PS02.018: MINIMALLY INVASIVE ESOPHAGECTOMY (MIE): FROM HYBRID, TO FULLY MINIMALLY-INVASIVE (MIE) AND TO ROBOTIC ASSISTED MIE (RAMIE): A SINGLE SURGEON ANALYSIS

Abstract Background The incidence of esophageal carcinoma is increasing in the western world and esophageal resection is the essential therapy depending on the tumor stage. Several studies report advantages of minimally invasive esophagectomies (MIE) versus conventional open procedures. The use of totally MIE (thoraco- and laparoscopic) or robotic assisted MIE (RAMIE) compared to the hybrid approaches remain unclear. Methods Between July 2015 and August 2017, the data of 75 patients with esophageal carcinoma were prospectively registered. 25 were treated with a hybrid MIE (hybrid), another 25 with a totally MIE (MIE) and another 25 with a robotic assisted MIE (RAMIE). All patients were operated by the same specialized surgeon in our center. Demographic data), duration of total hospital- and intensive-care-stay (ICU), number of remote lymph nodes and histopathological R-status, as well as operating times were compared. The complications were assessed according to the Dindo-Clavien classification. Results The overall 30- and 90-day mortality rate were 0% and 1.33% (1/75) respectively. Hospital stay (P = 0.262), ICU stay (P = 0.079), number of resected lymph nodes (P = 0.863) and R status (P = 0.132) did not differ significantly between the groups. However more pneumonias and wound infections (P = 0.046 and P = 0.003 respectively) were found in the hybrid group when compared to the minimally invasive group (MIE und RAMIE). Conclusion Although the MIE as well as the RAMIE group contained the first 25 patients treated in this clinic with this procedures, comparable results with regard to oncological outcomes and morbidity could be achieved. Additionally the minimally invasive approaches seem to be assosiated with low occurence of pneumonia and wound infects. Disclosure All authors have declared no conflicts of interest.

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FA04.03: MIE VERSUS RAMIE: PROMISING RESULTS OF A SINGLE-CENTER AND SINGLE-SURGEON ANALYSIS

Diseases of the Esophagus ◽

10.1093/dote/doy089.fa04.03 ◽

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.

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Robotic-assisted minimally invasive esophagectomy for treatment of esophageal carcinoma

Journal of Robotic Surgery ◽

10.1007/s11701-016-0644-2 ◽

2016 ◽

Vol 11 (2) ◽

pp. 193-199 ◽

Cited By ~ 8

Author(s):

Philip W. Chiu ◽

Anthony Y. Teoh ◽

Vivien W. Wong ◽

Hon Chi Yip ◽

Shannon M. Chan ◽

...

Keyword(s):

Minimally Invasive ◽

Esophageal Carcinoma ◽

Minimally Invasive Esophagectomy ◽

Robotic Assisted ◽

Invasive Esophagectomy

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PS01.220: COMPARISON OF SHORT-TERM OUTCOMES BETWEEN RAMIE AND VAMIE IN TREATMENT MIDDLE THORACIC ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.220 ◽

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.

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Intraoperative Near-Infrared Fluorescence Imaging as an Adjunct to Robotic-Assisted Minimally Invasive Esophagectomy

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/155698451400900513 ◽

2014 ◽

Vol 9 (5) ◽

pp. 391-393 ◽

Cited By ~ 1

Author(s):

Inderpal S. Sarkaria ◽

Manjit S. Bains ◽

David J. Finley ◽

Prasad S. Adusumilli ◽

James Huang ◽

...

Keyword(s):

Minimally Invasive ◽

Fluorescence Imaging ◽

Near Infrared ◽

Minimally Invasive Esophagectomy ◽

Near Infrared Fluorescence ◽

Robotic Assisted ◽

Invasive Esophagectomy ◽

Near Infrared Fluorescence Imaging

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Robotic assisted minimally invasive esophagectomy: Ivor-Lewis approach

Shanghai Chest ◽

10.21037/shc-2019-mies-10 ◽

2021 ◽

Vol 5 ◽

pp. 21-21

Author(s):

Kelsey Musgrove ◽

Charlotte R. Spear ◽

Jahnavi Kakuturu ◽

Britney R. Harris ◽

Fazil Abbas ◽

...

Keyword(s):

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Ivor Lewis ◽

Robotic Assisted ◽

Invasive Esophagectomy

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PS02.250: PREEMPTIVE ENDOSCOPIC VACUUM DRAINAGE TO PREVENT ANASTOMOTIC LEAKAGE IN UPPER-GI SURGERY: A GAME-CHANGING TECHNOLOGY?

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.250 ◽

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.

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PS01.159: THE IMPROVED POSTOPERATIVE RECOVERY OUTCOMES FROM MINIMALLY INVASIVE ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.159 ◽

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.

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PS01.219: SINGLE-PORT THORACOSCOPIC MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.219 ◽

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.

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PS01.176: OPEN VERSUS HYBRID VERSUS MINIMALLY INVASIVE ESOPHAGECTOMY FOR PATIENTS WITH ESOPHAGEAL CANCER: A PROPENSITY SCORE MATCHED ANALYSIS

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.176 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 99-100

Author(s):

Els Visser ◽

David Edholm ◽

Mark Smithers ◽

Janine Thomas ◽

Sandra Brosda ◽

...

Keyword(s):

Length Of Stay ◽

Minimally Invasive ◽

Survival Data ◽

Operative Time ◽

Conflicts Of Interest ◽

Minimally Invasive Esophagectomy ◽

Neoadjuvant Treatment ◽

Respiratory Complications ◽

Term Survival ◽

Invasive Esophagectomy

Abstract Background MIE is becoming more common and is considered safe. There are few studies supporting laparoscopy in favor of laparotomy for the abdominal part of a three-field esophagectomy and long term survival data are scarce. The objective was to compare open esophagectomy (OE), with hybdrid thoracoscopic-laparotomic esophagectomy (HMIE) and minimally invasive esophagectomy (MIE) with regard to surgical outcomes, postoperative complications and survival. Methods A prospective database of esophageal resection for cancer at a single centre identified 243 OE, 688 HMIE and 80 MIE procedures. Propensity scores were used to match 80 patients in each group adjusting for age, gender, weight, clinical stage, neoadjuvant treatment, and year of surgery. Results Respiratory complications were more common after OE (49%) than after MIE (31%, P = 0.02). Median operative time was longer for MIE (330 minutes) versus HMIE or OE (both 300 minutes, P < 0.001). Median length of stay was shorter following MIE (12 days) compared with HMIE (14 days) and OE (15 days), P = 0.001. There were no significant differences between groups with respect to other complications, median number of lymph nodes examined (22–23 for all groups), or R0 resection rate (range 85–91%) for all groups. There was no difference in 5-year overall survival between groups. Conclusion Compared with OE and HMIE, MIE was associated with shorter length of stay and fewer respiratory complications, but longer operative time. Thus, there may be additional benefit for MIE without comprising oncological outcomes. Disclosure All authors have declared no conflicts of interest.

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