PS01.211: IMPLEMENTATION OF A TOTALLY MINIMALLY INVASIVE OESOPHAGECTOMY PROGRAMME IN A UK SPECIALIST CENTRE: INITIAL EXPERIENCE AND OUTCOMES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 109-110
Author(s):  
Temisanren Akitikori ◽  
Bruno Lorenzi ◽  
Kanatheepan Shanmuganathan ◽  
Oluwasunmisola Soile ◽  
Aadil Hussain ◽  
...  
Keyword(s):  
Lymph Node ◽  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
High Volume ◽  
Pulmonary Complications ◽  
Cardiac Complications ◽  
Initial Experience ◽  
Chyle Leak ◽  
Anastomotic Strictures ◽  
Minimally Invasive Oesophagectomy

Abstract Background Totally minimally invasive oesophagectomy although challenging to perform has garnered popularity in the surgical treatment of oesophageal cancer. Advanced laparoscopic surgical skills are needed with the construction of the intra-thoracic anastomosis in the case of a 2-stage procedure being the rate-limiting step. We aim to report our initial experience and short-term outcomes of totally minimally invasive 3-stage and 2-stage oesophagectomies for cancer. Methods From January 2016 when the minimally invasive oesophagectomy programme was implemented in our Unit, to December 2017, 65 consecutive cases underwent either a 2-stage or a 3-stage oesophagectomy for cancer. In all cases a radical 2-field lymph node dissection was performed. All were performed in a prone position and in the 3-stage oesophagectomies, superior mediastinal lympadenectomy was additionally performed. In the 2-stage cases an end-to-side esophago-gastric anastomosis was constructed in two layers with barbed knotless suture (V-LocTM). Results Male: female was 4:1 with a mean age of 66.44 years (IQR, 43–82). n = 53 were 2-stage and 12 were 3-stage oesophagectomies. Thirty five (53.8%) had neoadjuvant chemotherapy and 30(46.2%) went straight to surgery. There were no open conversions. No feeding jejunostomies were placed routinely. Complete resection (R0) rate was 61.54% (40/65) with a mean lymph node harvest of 28 (IQR, 11–68). Five (7.6%) anastomotic leaks were diagnosed (4 in 2-stage and 1 in 3-stage oesophagectomies), with 1(1.5%) of them (in the 2-stage group) being subclinical requiring no intervention. Furthermore, 1(1.5%) chyle leak and 1(1.5%) gastric staple line leak were also observed. Pulmonary complications were reported in 13.8% of cases and cardiac complications arose in 1.5%. Seven (10.8%) anastomotic strictures were also noted that were treated with endoscopic balloon dilatation. Mean hospital stay was 13 days and 30-day mortality rate was 4.62%. Conclusion Implementation of a minimally invasive oesophagectomy program in our high-volume tertiary centre is yielding good initial results. Vast previous experience in the field is of paramount importance. Hand-sewn intrathoracic anastomosis during 2-stage procedures is feasible and with repetitively good outcomes. Disclosure All authors have declared no conflicts of interest.

scholarly journals Anesthetic and critical care challenges in massive chyle leak following robotic surgery: a special case report

2015 ◽  
Vol 2 (2) ◽  
pp. 73-76
Author(s):  
Uma Hariharan ◽  
Itee Choudhary ◽  
Ajay Kumar Bhargava
Keyword(s):  
Critical Care ◽  
Case Report ◽  
Lymph Node ◽  
Robotic Surgery ◽  
Minimally Invasive ◽  
Germ Cell ◽  
Retroperitoneal Lymph Node Dissection ◽  
Node Dissection ◽  
Retroperitoneal Lymph Node ◽  
Chyle Leak

