hiatal hernia seems to increase. This study aimed to present our cases with hiatal hernia after Ivor Lewis minimally invasive esophagectomy. Methods After Ivor Lewis minimally invasive esophagectomy, five cases of hiatal hernia were observed. Patients' age, sex, symptoms, diagnosis, herniated organs, surgical method, morbidity and mortality rates and hospital stay were reviewed. Results Three of the patients were male and two were female. The mean age of the patients was 56.2 years (35–71 years). Hiatal hernia was detected after an average of 1.4 years with minimal invasive esophagectomies (5 months, 1 year, 1 year, 18 months and 3 years respectively). Three of the cases were symptomatic and two cases were asymptomatic. Thorax CT was used in all cases, and two cases were additionally imaged with barium esophagography. Herniated organs were: omentum in 5 cases, transverse colon in 4 cases, small bowel in two cases. All cases were laparoscopically approached. Diaphragmatic defects were repaired using nonabsorbable sutures in all cases. No complication and mortality was observed in patients. The mean length of hospital stay was 4.9 days (range, 3 to 10 days). Conclusion Hiatal hernia is more frequently seen in minimally invasive esophagectomies than open esophagectomies. Patients undergoing minimal esophagectomy should be closely monitored for hiatal hernia postoperatively. These cases can also be treated by minimally invasive laparoscopy. Disclosure All authors have declared no conflicts of interest.

PS02.250: PREEMPTIVE ENDOSCOPIC VACUUM DRAINAGE TO PREVENT ANASTOMOTIC LEAKAGE IN UPPER-GI SURGERY: A GAME-CHANGING TECHNOLOGY?

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 194-194
Author(s):  
Henner M Schmidt ◽  
Diana Vetter ◽  
Christoph Gubler ◽  
Piero Valli ◽  
Bernhard Morell ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Case Series ◽  
Gastric Surgery ◽  
Safe Procedure ◽  
Comprehensive Complication Index ◽  
Invasive Esophagectomy ◽  
Upper Gi ◽  
Primary Endpoints

Abstract Background Anastomotic leak (AL) remains a major cause of morbidity in upper-GI surgery. In many centers, endoluminal vacuum drainage (EVD) has become the mainstay of therapy for AL after esophageal and gastric resections. A new idea is to use the EVD technology in a preemptive setting. In this context, we present a case series of patients that received PEVD upon completion of the anastomosis during esophago-gastric surgery. Methods Intraoperative PEVD was performed in 10 consecutive patients undergoing minimally invasive esophagectomy with cervical (n = 1) or high intrathoracic (n = 6) anastomosis, and open transhiatally extended (n = 1) or minimally invasive (n = 2) total gastrectomy. The EVD device was removed after three to six (mean 4) days, and the anastomosis was endoscopically inspected for ischemia and AL. Additional contrast radiography, computed tomography, or gastroscopy to exclude AL was performed in seven patients. Primary endpoints in this retrospective series was AL; secondary endpoints were the postoperative morbidity measured by the Clavien-Dindo (CD) classification and the comprehensive complication index (CCI), all at 30 days after surgery. Results Perioperative mortality was 0% with uneventful anastomotic healing in all patients of this series (AL rate 0%, anastomotic stenosis 0%). There were no adverse events attributable to PEVD. None of the patients experienced major morbidity (> CD grade IIIa) during the postoperative course. The median postoperative ICU and hospital stay was 1 (IQR 1-1.75) and 14 (IQR 12-16) days, respectively. Five patients (50%) developed at least one complication, mostly related to infection (2 patients) and pulmonary events (2 patients). The mean CCI at 30 days after surgery was 13.7 (range 0-39.5). Conclusion PEVD appears to be a safe procedure that may emerge as a groundbreaking technology in patients undergoing esophageal or gastric resection. Further research is needed to elucidate the true potential of this technique. Disclosure All authors have declared no conflicts of interest.

