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.

P175 TRANSLATION OF MINIMALLY INVASIVE ESOPHAGECTOMY FROM RANDOMIZED CONTROLLED TRIAL SETTING (TIME) TO NATIONAL PRACTICE (DUCA) IN NETHERLANDS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
R Markar Sheraz ◽  
Ni Melody ◽  
Gisbertz Suzanne ◽  
Straatman Jennifer ◽  
van der Peet Donald ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Time Trial ◽  
Reoperation Rate ◽  
Invasive Esophagectomy

Abstract Aims The TIME trial showed reduced pulmonary complications from minimally invasive esophagectomy (MIE) over an open approach, and led to widespread adoption of MIE in the Netherlands. The aim of this study was to compare clinical outcomes from minimally invasive esophagectomy in the DUCA (national dataset) and the TIME trial (RCT) for transthoracic esophagectomy1. Methods Original patient data from the TIME trial1 was extracted along-with data from the Dutch National Cancer Audit (DUCA) (2011-2017). Initially univariate analysis was used to compare patient and tumor demographics and clinical and pathological outcomes from patients receiving MIE in the TIME trial and in the DUCA-dataset. Secondly multivariate analysis, with adjustment patient and tumor factors, was performed for the effect of MIE vs. Open esophagectomy on clinical outcomes in both datasets. Thirdly the datasets were combined and multivariate analysis, was performed for the effect of patient inclusion in TIME trial or DUCA-dataset. Results 115 patients from TIME (59 MIE vs. 56 open) and 4605 patients from the DUCA-dataset (2652 MIE vs. 1953 open) were included. Univariate analysis showed, in TIME trial, MIE reduced postoperative complications and length of hospital stay. However in the DUCA-dataset, MIE increased postoperative complications, re-intervention rate and length of hospital stay, however pathological benefits included increased proportion of R0 margin and lymph nodes harvested. Multivariate analysis confirmed the TIME data showed MIE reduced postoperative complications (OR=0.38, 95%CI 0.16–0.90). In the DUCA-dataset, MIE was associated with increased postoperative complications (OR=1.37, 95%CI 1.20–1.55), re-intervention (OR=1.84, 95%CI 1.57–2.14), and length of hospital stay (Coeff=1.57, 95%CI 0.06–3.08). Pathological benefits to MIE in the DUCA-dataset included a reduction in proportion of R1 margin, and increased lymph node harvest. Multivariate analysis of the combined dataset, showed inclusion in the TIME trial was associated with a reduction in postoperative complications (OR=0.23, 95%CI 0.15–0.36) and reoperation rate (OR=0.34, 95%CI 0.17–0.66). Conclusions MIE when adopted nationally outside the TIME-trial, was associated with an increase in postoperative complications and reoperation rate, which may reflect surgeons on a national level going through their proficiency-gain curve in the technique and outside of expert MIE centers.

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.

PS02.016: MINIMALLY INVASIVE ESOPHAGECTOMY IN ESOPHAGEAL CANCER: EXPERIENCE IN THE FIRST 100 CASES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 124-125
Author(s):  
Atila Eroglu ◽  
Coskun Daharli ◽  
Yener Aydin ◽  
Ali Ulas ◽  
Haci Alici
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Cell Cancer ◽  
Neoadjuvant Chemoradiotherapy ◽  
Thoracoscopic Esophagectomy ◽  
Invasive Esophagectomy ◽  
The Mean