A unique case report is hereby presented which entails the multi-modality management of a very rare complication of modern minimally-invasive robotic surgery. Chyle leak can be an extremely challenging problem following certain surgeries, especially in cancer patients. Medical, nutritional and/or surgical management is required to control the leak. Prolonged massive chyle leaks which do not respond to conservative management require surgical intervention. Retroperitoneal lymph node dissection is a complex procedure undertaken for lymph node clearance in germ cell tumors after primary radical surgery. Robotic surgeries have revolutionized the field of minimally invasive operations. A patient who underwent robotic nerve sparing retroperitoneal lymph node dissection for non-seminomatous germ cell tumor of the right testis, post-chemotherapy, developed a continuous large volume chylous ascites, presenting with electrolyte imbalances and hypotension. Exploratory laparotomy in the operation theatre was required for sealing the chyle leak after failure of medical and nutritional management in the intensive care unit. The main take-away message is that refractory chyle leak can occur in retroperitoneal surgeries requiring multidisciplinary management. Careful coordinated action between critical care, oncological, anesthesia and surgical teams is mandatory for a favourable outcome. Familiarity with the nuances of robotic surgery and eternal vigilance are the keys to successful conduction of complex robotic procedures.Journal of Society of Anesthesiologists of Nepal 2015; 2(2): 73-76

O100 WORLDWIDE TECHNIQUES AND OUTCOMES OF ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE): RESULTS FROM THE INTERNATIONAL UGIRA REGISTRY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
B F Kingma ◽  
P P Grimminger ◽  
M J van Det ◽  
Y K Chao ◽  
P Chiu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Operating Time ◽  
Case Series ◽  
Radical Resection ◽  
Pulmonary Complications ◽  
Cardiac Complications ◽  
Robot Assisted ◽  
Invasive Esophagectomy ◽  
The Mean

Abstract Aim The aim of this study was to gain insight in the techniques and outcomes of RAMIE worldwide. Background & Methods Although robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted. The current literature on RAMIE mainly consists of single-center case series with considerable variation in reported techniques and outcomes. To gain an overview of the worldwide practice in RAMIE, an online registry was established by the Upper GI International Robotic Association (UGIRA). The collected data involve patient- and treatment characteristics, as well as postoperative outcomes that include complications as defined by the Esophageal Complications Consensus Group, length of stay, re-admissions (i.e. <30 days after discharge), mortality (i.e. in-hospital or <30 days after surgery), and pathological results. The outcomes were descriptively analyzed for this interim report. Results A total of 434 patients who underwent RAMIE for esophageal cancer between 2016-2019 were included in this interim analysis. The mean age was 63 years (SD ±9.7), the majority was male (n=359, 83%), and nearly all patients had an ASA score ≥2 (n=398, 92%). Adenocarcinoma (n=253, 58%) and squamous cell carcinoma (n=162, 37%) were most prevalent. The usual surgical approach was transthoracic (n=428, 99%) with the patient in semiprone position (n=393, 91%). Gastric conduit reconstruction was performed in all except one patient, who received a colonic interposition. The anastomosis was created by hand-sewing (n=207, 48%), circular stapling (n=142, 32%), or linear stapling (n=85, 20%). The median intraoperative blood loss was 120 milliliters (IQR 70-280) and the median operating time was 392 minutes (IQR 353-455). Postoperative complications occurred in 251 patients (59%) and mainly involved pulmonary complications (n=138, 32%), anastomotic leakage (n=80, 18%), and cardiac complications (n=55, 13%). Mortality occurred in 9 patients (2%) and re-admission because of complications was required in 57 patients (14%). A median of 28 lymph nodes (IQR 21-35) were removed and a radical resection was achieved in 400 patients (92%). Conclusion The presented results are the first to provide an overview of the techniques that are commonly used in RAMIE. By demonstrating results that are in line with recent benchmarking literature, this study demonstrates the safety and feasibility of RAMIE.

scholarly journals Robotic-assisted single-incision gastric mobilization for minimally invasive oesophagectomy for oesophageal cancer: preliminary results

2020 ◽  
Vol 58 (Supplement_1) ◽  
pp. i65-i69
Author(s):  
Yu-Han Huang ◽  
Ke-Cheng Chen ◽  
Sian-Han Lin ◽  
Pei-Ming Huang ◽  
Pei-Wen Yang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Minimally Invasive ◽  
Lymph Node Dissection ◽  
Oesophageal Cancer ◽  
Single Incision ◽  
Single Port ◽  
Node Dissection ◽  
Abdominal Lymph Node ◽  
Robotic Assisted ◽  
Minimally Invasive Oesophagectomy

