VS01.01: STEP BY STEP INSTRUCTIONAL VIDEO OF MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER FOR SURGEONS-IN-TRAINING IN A SINGAPORE INSTITUTION

Abstract Description Tan Tock Seng Hospital is second largest hospital in Singapore. It is affiliated to two medical schools in Singapore and it is a training hospital for both undergraduate and postgraduate training. Minimally Invasive Esophagectomy for esophageal cancer is more and more popular nowadays. In our department, all the residents have to view the step by step instructional videos of mininally invasive surgeries before they can assist in the cases. The viewing of the instructional videos help them with better understanding of the procedures. The viewing of videos help them with the importance of steps, standardization of steps. With the help of instructional video, they can not only assist better in the surgery but also reduce the learning curve when they start doing the procedure themselves after the graduation from the residency programme. This is the step by step instructional video of minimally invasive esophagectomy for surgeons-in-training rotated to our department. To view the video please follow this link: https://www.dropbox.com/sh/3azfkz37x7zh6z8/AABXRSxJUhhtWlEA0Eo2p599a?dl=0 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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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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PS01.225: SINGLE HOLE PNEUMOPERITONEUM COMBINED WITH LAPAROSCOPIC RADICAL MASTECTOMY FOR ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.225 ◽

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.

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PS02.023: SINGLE-INCISION MINIMALLY INVASIVE ESOPHAGECTOMY FOR TREATING ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.023 ◽

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.

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Short- and long-term outcomes in patients operated with total minimally invasive esophagectomy for esophageal cancer

Diseases of the Esophagus ◽

10.1093/dote/doab061 ◽

2021 ◽

Author(s):

Tobias Hauge ◽

Dag T Førland ◽

Hans-Olaf Johannessen ◽

Egil Johnson

Keyword(s):

Overall Survival ◽

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

University Hospital ◽

Long Term Results ◽

Resection Margins ◽

Invasive Esophagectomy ◽

Short And Long Term

Summary At our hospital, the main treatment for resectable esophageal cancer (EC) has since 2013 been total minimally invasive esophagectomy (TMIE). The aim of this study was to present the short- and long-term results in patients operated with TMIE. This cross-sectional study includes all patients scheduled for TMIE from June 2013 to January 2016 at Oslo University Hospital. Data on morbidity, mortality, and survival were retrospectively collected from the patient administration system and the Norwegian Cause of Death Registry. Long-term postoperative health-related quality of life (HRQL) and level of dysphagia were assessed by patients completing the following questionaries: EORTC QLQ-OG25, QLQ-C30, and the Ogilvie grading scale. A total of 123 patients were included in this study with a median follow-up time of 58 months (1–88 months). 85% had adenocarcinoma, 15% squamous cell carcinoma. Seventeen patients (14%) had T1N0M0, 68 (55%) T2-T3N0M0, or T1-T2N1M0 and 38 (31%) had either T3N1M0 or T4anyNM0. Ninety-eight patients (80%) received neoadjuvant (radio)chemotherapy and 104 (85%) had R0 resection. Anastomotic leak rate and 90-days mortality were 14% and 2%, respectively. The 5-year overall survival was 53%. Patients with tumor free resection margins of >1 mm (R0) had a 5-year survival of 57%. Median 60 months (range 49–80) postoperatively the main symptoms reducing HRQL were anxiety, chough, insomnia, and reflux. Median Ogilvie score was 0 (0–1). In this study, we report relatively low mortality and good overall survival after TMIE for EC. Moreover, key symptoms reducing long-term HRQL were identified.

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696 LONG-TERM OUTCOMES OF MINIMALLY INVASIVE ESOPHAGECTOMY COMPARED TO OPEN ESOPHAGECTOMY: A RETROSPECTIVE ANALYSIS OF 2958 CASES IN SINGLE CANCER CENTER

Diseases of the Esophagus ◽

10.1093/dote/doab052.696 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Xue-feng Leng ◽

Kexun Li ◽

Qifeng Wang ◽

Wenwu He ◽

Kun Liu ◽

...

