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.

PS01.232: 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.

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.

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.

PS02.015: EXPERIENCES OF COMPLETE LAPARO-THORACOSCOPIC MINIMALLY INVASIVE ESOPHAGECTOMY WITH SIDE-TO-SIDE ESOPHAGOGASTROSTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 124-124
Author(s):  
Satoshi Kamiya ◽  
Ioannis Rouvelas ◽  
Fredrik Klevebro ◽  
Mats Lindblad ◽  
Magnus Nilsson
Keyword(s):  
Minimally Invasive ◽  
Cox Regression ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Operation Time ◽  
Future Research ◽  
Ivor Lewis ◽  
Cox Regression Analysis ◽  
Invasive Esophagectomy ◽  
Upper Abdominal

Abstract Background Recently minimally invasive esophagectomy (MIE) has become more common over the world. Since 2014 we applied the laparo-thoracoscopic minimally invasive esophagectomy with intrathoracic side-to-side esophagogastrostomy. In this study, we present our experiences of minimally invasive Ivor-Lewis (IL) technique. Methods In succession to laparoscopic abdominal operation with upper abdominal lymphadenectomy and formation of the gastric tube conduit, patients were turned to prone position. After middle and lower mediastinal lymphadenectomy, the gastric conduits were pulled up to the chest through the hiatus and the specimens were removed. The side-to-side anastomoses were done using linear triple stapler and the defects were closed with thoracoscopic suturing. The outcomes of minimally invasive IL during 2014–2018 have been compared with those of open IL for esophageal adenocarcinoma. Results Among 279 patients with esophagectomy a minimally invasive IL was done in 118 3 cases (2.5%) were converted to open technique due to technical or oncological reasons. There were no significant differences in age, sex, BMI and ASA score at baseline. In the MIE group the peroperative blood loss and operation time was reduced 100 ml vs 550 ml (P < 0.01), and 395 min vs 420 min (P < 0.01). The numbers of harvested lymph nodes were superior in MIE group: 33 vs 23 (P < 0.01). Although there were no significant differences in the incidence of postoperative complication rate (36% vs 38%) and leakage rate (20% vs 16%), 1-year and 3-year overall survival rate were significantly better in MIE group (0.76 and 0.63, respectively (P = 0.01) as compared to open procedure (0.73 and 0.42, respectively) (P = 0.01). MIE was proven to be an independent factor for better prognosis in a Cox regression analysis. Conclusion Our minimally invasive Ivor-Lewis esophagectomy technique is feasible and might achieve better prognosis. Future research has to provide further evidence whether the method can minimize the risk and severity of postoperative complications including anastomotic leakages and improve survival. Disclosure All authors have declared no conflicts of interest.

Costs and benefits of different methods of esophagectomy for esophageal cancer

2017 ◽  
Vol 25 (7-8) ◽  
pp. 513-517 ◽  
Author(s):  
Alongkorn Yanasoot ◽  
Kamtorn Yolsuriyanwong ◽  
Sakchai Ruangsin ◽  
Supparerk Laohawiriyakamol ◽  
Somkiat Sunpaweravong
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Pain ◽  
Minimally Invasive ◽  
Operative Time ◽  
Minimally Invasive Esophagectomy ◽  
Laparoscopic Approach ◽  
Costs And Benefits ◽  
Invasive Approach ◽  
Invasive Esophagectomy ◽  
Open Esophagectomy

Background A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of the costs and benefits of minimally invasive, hybrid, and open esophagectomy approaches for esophageal cancer surgery. Methods The data of 83 consecutive patients who underwent a McKeown’s esophagectomy at Prince of Songkla University Hospital between January 2008 and December 2014 were analyzed. Open esophagectomy was performed in 54 patients, minimally invasive esophagectomy in 13, and hybrid esophagectomy in 16. There were no differences in patient characteristics among the 3 groups Minimally invasive esophagectomy was undertaken via a thoracoscopic-laparoscopic approach, hybrid esophagectomy via a thoracoscopic-laparotomy approach, and open esophagectomy by a thoracotomy-laparotomy approach. Results Minimally invasive esophagectomy required a longer operative time than hybrid or open esophagectomy ( p = 0.02), but these patients reported less postoperative pain ( p = 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 3 groups. Minimally invasive esophagectomy incurred higher operative and surgical material costs than hybrid or open esophagectomy ( p = 0.01), but there were no significant differences in inpatient care and total hospital costs. Conclusion Minimally invasive esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain. Hybrid esophagectomy had a shorter learning curve while sharing the advantages of minimally invasive esophagectomy.

