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.

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.

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.

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.

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.

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.

PS02.023: 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.

Sign in / Sign up

Export Citation Format

Share Document