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.

PS01.219: 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.

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.

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.

Early outcomes of minimally invasive esophagectomy after neoadjuvant chemotherapy for esophageal squamous cell carcinoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Võ Vĩnh Lộc Nguyễn ◽  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Minimally Invasive ◽  
Lymph Nodes ◽  
Minimally Invasive Esophagectomy ◽  
Locally Advanced ◽  
Postoperative Mortality ◽  
Thoracic Esophagus ◽  
Invasive Esophagectomy ◽  
Stage Ib

Abstract Introduction: Neoadjuvant chemotherapy (NAC) is the standard treatment which recommended for resectable locally advanced esophageal cancer (EC), but the safety of minimally invasive esophagectomy (MIE) after neoadjuvant chemotherapy (NAC) for esophageal cancer has not been reported. We investigated the effect of NAC on the safety and feasibility of MIE for EC.The purpose of this study was to evaluate the morbidity, mortality and oncologic outcomes of MIE after neoadjuvant chemotherapy. Materials and Methods: This was a prospective study of the patients who underwent MIE after neoadjuvant chemotherapy between August 2018 and May 2020. Patients with clinical stage IB, IIA, IIB, IIIA, IIIB, or IIIC EC, and no active concomitant malignancy were included. The data regarding the intraoperative incident, postoperative morbidity and mortality as well as oncologic examination were collected and analyzed. Results: From August 2018 to May 2020, 68 patients with EC have been included into the study. There were 66 males and 2 females with mean age of 58.1 ± 13.9 (42 – 77). Sixty-two patients had neoadjuvant with DCX, four patients were indicated for EOX therapy, and remained two patients were treated by PAR-CAR. Two patients with stage IB, 23 with stage IIA, 22 with stage IIB, 14 with stage IIIA, one with stage IIIB, and 6 with stage IIIC. Tumor located in middle thoracic esophagus was 34 (50%), lower thoracic esophagus was 32 (47.1%) and upper thoracic esophagus was 2 cases. Median operation time was 420 minutes with minimal blood loss. Median hospitalization duration was 11 days (7 – 31). Median lymph nodes harvested in cervical, mediastinal and abdominal fields was 10, 16 and 7 respectively. Twenty-seven (42.2%) patients had metastatic lymph nodes. Postoperative mortality was 1.5% (1 case). Overall morbidity was 33.8% included 6 cases complicated pneumonia, 9 cases with anastomotic leak (conservative treatment), 1 case was re-operated due to cervical lymph leak, 16 cases with temporary hoarse voice. Conclusion: Results from our study to conclude that MIE is safe and effective for locally advanced EC, even after NAC. Key word: Neoadjuvant chemotherapy, minimally invasive esophagectomy, esophageal cancer. Tóm tắt Đặt vấn đề: Hóa trị tân hỗ trợ là điều trị tiêu chuẩn cho ung thư thực quản tiến triển tại chỗ, nhưng đến tính an toàn và khả thi của phẫu thuật nội soi cắt thực quản sau hóa trị tân hỗ trợ vẫn chưa được báo cáo. Chúng tôi đánh giá ảnh hưởng của hóa trị tân hỗ trợ lên tính an toàn và khả thi của phẫu thuật nội soi cắt thực quản sau hóa trị tân hỗ trợ. Nghiên cứu đánh giá tỉ lệ tai biến, biến chứng, tử vong và kết quả ung thư học của phẫu thuật nội soi cắt thực quản sau hóa trị tân hỗ trợ. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, đánh giá các người bệnh phẫu thuật nội soi cắt thực quản sau hóa trị tân hỗ trợ từ tháng 8 năm 2018 đến tháng 5 năm 2020. Chúng tôi chọn những người bệnh ung thư thực quản giai đoạn IB, IIA, IIB, IIIA, IIIB và IIIC và không có ung thư khác kèm theo. Tai biến, biến chứng, tử vong và kết quả ung thư học sẽ được đánh giá. Kết quả: Từ tháng 8 năm 2018 đến tháng 5 năm 2020, có 68 người bệnh đạt tiêu chuẩn nghiên cứu. Có 66 nam và 2 nữ, tuổi trung bình là 58,1 ± 13,9 (42 – 77). 62 người bệnh hóa trị với phác đồ DCX, 4 người bệnh hóa trị với phác đồ EOX và 2 người bệnh hóa trị với phác đồ PAR-CAR. Có 2 người bệnh giai đoạn IB, 23 người bệnh giai đoạn IIA, 22 người bệnh giai đoạn IIB, 14 người bệnh giai đoạn IIIA, 1 người bệnh giai đoạn IIIB và 6 người bệnh giai đoạn IIIC. U nằm ở thực quản ngực giữa ở 34 (50%) người bệnh, thực quản ngực dưới ở 32 (47,1%) người bệnh và thực quản ngực trên ở 2 người bệnh. Thời gian mổ trung vị là 420 phút, máu mất không đáng kể. Thời gian nằm viện trung vị là 11 ngày (7 – 31). Số hạch nạo được trung vị ở cổ là 10, trung thất là 16 và bụng là 7. Có 27 (42.2%) người bệnh có di căn hạch. Tử vong chu phẫu là 1,5% (1 người bệnh). Tỉ lệ biến chứng là 33,8% gồm 6 viêm phổi, 9 rò miệng nối (điều trị bảo tồn), 1 ca rò bạch huyết cần mổ lại và 16 ca khàn tiếng tạm thời. Kết luận: Từ những kết quả đạt được, phẫu thuật nội soi cắt thực quản sau hóa trị tân hỗ trợ là phẫu thuật an toàn và khả thi. Từ khóa: Hóa trị tân hỗ trợ, phẫu thuật nội soi cắt thực quản, ung thư thực quản.