PS01.159: THE IMPROVED POSTOPERATIVE RECOVERY OUTCOMES FROM MINIMALLY INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 94-94
Author(s):  
Xiaobin Zhang ◽  
Zhigang Li
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Conflicts Of Interest ◽  
Perioperative Complications ◽  
Minimally Invasive Esophagectomy ◽  
Postoperative Recovery ◽  
Open Group ◽  
Recurrent Nerve ◽  
Invasive Esophagectomy ◽  
Open Esophagectomy

Abstract Background The minimally invasive esophagectomy (MIE) has been developed in the past three decades. In our institution, the MIE was first introduced in 2012, and the proportion of MIE was used for over 70% in 2016–2017. This study aimed to compare the postoperative recovery outcomes between MIE and open esophagectomy in different period. Methods A total of 725 patients were enrolled in this study including 248 patients who underwent open esophagectomy within 2012–2013 and 477 patients who underwent MIE within 2016–2017. All patients received McKeown esophagectomy with two-field lymphadenectomy. And the perioperative complications were recorded according to the Esophagectomy Complications Consensus Group (ECCG) complication definitions. Results There was no statistically difference between OPEN and MIE groups with regard to preoperative characters except for age (60.8 ± 7.2 vs. 62.7 ± 7.7, P < 0.001) and body mass index (22.4 ± 3.0 vs. 23.1 ± 3.0, P = 0.002). One (0.2%) patient in the MIE group died within 90 days from anastomotic leakage, compared to 6 (2.4%) patients in the OPEN group (P = 0.004). The length of hospital stay was shorter in the MIE group (11 range 6–131 days, vs. 15 range 9–164 days, P < 0.001). The MIE group was in favor of lower complications (32.3% vs. 46.4%, P < 0.001). Pneumonia was the most common complications in both groups (12.6% in MIE vs. 27.4% in OPEN, P < 0.001). 15 (3.1%) patients in the MIE group experienced atrial arrhythmias compared with 30 (12.1%) in the OPEN group (P < 0.001). Lower anastomotic leakage was noted in the MIE group (11.5% vs. 25.4%, P < 0.001), as well as the wound infection (0.2% vs. 2.8%, P = 0.001), than in the OPEN group. The recurrent nerve injury was higher in the MIE group (11.7% vs. 6.5%, P = 0.024) but with more lymph nodes dissection along the recurrent laryngeal nerve (3.8 ± 2.8 vs. 1.4 ± 2.0, P < 0.001). Conclusion The MIE was associated with better postoperative recovery outcomes and lower mortality. MIE technique should be considered as the mainstay surgical treatment for esophageal cancer in the current and future period. Disclosure All authors have declared no conflicts of interest.

PS01.219: SINGLE-PORT THORACOSCOPIC MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 112-112
Author(s):  
Yong Yuan
Keyword(s):  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Single Port ◽  
Minimally Invasive Esophagectomy ◽  
Operation Time ◽  
Surgical Instruments ◽  
Thoracoscopic Esophagectomy ◽  
Invasive Technique ◽  
Invasive Approach ◽  
Invasive Esophagectomy

Abstract Background This study was conducted to optimize the surgical procedures for single-port thoracoscopic esophagectomy, and to explore its potential advantages over multi-port minimally invasive esophagectomy. Methods For single-port thoracoscopic esophagectomy, the patient was placed in left lateral-prone position and a 4-cm incision through the 4th-5th intercostal space was taken on the postaxillary line. The 10-mm camera and two or three surgical instruments were used for the VATS esophagectomy and radical mediastinal lymph node dissection. The camera position was different for the upper and lower mediastinal regions. Mobilization of stomach was conducted via multiple-port laparoscopic approach. Cervical end-to-side anastomosis was completed by hand-sewn procedures.A propensity-matched comparison was made between the single-port and four-port thoracoscopic esophagectomy groups. Results From 2014 to 2016, 56 matched patients were analyzed. There was no conversion to open surgery or operative mortality. The use of single-port thoracoscopic esophagectomy increased the length of operation time in comparison with using multiple-port minimally invasive technique (mean, 257 vs. 216 min, P = 0.026). The time taken for thoracic procedure in the single-port group was significant longer that in the multi-port group (mean, 126 vs. 84 min, P < 0.001). There were no significant differences between groups in the number of lymph nodes dissected, blood loss, complications or hospital stay (P > 0.05). In single-port thoracoscopic group, the pain in the abdomen was more severe than that in the chest (P = 0.042). The pain scores for postoperative day 1 and day 7 were significantly lower in the single-port group as compared with multiple-port group (P = 0.038 and P < 0.001), a similar trend could be seen for the pain score on postoperative day 3 (P = 0.058). Conclusion Single-port thoracoscopic esophagectomy contributes to reducing postoperative pain with an acceptable increase of operation time, which does not compromise surgical radicality and has similar short-term postoperative outcomes when compared with multiple-port minimally invasive approach. Disclosure All authors have declared no conflicts of interest.