Abstract Background In this study, the efficiency of minimally invasive esophagectomy in esophageal cancer was examined. Methods A total of 100 consecutive patients who were hospitalized due to esophageal cancer and planned minimally invasive esophagectomy were evaluated prospectively between September 2013 and December 2017 in our clinic. Laparoscopic and thoracoscopic esophagectomy was performed in all of the patients included in the study. Inoperable cases were not included in the study. Age and sex of the patients, symptoms, localization of tumor, histopathological type, surgical modality, operation time, length of hospital stay and morbidity and mortality rates were reviewed. Results Thirty-eight (38%) patients were male and 62 (62%) patients were female. The mean age was 55.5 ± 10.8 (32–75 years). The most symptoms were dysphagy (96%) and weight loss (39%). Eighty-one patients (81%) had squamous cell cancer, ten (10%) had adenocarcinoma and nine had another form of esophageal cancer. Neoadjuvant chemoradiotherapy was performed in 36 of the 100 patients. Laparoscopic and thoracoscopic esophagectomy and intrathoracic anastomosis were performed in 94 patients (94%). Laparoscopic and thoracoscopic esophagectomy and neck anastomosis were performed in six patients (6%). The mean duration of operation was 260.1 ± 33.4 minutes (185–335 minutes). The mean intraoperative blood loss was 114.2 ± 191.4 ml (10–800 ml). In 51 (51%) of the patients, complications occurred in perioperative, early postoperative and late postoperative periods. In postoperative complications, anastomotic leak rate was eight patients (8%) and pulmonary complication rate was 21 patients (21%). While mortality was seen in three patients that had diabetes mellitus and hypertension, the 30-day mortality was 2% and the hospital mortality was 3%. The mean hospital stay was 11.2 ± 8.3 days (range 8–44). In our study, the probability of one-year overall survival was 91% and the probability of two years overall survival was 66%. Conclusion Minimally invasive esophagectomy is a safe and preferred method with low mortality, acceptable morbidity, short operative time and short hospital stay and has become a routine approach in the treatment of esophageal cancers. Multicenter studies to be performed in the near future will further assist in defining the benefits of minimally invasive esophagectomy. Disclosure All authors have declared no conflicts of interest.

PS01.218: MORBIDITY AND MORTALITY IN ELDERLY PATIENTS AFTER MINIMALLY INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 112-112
Author(s):  
Jeroen Hol ◽  
Joos Heisterkamp ◽  
Barbara Langenhoff
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Length Of Hospital Stay ◽  
Morbidity And Mortality ◽  
Tumor Type ◽  
Invasive Esophagectomy ◽  
Group 2 ◽  
Group 1

Abstract Background Elderly patients undergoing gastrointestinal surgery are at higher risk for postoperative complications and mortality. Currently available literature on elderly patients undergoing an esophagectomy is inconclusive and dates back from the time before minimally invasive techniques were implemented. Methods Length of hospital stay, 90-day morbidity and mortality were analyzed from patients undergoing minimally invasive esophagectomy (MIE) between 2014 and 2017 in a single center. Data from patients aged 76 years or older was compared to the cohort of patients aged 71 to 75 years old. Results From a consecutive series of in total 187 patients two cohorts were retrieved: 19 patients 76 years or older (group 1) were compared to 41 patients 71 to 75 years old (group 2). Median age was 77 years (76–83) in group 1 and 72 years (71–75) in group 2 (P < 0.05). There were no significant differences in sex, Charlson comorbidity score, number of patients undergoing neoadjuvant chemoradiaton, histological tumor type, tumor stage, number of lymph nodes harvested and type of anastomosis. There were no significant differences in length of hospital stay, 90-day morbidity and mortality. The percentage of anastomotic leakage was 21.2% in group 1 and 14.6% in group 2. Mortality was 10.5% and 4.9% respectively. Conclusion No difference was seen in morbidity and mortality after MIE comparing the eldest old to younger old patients. Therefore, patient selection should not be based on calendar age alone. Disclosure All authors have declared no conflicts of interest.

Outcomes associated with minimally invasive esophagectomy techniques.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 171-171
Author(s):  
Andrea M. Abbott ◽  
Matthew Doepker ◽  
Ravi Shridhar ◽  
Sarah E. Hoffe ◽  
Khaldoun Almhanna ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Surgical Techniques ◽  
Esophageal Resection ◽  
Oncologic Outcomes ◽  
Surgical Approaches ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Operative Outcomes ◽  
Estimated Blood Loss