P123 ROBOT ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE4) WITH INTRATHORACIC ANASTOMOSIS: PROMISING RESULTS AND LESSONS LEARNED IN 100 PATIENTS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
E Tagkalos ◽  
der Sluis P C van ◽  
E Hadzijusufovic ◽  
B Babic ◽  
E Uzun ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Case Series ◽  
Oncologic Outcomes ◽  
Robot Assisted ◽  
Short Term ◽  
Intrathoracic Anastomosis ◽  
Invasive Esophagectomy

Abstract Aim The aim of this study was to describe postoperative complications and short-term oncologic outcomes for RAMIE4 with intrathoracic anastomosis for esophageal cancer within our case series of 100 consecutive patients. Background & Methods Robot assisted minimally-invasive esophagectomy (RAMIE) with intrathoracic anastomosis is gaining popularity as a treatment for esophageal cancer. In this study, we present the results of 100 RAMIE procedures using the da Vinci Xi robotic system (RAMIE4). The aim of this study was to describe postoperative complications and short-term oncologic outcomes for RAMIE4 within our case series of 100 consecutive patients. Between January 2017 and February 2019, 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-operatively and post operatively complications were graded according to definitions stated by the Esophagectomy Complications Consensus Group (ECCG). Results Mean duration of the surgical procedure was 416 min (± 80). In total, 70 patients (70%) had an uncomplicated operative procedure and postoperative recovery. Pulmonary complications were most common and were observed in 17 patients (17 %). Anastomotic leakage was observed in 8 patients (8%). Median ICU stay was 1 day and median overall postoperative hospital stay was 11 days. 30 day mortality was 1%. A R0 resection was reached in 92% of patients with a median number of 29 dissected lymph nodes. Conclusion RAMIE4 with intrathoracic anastomosis for esophageal cancer or cancer located in the esophagus was technically feasible and safe. Postoperative complications and short term oncologic results were comparable to the highest international standards nowadays. These results could only be obtained due to a structured RAMIE training pathway. The superiority of RAMIE compared to conventional minimally invasive esophagus is currently investigated in multiple randomized controlled trials. Results of these trials will define the role for RAMIE for patients with esophageal cancer in the future.

Comparison of Short-Term Outcomes Between Open and Minimally Invasive Esophagectomy for Esophageal Cancer Using a Nationwide Database in Japan

2017 ◽  
Vol 24 (7) ◽  
pp. 1821-1827 ◽  
Author(s):  
Hiroya Takeuchi ◽  
Hiroaki Miyata ◽  
Soji Ozawa ◽  
Harushi Udagawa ◽  
Harushi Osugi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Short Term ◽  
Invasive Esophagectomy ◽  
Nationwide Database

464 IS OPEN LEFT THORACO-ABDOMINAL ESOPHAGECTOMY A VIABLE OPTION IN THE ERA OF MINIMALLY INVASIVE ESOPHAGECTOMY?

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Fredrik Klevebro ◽  
Piers R Boshier ◽  
Carmen Mueller ◽  
Jonathan Cools-Lartigue ◽  
Lorenzo Ferri ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Lymph Nodes ◽  
Minimally Invasive Esophagectomy ◽  
Gastroesophageal Junction ◽  
Neoadjuvant Treatment ◽  
Postoperative Mortality ◽  
R0 Resection ◽  
Resection Rate ◽  
Short Term ◽  
Invasive Esophagectomy