PS01.176: OPEN VERSUS HYBRID VERSUS MINIMALLY INVASIVE ESOPHAGECTOMY FOR PATIENTS WITH ESOPHAGEAL CANCER: A PROPENSITY SCORE MATCHED ANALYSIS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 99-100
Author(s):  
Els Visser ◽  
David Edholm ◽  
Mark Smithers ◽  
Janine Thomas ◽  
Sandra Brosda ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Survival Data ◽  
Operative Time ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Neoadjuvant Treatment ◽  
Respiratory Complications ◽  
Term Survival ◽  
Invasive Esophagectomy

Abstract Background MIE is becoming more common and is considered safe. There are few studies supporting laparoscopy in favor of laparotomy for the abdominal part of a three-field esophagectomy and long term survival data are scarce. The objective was to compare open esophagectomy (OE), with hybdrid thoracoscopic-laparotomic esophagectomy (HMIE) and minimally invasive esophagectomy (MIE) with regard to surgical outcomes, postoperative complications and survival. Methods A prospective database of esophageal resection for cancer at a single centre identified 243 OE, 688 HMIE and 80 MIE procedures. Propensity scores were used to match 80 patients in each group adjusting for age, gender, weight, clinical stage, neoadjuvant treatment, and year of surgery. Results Respiratory complications were more common after OE (49%) than after MIE (31%, P = 0.02). Median operative time was longer for MIE (330 minutes) versus HMIE or OE (both 300 minutes, P < 0.001). Median length of stay was shorter following MIE (12 days) compared with HMIE (14 days) and OE (15 days), P = 0.001. There were no significant differences between groups with respect to other complications, median number of lymph nodes examined (22–23 for all groups), or R0 resection rate (range 85–91%) for all groups. There was no difference in 5-year overall survival between groups. Conclusion Compared with OE and HMIE, MIE was associated with shorter length of stay and fewer respiratory complications, but longer operative time. Thus, there may be additional benefit for MIE without comprising oncological outcomes. Disclosure All authors have declared no conflicts of interest.

PS01.167: MUMELE STUDY: MULTICENTER STUDY ON INCIDENCE OF MEDIASTINAL LEAKS AFTER ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 96-97
Author(s):  
Uberto Fumagalli Romario ◽  
Andrea Celotti ◽  
Stefano De Pascale ◽  
Riccardo Rosati ◽  
Andrea Cossu ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Conflicts Of Interest ◽  
High Volume ◽  
Esophageal Resection ◽  
Esophageal Surgery ◽  
Leakage Rate ◽  
First Line ◽  
Stoma Formation ◽  
Standard Strategy ◽  
First Line Treatment