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Cancer Center ◽

Term Survival ◽

Invasive Esophagectomy ◽

Open Esophagectomy ◽

Single Cancer

Abstract Esophageal cancer is the fourth primary cause of cancer-related death in the male in China.The cornerstone of treatment for resectable esophageal cancer is surgery. With the development of minimally invasive esophagectomy (MIE), it is gradually adopted as an alternative to open esophagectomy (OE) in real-world practice. The purpose of this study is to explore whether MIE vs. OE will bring survival benefits to patients with the advancement of treatment techniques and concepts. Methods Data were obtained from the Sichuan Cancer Hospital & Institute Esophageal Cancer Case Management Database (SCH-ECCM Database). We retrospective analyzed esophageal cancer patients who underwent esophagectomy from Jan. 2010 to Nov. 2017. Patients were divided into two groups: MIE and OE groups. Clinical outcome and survival data were compared using TNM stages of AJCC 8th edition. Results After 65.3 months of median follow-up time, 2958 patients who received esophagectomy were included. 1106 of 2958 patients (37.4%) were underwent MIE, 1533 of 2958 patients (51.8%) were underwent OE. More than half of the patients (56.7%, 1673/2958) were above stage III. The median overall survival (OS) of 2958 patients was 51.6 months (95% CI 45.2–58.1). The MIE group's median OS was 74.6 months compared to 42.4 months in the OE group (95% CI 1.23–1.54, P < 0.001). The OS at 1, 3, and 5 years were 90%, 68%, 58% in the MIE group; 85%, 54%, 42% in the OE group,respectively (P<0.001). Conclusion The nearly 8-year follow-up data from this single cancer center suggests that with the advancement of minimally invasive surgical technology, MIE can bring significant benefits to patients' long-term survival compared with OE. Following the continuous progression of minimally invasive surgery and establishing a mature surgical team, MIE should be encouraged.

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Learning Curve and Associated Morbidity of Minimally Invasive Esophagectomy

Annals of Surgery ◽

10.1097/sla.0000000000002469 ◽

2019 ◽

Vol 269 (1) ◽

pp. 88-94 ◽

Cited By ~ 68

Author(s):

Frans van Workum ◽

Marianne H. B. C. Stenstra ◽

Gijs H. K. Berkelmans ◽

Annelijn E. Slaman ◽

Mark I. van Berge Henegouwen ◽

...

Keyword(s):

Minimally Invasive ◽

Learning Curve ◽

Minimally Invasive Esophagectomy ◽

Invasive Esophagectomy

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Costs and benefits of different methods of esophagectomy for esophageal cancer

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492317731389 ◽

2017 ◽

Vol 25 (7-8) ◽

pp. 513-517 ◽

Cited By ~ 8

Author(s):

Alongkorn Yanasoot ◽

Kamtorn Yolsuriyanwong ◽

Sakchai Ruangsin ◽

Supparerk Laohawiriyakamol ◽

Somkiat Sunpaweravong

Keyword(s):

Esophageal Cancer ◽

Postoperative Pain ◽

Minimally Invasive ◽

Operative Time ◽

Minimally Invasive Esophagectomy ◽

Laparoscopic Approach ◽

Costs And Benefits ◽

Invasive Approach ◽

Invasive Esophagectomy ◽

Open Esophagectomy

Background A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of the costs and benefits of minimally invasive, hybrid, and open esophagectomy approaches for esophageal cancer surgery. Methods The data of 83 consecutive patients who underwent a McKeown’s esophagectomy at Prince of Songkla University Hospital between January 2008 and December 2014 were analyzed. Open esophagectomy was performed in 54 patients, minimally invasive esophagectomy in 13, and hybrid esophagectomy in 16. There were no differences in patient characteristics among the 3 groups Minimally invasive esophagectomy was undertaken via a thoracoscopic-laparoscopic approach, hybrid esophagectomy via a thoracoscopic-laparotomy approach, and open esophagectomy by a thoracotomy-laparotomy approach. Results Minimally invasive esophagectomy required a longer operative time than hybrid or open esophagectomy ( p = 0.02), but these patients reported less postoperative pain ( p = 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 3 groups. Minimally invasive esophagectomy incurred higher operative and surgical material costs than hybrid or open esophagectomy ( p = 0.01), but there were no significant differences in inpatient care and total hospital costs. Conclusion Minimally invasive esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain. Hybrid esophagectomy had a shorter learning curve while sharing the advantages of minimally invasive esophagectomy.

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