Abstract   The aim of the study was to evaluate short-term and oncological outcomes of left thoracoabdominal esophagectomy (LTE) compared to minimally invasive esophagectomy for cancer of the esophagus and gastroesophageal junction. LTE facilitates complete resection of esophageal cancer particularly for bulky tumors, but there are concerns that this approach is associated with significant morbidity. Methods Prospectively entered esophagectomy databases from two high volume North American centers were reviewed for patients undergoing LTE or MIE in the 2012–2018. Patient demographics, tumour characteristics, operative outcomes, postoperative outcomes, and pathologic surrogates of oncologic efficacy (R0 resection rate, and number of resected lymph nodes) were compared. In total 247 patients were included in the study, LTE was applied in 170 (68.8%) patients, and MIE in 77 (31.2%) patients. Results LTE patients had more neoadjuvant treatment (LTE = 78.2%, MIE = 34.2%, P &lt; 0.001). There was no difference in overall postoperative complications (LTE = 56.9%, MIE = 55.0%, P = 0.799), severe complications (Clavien Dindo&gt;2—LTE = 26.1%, MIE17.0%, P = 0.184), pulmonary complications (LTE = 31.9%, MIE = 20.0%, P = 0.085), pneumonia (LTE = 15.2%, MIE = 13.6%, P = 0.768), anastomotic leak (LTE = 7%, MIE = 10%, P = 0.396), or postoperative mortality (LTE = 0%, MIE = 1.3%, P = 0.140). Median length of stay was 7 days in both groups. R0 resection rate was 93.8% and 95.5% respectively (P = 0.631). Median number of resected lymph nodes was 24 for LTE and 22 for MIE (P = 0.226). LTE had more stage II-IV tumors (LTE = 67.8%, MIE = 40.7%, P &lt; 0.001), and more node positive resections (LTE = 52.5%, MIE = 31.4%, P = 0.003). Conclusion LTE was used for larger tumors with greater lymph node burden in patients that were more likely to have received neoadjuvant treatment compared to MIE. Despite this the postoperative morbidity was equal to that of MIE, with no difference in short-term or oncological results in this cohort.

P72 IS OPEN LEFT THORACO-ABDOMINAL ESOPHAGECTOMY A VIABLE OPTION IN THE ERA OF MINIMALLY INVASIVE ESOPHAGECTOMY?

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
F Klevebro ◽  
P Boshier ◽  
C Mueller ◽  
J Cools-Lartigue ◽  
L Ferri ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Lymph Nodes ◽  
Minimally Invasive Esophagectomy ◽  
Gastroesophageal Junction ◽  
Neoadjuvant Treatment ◽  
Postoperative Mortality ◽  
R0 Resection ◽  
Resection Rate ◽  
Short Term ◽  
Invasive Esophagectomy

Abstract Aim To evaluate short-term and oncological outcomes of left thoracoabdominal esophagectomy compared to minimally invasive esophagectomy for cancer of the esophagus and gastroesophageal junction Background and Methods Left thoracoabdominal esophagectomy (LTE) facilitates complete resection of esophageal cancer particularly for bulky tumors, but there are concerns that this approach is associated with significant morbidity. Prospectively entered esophagectomy databases from two high volume North American centers were reviewed for patients undergoing LTE or MIE in the 2012-2018. Patient demographics, tumour characteristics, operative outcomes, postoperative outcomes, and pathologic surrogates of oncologic efficacy (R0 resection rate, and number of resected lymph nodes) were compared. Results In total 247 patients were included in the study, LTE was applied in 170 (68.8%) patients, and MIE in 77 (31.2%) patients. LTE patients had more neoadjuvant treatment (LTE=78.2%, MIE=34.2%, P<0.001). There was no difference in overall postoperative complications (LTE=56.9%, MIE=55.0%, P=0.799), severe complications (Clavien Dindo>2 - LTE=26.1%, MIE17.0%, P=0.184), pulmonary complications (LTE=31.9%, MIE=20.0%, P=0.085), pneumonia (LTE=15.2%, MIE=13.6%, P=0.768), anastomotic leak (LTE=7%, MIE=10%, P=0.396), or postoperative mortality (LTE=0%, MIE=1.3%, P=0.140). Median length of stay was 7 days in both groups. R0 resection rate was 93.8% and 95.5% respectively (P=0.631). Median number of resected lymph nodes was 24 for LTE and 22 for MIE (P=0.226). LTE had more stage II-IV tumors (LTE=67.8%, MIE=40.7%, P<0.001), and more node positive resections (LTE=52.5%, MIE=31.4%, P=0.003). Conclusion LTE was used for larger tumors with greater lymph node burden in patients that were more likely to have received neoadjuvant treatment compared to MIE. Despite this the postoperative morbidity was equal to that of MIE, with no difference in short-term or oncological results in this cohort.

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