171 Background: Surgery is pivotal in the management of patients with esophageal cancer. Recent prospective data demonstrates advantages of minimally invasive techniques. However, varying surgical techniques precludes the recommendation of a standard approach. We sought to examine our outcomes with differing approaches to minimally invasive esophagectomy. Methods: We queried a prospective esophageal database to identify patients who underwent minimally invasive esophagectomy (MIE) from 1994 and 2014. Surgical approaches included trans-hiatal (TH), Ivor Lewis (IVL), and robotic assisted Ivor Lewis (RAIL). Demographics, operative variables and post-operative complications were all compared. Results: We identified 280 patients who underwent MIE with a mean age of 65.65 ± 10.5 and a median follow-up of 48 months. Fifty-seven patients underwent IVL, 78 underwent TH, and 145 underwent RAIL. The length of operation was significantly longer in IVL and RAIL approaches compared to TH (TH=242, IVL=320, RAIL=415, p=0.001). Estimated blood loss did not differ between cohorts (TH=150, IVL=125, RAIL=158, p=0.8). Anastomotic leakage, stricture, pneumonia, and wound infections were all higher in the TH compared to the trans-thoracic approaches p=0.04, p=0.02, p=0.01, and p<0.001 respectively. Operative mortality was low for each cohort and did not differ between approaches (TH=2.6%, IVL=0%, RAIL=2%, p=0.2). The median length of hospitalization also did not differ between groups (TH=10 days, IVL=8.5 days, and RAIL=9 days, p=0.15). Adequacy of oncologic resection was measured by margins and nodal harvest. There was decreased R1 resections in both the IVL and RAIL compared to TH (TH=8%, IVL=0%, and RAIL=0% p=0.04). Additionally, the mean number of lymph nodes harvested was lower in patients undergoing TH compared to IVL and RAIL groups (TH=9.2, IVL=12.8, and RAIL=20.6, p=0.05). Conclusions: In our large series comparing minimally invasive approaches to esophageal resection we have demonstrated improved operative outcomes and oncologic outcomes in trans-thoracic approaches compared to trans-hiatal approaches. We recommend that patients undergoing minimally invasive esophagectomy be strongly considered for a trans-thoracic approach.

VS02.08: VIDEO PRESENTATION ON LAPAROSCOPIC REPAIR OF INCARCERATED LEFT HIATAL HERNIA AFTER MINIMALLY INVASIVE ESOPHAGECTOMY FOR DISTAL ESOPHAGEAL ADENOCARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 47-47
Author(s):  
Aung Myint Oo
Keyword(s):  
Small Bowel ◽  
Minimally Invasive ◽  
Hiatal Hernia ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Neoadjuvant Chemoradiotherapy ◽  
Distal Esophagus ◽  
Invasive Esophagectomy ◽  
Soft Diet ◽  
History Of

Abstract Description 63 years old Chinese gentleman with past medical history of ypT3 N0 adenocarcinoma of distal esophagus invovling the cardioesophageal junction status post neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy was presented to emergency department for severe epgiastric pain one and half year after surgery. Emergency CT scan showed the incarcerated hiatal hernia containing most of the small bowel mesentery, large portion of small bowel loops and part of trasnverse colon. There was a loop of small bowel which showed decreased enhancment and worrisome for ischemia. He underwent emergency diagnostic laparoscopy, laparoscopic reduction of hernia contents and repair of hiatal hernia. He resumed oral feeds and progressed to soft diet next day and discharged well on post operative day 3. This is the video showing the emergency repair of hiatal hernia in the pateient with previous minimally invasive esophagectomy for adenocarcinoma of distal esophagus. To view this video please follow this link: https://www.dropbox.com/sh/t9jvgk9w2y0nqhk/AABP9TcR0NDK9PcXjvV8TAWSa?dl=0 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.