Abstract Background Mediastinal anastomotic leak (ML) represent one of the most feared complication of esophageal resection. The incidence of ML, and of the associated mortality rate and the treatment strategy are variously reported. A standard strategy for diagnosis and treatment is difficult to establish Methods In order to evaluate the incidence, predictive factors, treatment and mortality of ML in 7 Italian surgical centers with interest in esophageal surgery (5 high volume centers) a retrospective study including all esophagectomies (E) with intrathoracic esophagogastric anastomosis performed in a 3 year period (2014–2017), was planned. ML were defined according to the classification proposed by the Esophagectomy Complications Consensus Group. Results The data of 501 E were collected. Overall incidence of ML was 11.8%. Surgical approach significantly influenced the rate of ML: leakage rate was highest for totally minimally invasive (TMIE) and lowest for hybrid esophagectomy (HE) (respectively 20 and 9%). No other predictive factor was found. Overall 30 and 90 day (d) mortality rate (M) were respectively 1,4% and 3,2%; 30 and 90 d M for leaks were respectively 5% and 15,3%; 90 d M for TMIE and HE were 5,9% and 1,8% respectively. Endoscopy was the first line treatment in 49% of leaks, with a need for retreatment in 17,2% of cases. Surgery was needed globally in 44,1% of ML. Endoscopic treatment appeared to have the lowest M (6,9%). Removal of the gastric tube with stoma formation was necessary in 8 cases (13.6%). Conclusion The incidence of mediastinal leaks after esophagectomy in the MUMELE study is high mainly in TMIE group. General and specific (leak) mortality rate is however low. Early ‘aggressive’ treatment of severe leaks is mandatory, with no hesitation to redo surgery if first attempt of conservative management fails. Disclosure All authors have declared no conflicts of interest.

scholarly journals Minimally invasive esophagectomy in achalasia: a more liberal approach to esophageal resection

2017 ◽  
Author(s):  
Eduardo Crema ◽  
Júverson Alves Terra Júnior ◽  
Guilherme Azevedo Terra ◽  
Celso Junior De Oliveira Teles ◽  
Alex Augusto Da Silva
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Esophageal Resection ◽  
Invasive Esophagectomy ◽  
Liberal Approach

PS02.008: MINIMAL INVASIVE OSEOPHAGECTOMY FOR CARCINOMA OESOPHAGUS BY USING WITH AN INNOVATIVE TECNIQUE: OUR EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 122-122
Author(s):  
Suraj Pawar
Keyword(s):  
Esophageal Carcinoma ◽  
Large Scale ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Length Of Hospital Stay ◽  
Lateral Position ◽  
Thoracoscopic Approach ◽  
Invasive Esophagectomy ◽  
Operative Complications ◽  
Post Operative Complications

Abstract Background Minimally invasive esophagectomy(MIE) is associated with lower morbidity and mortality compared to open procedures. In order to retain the benefits and overcome disadvantages of the left lateral decubitious and fully prone positions, a modified semiprone position was developed at our centre.We aim to describe our growing experience of operating patients of esophageal carcinoma with MIE in a semiprone position. Methods A retrospective review of hospital records of all patients who underwent MIE for esophageal carcinoma at our oncological surgical centre from January 2007 till December 2017 was done. A modified semi-prone position (dorsolateral) was developed i.e. left lateral position with an inclination of 45 degrees with the horizontal. All surgeries were performed under general + Epiduralanesthesia with a double lumen endotracheal tube. Esophageal mobilization was done by thoracoscopic approach in a semiprone position andthoracoscopic 2 field lymhadenectomy was done and end-to-end cervical anastomosis was done in the neck. From the records, we obtained intraoperative parameters and post-operative complications. A multidisciplinary follow-up was established for all patients for a period of 2 `to 5 years. Results Retrospective data of 214 patients was included in this study. Mean length of hospital stay was 15.46 ± 4.48 days (range from 3 to 33 days) and mean number of lymph nodes dissected were 15.64 ± 5.98 (range 0 to 32). The mean blood loss was 282.92 ± 197.22 ml. Operative time for the total surgical procedure and 211.29 ± 54.62 minutes. Only 7% of the patients had intra-operative complications like arrhythmia, azygous vein bleeding, cardiac arrhythmia, hypotension, splenic bleeding, and others. Most common immediate post-operative complications were pulmonary related (22.7%) and wound infections (8.7%). Approximately 6% of the patients died in the early and delayed post operative period Conclusion MIE with mediastinal lymphadenectomy in the semiprone position is a feasible, convenient and safe option which can combine the benefits of the two conventional left lateral and prone approaches. Further large scale studies are required to support our findings. Disclosure All authors have declared no conflicts of interest.

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