Abstract OBJECTIVES With the gradual acceptance of robotic-assisted surgery to treat oesophageal cancer and the application of a single-port approach in several abdominal procedures, we adopted a single-port technique in robotic-assisted minimally invasive oesophagectomy during the abdominal phase for gastric mobilization and abdominal lymph node dissection. METHODS Robotic-assisted oesophagectomy and mediastinal lymph node dissection in the chest were followed by robotic-assisted gastric mobilization and conduit creation with abdominal lymph node dissection, which were performed via a periumbilicus single incision. The oesophagogastrostomy was accomplished either in the chest (Ivor Lewis procedure) or neck (McKeown procedure) depending on the status of the proximal resection margin. RESULTS The procedure was successfully performed on 11 patients with oesophageal cancer from January 2017 to December 2018 in our institute. No surgical or in-hospital deaths occurred, though we had one case each of anastomotic leakage, pneumonia and hiatal hernia (9%). CONCLUSIONS Robotic single-incision gastric mobilization for minimally invasive oesophagectomy for treating oesophageal cancer seems feasible. Its value in terms of perioperative outcome and long-term survival results awaits future evaluation.

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.

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.

PS01.232: SHORT-TERM OUTCOMES OF ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 115-116
Author(s):  
Haiqi He ◽  
Junke Fu ◽  
Guangjian Zhang
Keyword(s):  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Pulmonary Complications ◽  
Invasive Technique ◽  
R0 Resection ◽  
Robot Assisted ◽  
Invasive Esophagectomy ◽  
Robotic Esophagectomy ◽  
Laparoscopic Esophagectomy

Abstract Background Surgical resection with radical lymphadenectomy is a pivotal component in the multidisciplinary therapy of esophageal cancer. Minimally invasive esophagectomy was shown to be effective in reducing the morbidity and was adopted increasingly. As a novel minimally invasive technique, robot-assisted esophagectomy remains in the initial stage ofapplication. This study describes the single-institution experience of robotic esophagectomy. Methods Between March 2016 and October 2017, 20 consecutive patients underwent robot assisted esophagectomy at our institute. The thoracic and abdominal mobilization were all performed with the assistance of the robot. We retrospectively collected the operative data and postoperative outcomes. Results The majority of patients were male (80%), and the median age was 62 years. The average operative time was 342 minutes (range 280–440). The average blood loss was 112 ml (range 50–400). No patient experienced conversion to a thoracotomy or laparotomy. R0 resection was achieved in all patients, the mean number of dissected lymph nodes was 19 (range 8–32). No 90-day operative mortality was observed, and postoperative complications were present in 8 of 20 patients (40.0%). Pulmonary complications were the most common event and were observed in 3 patients. Two patients experienced an anastomotic leak. Conclusion Our study demonstrated that robot-assisted esophagectomy is a safe and technically feasible alternative to conventional thoraco-laparoscopic esophagectomy. Disclosure All authors have declared no conflicts of interest.

Hybrid minimally invasive versus open oesophagectomy for patients with oesophageal cancer: A multicenter, open-label, randomized phase III controlled trial, the MIRO trial.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 5-5 ◽  
Author(s):  
Christophe Mariette ◽  
Bernard Meunier ◽  
Denis Pezet ◽  
Cecile Dalban ◽  
Denis Collet ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Oesophageal Cancer ◽  
Postoperative Morbidity ◽  
Controlled Trial ◽  
Pulmonary Complications ◽  
Phase Iii ◽  
Open Label ◽  
Intention To Treat ◽  
Randomised Controlled ◽  
Minimally Invasive Oesophagectomy