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.

scholarly journals Implementation of Minimally Invasive Esophagectomy From a Randomized Controlled Trial Setting to National Practice

2020 ◽  
Vol 38 (19) ◽  
pp. 2130-2139 ◽  
Author(s):  
Sheraz R. Markar ◽  
Melody Ni ◽  
Suzanne S. Gisbertz ◽  
Leonie van der Werf ◽  
Jennifer Straatman ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Time Trial ◽  
Pulmonary Complications ◽  
Invasive Technique ◽  
Invasive Esophagectomy

PURPOSE The aim of this study was to examine the external validity of the randomized TIME trial, when minimally invasive esophagectomy (MIE) was implemented nationally in the Netherlands, using data from the Dutch Upper GI Cancer Audit (DUCA) for transthoracic esophagectomy. METHODS Original patient data from the TIME trial were extracted along with data from the DUCA dataset (2011-2017). Multivariate analysis, with adjustment for patient factors, tumor factors, and year of surgery, was performed for the effect of MIE versus open esophagectomy on clinical outcomes. RESULTS One hundred fifteen patients from the TIME trial (59 MIE v 56 open) and 4,605 patients from the DUCA dataset (2,652 MIE v 1,953 open) were included. In the TIME trial, univariate analysis showed that MIE reduced pulmonary complications and length of hospital stay. On the contrary, in the DUCA dataset, MIE was associated with increased total and pulmonary complications and reoperations; however, benefits included increased proportion of R0 margin and lymph nodes harvested, and reduced 30-day mortality. Multivariate analysis from the TIME trial showed that MIE reduced pulmonary complications (odds ratio [OR], 0.19; 95% CI, 0.06 to 0.61). In the DUCA dataset, MIE was associated with increased total complications (OR, 1.36; 95% CI, 1.19 to 1.57), pulmonary complications (OR, 1.50; 95% CI, 1.29 to 1.74), reoperations (OR, 1.74; 95% CI, 1.42 to 2.14), and length of hospital stay. Multivariate analysis of the combined and MIE datasets showed that inclusion in the TIME trial was associated with a reduction in reoperations, Clavien-Dindo grade > 1 complications, and length of hospital stay. CONCLUSION When adopted nationally outside the TIME trial, MIE was associated with an increase in total and pulmonary complications and reoperation rate. This may reflect nonexpert surgeons outside of high-volume centers performing this minimally invasive technique in a nonstandardized fashion outside of a controlled environment.

T-shaped linear-stapled cervical esophagogastric anastomosis for minimally invasive esophagectomy: a pilot study

2020 ◽  
Vol 106 (6) ◽  
pp. 506-509 ◽  
Author(s):  
Xinju Li ◽  
Zhe Wang ◽  
Guangjian Zhang ◽  
Junke Fu ◽  
Qifei Wu
Keyword(s):  
Esophageal Cancer ◽  
Pilot Study ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Operation Time ◽  
Esophagogastric Anastomosis ◽  
Anastomotic Complications ◽  
Invasive Esophagectomy ◽  
Cervical Esophagogastric Anastomosis ◽  
A Minor

Background: Minimally invasive esophagectomy (MIE) has become a good option in the surgical treatment of esophageal cancer. Cervical esophagogastric anastomoses (CEGA) are widely used during esophagectomy. However, CEGA are related with a higher incidence of anastomotic complications. In the present study, a new procedure of T-shaped linear-stapled cervical esophagogastric anastomosis was used during MIE and the short-term outcomes are presented. Methods: From May 2014 to December 2018, 32 consecutive patients with esophageal cancer who underwent total MIE followed by T-shaped linear-stapled cervical esophagogastric anastomosis were included. Postoperative outcomes were analyzed. Results: Fifteen men and 17 women were included this pilot study. The histology of all cases was squamous cell carcinoma. Mean operation time of T-shaped linear-stapled cervical esophagogastric anastomosis was 17.6 minutes. There were no early or late mortalities. A minor cervical anastomotic leakage occurred in 1 patient. No complications of anastomotic stenosis occurred in this study. Conclusion: The T-shaped linear-stapled cervical esophagogastric anastomosis is efficient, reliable, easy to perform, and associated with lower postoperative complication rate.

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