PS01.244: MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER WITH THE PATIENT IN PRONE POSITION: EXPERIENCE OF 156 CONSECUTIVE CASES IN A SINGLE CENTER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 119-119
Author(s):  
Antonio Ziccarelli ◽  
Massimo Vecchiato ◽  
Chiara Lirusso ◽  
Alessandro Rosignoli ◽  
Roberto Silvestro ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Mortality Rate ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Cell Carcinoma ◽  
Prone Position ◽  
Minimally Invasive Esophagectomy ◽  
Cervical Anastomosis ◽  
Invasive Esophagectomy ◽  
The Mean

Abstract Background Minimally invasive esophagectomy is performed with increasing frequency and proves to be a safe and effective surgical alternative to the open technique. Minimally invasive esophagectomy using thoracoscopic esophageal mobilization with the patient in prone position seems to offer some advantages with regard to surgeon ergonomics and clinical outcome. Methods Between July 2005 and December 2017, 156 patients underwent minimally invasive esophagectomy in the prone position at the authors' institutionin. Was performed 132 three field McKeown MIE (84,6%) with circular stapled cervical anastomosis and 24 two field Ivor Lewis MIE (15,4%) with circular stapled intrathoracic anastomosis; For four patients (2,6%) the colon was used for cervical anastomosis, and two patients (1,3%) had previously undergone left pneumonectomy because of lung cancer. The preoperative indication was squamous cell carcinoma for 100 patients (64,1%) and adenocarcinoma for 53 patients (33,9%). In three cases (1,9%), the histology of the specimen showed a squamous cell carcinoma with neuroendocrine differentiation. Neoadjuvant treatment was administered to 79 patients (50,6%) Results In 152 patients (97,4%) was performed esophagectomy using minimally invasive thoracic mobilization of the esophagus with the patient in prone position. In four cases (2,6%) an early thoracotomic conversion was necessary due to the presence of lung adhesions such that made it impossible to establish the pneumothorax. The mean operative time was 255 min (range: 130–420 min). The median intensive care unit stay was 2 days (range: 0–77 day), and the median postoperative hospital stay was 15 days (range: 8–79 day). The mean number of procured lymph nodes was 16 (range: 0–56 Ln). The perioperative pulmonary morbidity rate was 22,4%, and the perioperative mortality rate was 2.6%. An anastomotic leakage occurred in 13 patients (8,3%). Conclusion Minimally invasive esophagectomy is safe and technically feasible. It entails a lower mortality rate and a shorter hospital stay than those reported in most open series. Thoracoscopy with the patient in prone position offers results comparable with those obtained using other minimally invasive techniques.This technique shows considerable advantages such as improved surgeon ergonomics, increased operative field exposure, and satisfactory respiratory results. 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.

PS01.234: MINIMALLY INVASIVE ESOPHAGECTOMY IN PATIENTS WITH MORBID OBESITY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 116-116
Author(s):  
Norbeto Velasco Hernandez ◽  
Lucas Rivaletto ◽  
Hector Horiuchi ◽  
Maria Zicavo ◽  
Santiago De Battista Gerrini
Keyword(s):  
Morbid Obesity ◽  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Posterior Mediastinum ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
The Difference ◽  
La Plata City ◽  
San Martín

Abstract Background The first publication of minimally invasive esophagectomy in prone position (MIE PP) was developed by Cuschieri in 1994. This approach was described to access the posterior mediastinum and esophagus for mobilization and resection. In 2006, after several reports, Palanivelu presented his study, which was one of the most important series published at that time.The objective is to analyze the mortality of a group of patients with morbid obesity that underwent MIE PP. Retrospective, observational study. Methods From November 2011 to June 2017, 52 esophagectomies were performed in H.I.G.A San Martín and Instituto de Diagnóstico of La Plata city. Out of the 52 cases, only 36 of them were MIE PP, and were the ones chosen to be included in the study. Results Perioperative mortality was 8.3% (3 cases) Two cases, in the group of patients with obesity (IMC ≥ 30) were due to pneumonia and heart failure and surgery was performed using the McKeown procedure. Another case was in the group of patients without obesity (IMC ≤ 30) due to mediastinitis by leak, and the surgery performed was applying Ivor-Lewis procedure. These results did not evidence statistically significance (P ≤ 0.54) However, in the analysis of patients with morbid obesity (BMI ≥ 35) when compared with all the remaining cases, the difference was significant (P = 0.02) Conclusion There are many publications suggesting that obesity is not a risk factor for mortality after MIE. However, in our study, although it is a series with a small number of cases, there was evidence that mortality increases in patients with BMI ≥ 35 Disclosure All authors have declared no conflicts of interest.

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