PS02.230: CLOSURE OF POSTESOPHAGECTOMY GASTROTRACHEAL FISTULA FOLLOWING MINIMALLY INVASIVE ESOPHAGECTOMY THROUGH THE STOMACH CONDUIT OPENING

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 187-187
Author(s):  
Junhee Lee ◽  
Eunjue Yi ◽  
Sungho Lee ◽  
Jae Ho Chung
Keyword(s):  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Gastric Conduit ◽  
Fistula Tract ◽  
Severe Malnutrition ◽  
External Beam Irradiation ◽  
Invasive Esophagectomy ◽  
Vats Esophagectomy ◽  
Membranous Wall

Abstract Background The prevalence gastro-tracheal fistula following esophagectomy is rare, however, very difficult to cure, and often results in fatal outcomes. We experienced surgical repair of gastro-tracheal fistula after minimally invasive esophagectomy, thereby reported here. Methods A 66 year-old male patient had undergone VATS esophagectomy combined with cervical esophagogastrostomy through posteromediastinal route for his esophageal cancer (pT2N2M0). After concurrent chemo-radiation therapy for local recurrence in subcarinal area, gastro-tracheal fistula was developed between the posterior membranous wall of trachea just above carina and gastric conduit. Surgical correction was performed through right posterolateral thoracotomy. After longitudinal incision on the gastric conduit near the location of gastro-esophageal fistula, the fistula tract was exposed, and closed using three layer sutures with vicryl 3–0. Results The patient stayed at intensive care unit for only one day. During the periods of nil per os, the nutrition had supported by intravenous administration and jejunostomy. After 2 weeks of nil per os, postoperative bronchoscopy and endoscopy was performed. No remnant fistula was noted on both examinations suggesting successful fistula closure. And, the patient was discharged without any complications on postoperative day 28. Conclusion Conduit-airway fistula could be caused by diverse risk factors such as thermal injury during the dissection, external beam irradiation, and severe malnutrition. Less invasive procedures including endoscopic interventions could be amenable, however, direct surgical repairs might be required for prompt closure of fistula and minimizing further complications. Disclosure All authors have declared no conflicts of interest.

384 SHORT-TERM OUTCOMES OF INTRA-THORACIC ESOPHAGO-GASTRIC ANASTOMOSES UNDER MINIMALLY INVASIVE ESOPHAGECTOMY VIA A PRONE POSITION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Shinji Mine ◽  
Masayuki Watanabe ◽  
Atushi Kanamori ◽  
Yu Imamura ◽  
Akihiko Okamura ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Stricture ◽  
Minimally Invasive Esophagectomy ◽  
Anterior Wall ◽  
Gastric Conduit ◽  
Linear Stapler ◽  
Short Term ◽  
Invasive Esophagectomy ◽  
Operative Complications ◽  
Gastric Anastomosis

Abstract   Although minimally invasive esophagectomy (MIE) has been performed for esophageal cancer worldwide, intra-thoracic anastomosis under prone positions is still challenging. In this retrospective study, we reviewed our short-term results of this anastomotic technique in our institution. Methods From November 2016 to December 2019, we performed 319 esophagectomies. Of these patients, 28 patients (9%) underwent intra-thoracic esophago-gastric anastomosis under MIE. Procedures The left side of an esophageal stump which had been closed using a linear stapler was opened for anastomosis. Then, the anterior wall of a gastric conduit, around 5 cm below the tip, was opened for anastomosis. Linear staplers were inserted in both esophageal stump and gastric conduit and side-to-side anastomosis was performed. The opening for insertion was closed using a hand-sewn anastomosis in 2 layers. Results Five patients (18%) suffered anastomotic leakage with Clavien-Dindo 2 and 3a, and all of them recovered by conservative treatments. Two patients (2/19, 11%) showed anastomotic stricture which improved by several endoscopic dilatations. Six patients (6/19, 32%) showed the reflux esophagitis of Grade C. Conclusion Although we have not experienced severe or critical post-operative complications, the short-term results of intra-thoracic anastomosis under MIE were not sufficient. Additional progresses in techniques are required.

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.

Classification and early recognition of gastric conduit failure after minimally invasive esophagectomy

2008 ◽  
Vol 23 (9) ◽  
pp. 2110-2116 ◽  
Author(s):  
Darmarajah Veeramootoo ◽  
Rajeev Parameswaran ◽  
Rakesh Krishnadas ◽  
Peter Froeschle ◽  
Martin Cooper ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Early Recognition ◽  
Minimally Invasive Esophagectomy ◽  
Gastric Conduit ◽  
Invasive Esophagectomy

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.

Extracorporeal Gastric Stapling Reduces the Incidence of Gastric Conduit Failure after Minimally Invasive Esophagectomy

2010 ◽  
Vol 76 (8) ◽  
pp. 823-828 ◽  
Author(s):  
Gregory D. Crenshaw ◽  
Suven S. Shankar ◽  
Russell E. Brown ◽  
Abbas E. Abbas ◽  
John S. Bolton
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Operative Mortality ◽  
Minimally Invasive Esophagectomy ◽  
Gastric Conduit ◽  
Short Term ◽  
Simple Modification ◽  
Invasive Esophagectomy ◽  
Clinic Foundation ◽  
Significant Difference

Esophageal cancer resection is associated with significant morbidity and mortality. To date, no standardized technique exists. In this study, we analyze our short-term results in 92 minimally invasive resections performed over the past 10 years in an attempt to identify technical factors, which contribute to improved short-term outcomes. A retrospective review of 92 minimally invasive esophagectomies was performed at the Ochsner Clinic Foundation from 1999 through 2009. Data collected included preoperative stage, whether or not preoperative chemoradiation was used, technique of minimally-invasive resection, technique of esophagogastric anastomosis, margin status, anastomotic leak, conduit necrosis, gastric conduit failure of any type, and operative mortality. Gastric stapling was done either laparoscopically (intracorporeal) or through a minilaparotomy (extracorporeal). Ninety-two patients met criteria for this study. There was a significant difference in the incidence of positive gastric margins ( P = 0.04), anastomotic leak ( P = 0.045), conduit necrosis ( P = 0.03), and any gastric conduit failure ( P = 0.02) favoring the extracorporeal group. The overall short-term morbidity and operative mortality with minimally invasive esophagectomy is comparable to the results obtained with open techniques. A relatively simple modification of the operative technique—performing extracorporeal stapling of the gastric conduit—led to a significant reduction in the incidence of gastric conduit failures when compared with the intracorporeal stapling technique.

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.

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

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.

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.

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.

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