5 Background: Surgical resection is regarded as the only curative option for resectable oesophageal cancer. Postoperative morbidity, in particular pulmonary complications, continues to be of great concern and occurs in more than half of patients after open oesophagectomy (OO). We assessed whether hybrid minimally invasive oesophagectomy (HMIO) reduces morbidity compared with OO. Methods: We performed a multicentre, open-label, randomised controlled trial at 12 study centres between October 2009 and April 2012. Patients aged 18-75 years old with resectable cancers of the middle or lower third of the oesophagus were assigned by a computer-generated randomisation sequence to undergo either transthoracic OO or HMIO. Surgical technique was standardised by both on site visits and the use of videos, and was based on an Ivor Lewis procedure with laparoscopic gastric mobilisation and open right thoracotomy. Randomisation was stratified by centre. The primary outcome was 30 day grade II-IV postoperative morbidity as defined by the Dindo-Clavien classification. Analysis was by intention to treat. Results: We randomly assigned 104 patients to the OO group and 103 to the HMIO group. Sixty-seven (64.4%) patients in the OO group had major postoperative morbidity compared with 37 (35.9%) in the HMIO group (OR 0·31, 95% CI 0·18-0·55; p=0·0001). Thirty-one (30.1%) patients in the OO had major pulmonary complications compared with 18 (17.7%) in the minimally invasive group p=0·037), whereas 30-day mortality was 5 (4.9%) vs. 5 (4.9%), respectively. Conclusions: These findings provide evidence for the short-term benefits of HMIO for patients with resectable oesophageal cancer (NCT00937456 ClinicalTrials.gov). Clinical trial information: NCT00937456.

PS02.167: IMPACT OF POSTOPERATIVE COMPLICATIONS AFTER RESECTION OF ESOPHAGUS FOR CARCINOMA ON LONG-TERM SURVIVAL

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 169-169
Author(s):  
Martin Snajdauf ◽  
Tomas Harustiak ◽  
Alexandr Pazdro ◽  
Robert Lischke
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Postoperative Complications ◽  
Conflicts Of Interest ◽  
Neoadjuvant Treatment ◽  
Chyle Leak ◽  
Term Survival ◽  
Long Term Survival ◽  
The Impact

Abstract Background Esophagectomy with 2–3 field lymph node dissection is one of the most invasive surgical treatment for malignancy and is still associated with a high mortality and morbidity despite improvements in surgical techniques and postoperative management. The impact of postoperative complications on perioperative morbidity is widely accepted. But the impact of postoperative complications on long-term survival remains controversial. Methods A retrospective analysis was performed on patient who underwent transthoracic esophagectomy with intrathoracic anastomosis for esophageal cancer between January 2005 and December 2012 in our department (415 patients). We excluded non-radical resections (R1, R2 – 27 patients, 6.5%) and patients who died within 90 day after operation (20 patients, 4.8%). Data on gender, BMI, histologic diagnosis, tumor staging, neoadjuvant treatment, comorbidities, technical complications and postoperative medical complications were reviewed. Considered postoperative complications were anastomotic leak, empyema, chyle leak, pneumonia, ARDS, cardiac arrhythmia, wound infection and urinary tract infection. We analysed separately extrapolated serious complications Clavien Dindo 3–4 and their possible impact on overall survival. Prognostic factors were assessed by multivariate analysis. Results Total number of analysed patients was 363. The median follow up was 8.5 years. From the baseline characteristics, the presence of atrial fibrillation (P = 0.0157, HR 2.376) and hypertension (P = 0.0093, HR 1.488), higher staging pT3–4 (0.0146, HR 1.437) and presence of lymph node metastasis pN + (P < 0.001, HR 2.263) had a negative impact on overall survival. Among the postoperative complications, only chyle leak (P = 0.0327, HR 4.023) had a negative prognostic factor on overall survival. Conclusion In this single institution series, among the postoperative complications only chylothorax affect negatively the overall survival. Accurate ligation of resected thoracic duct stumps to minimize chyle leak is important to improve outcomes. The influence of others postoperative complications wasn’t significant. We assume important to exclude postoperative mortality from analysis to prevent bias. Disclosure All authors have declared no conflicts of interest.

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