P16 PREEMPTIVE ENDOLUMINAL VACUUM THERAPY TO REDUCE ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY: A GAME-CHANGING APPROACH?

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
C Gubler ◽  
D Vetter ◽  
H Schmidt ◽  
P Müller ◽  
B Morell ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Postoperative Morbidity ◽  
Minimally Invasive Esophagectomy ◽  
Anastomotic Healing ◽  
Vacuum Therapy ◽  
Safe Procedure ◽  
Comprehensive Complication Index ◽  
Invasive Esophagectomy ◽  
Severe Comorbidity ◽  
Novel Concept

Abstract Background Endoluminal vacuum therapy (EVT) is an accepted treatment for anastomotic leakage (AL) after esophagectomy. A novel concept is to use this technology in a preemptive setting, with the aim to reduce AL rate and postoperative morbidity. Methods Preemptive EVT (pEVT) was performed intraoperatively in 19 consecutive patients undergoing minimally invasive esophagectomy, immediately after completion of esophago-gastrostomy. Twelve patients (63%) were high-risk cases with severe comorbidity. The EVT device was removed routinely three to six (median 5) days after esophagectomy. Endpoints of this study were AL rate and postoperative morbidity. Results There were 20 anastomoses at risk in 19 patients. One patient (5.3%) experienced major morbidity (Clavien-Dindo grade IIIb) unrelated to anastomotic healing. He underwent open re-anastomosis at postoperative day 12 with pEVT for redundancy of the gastric tube and failure of transition to oral diet. Mortality after 30 days was 0% and anastomotic healing was uneventful in 19/20 anastomoses (95%). One minor contained AL healed after a second course of EVT. Except early proximal dislodgement in one patient, there were no adverse events attributable to pEVT. The median comprehensive complication index 30 days after surgery was 20.9 (IQR 0-26.2). Conclusions PEVT appears to be a novel and safe procedure that may have the potential to improve surgical outcome in patients undergoing esophagectomy.

scholarly journals Preemptive endoluminal vacuum therapy to reduce anastomotic leakage after esophagectomy: a game-changing approach?

2018 ◽  
Vol 32 (7) ◽  
Author(s):  
C Gubler ◽  
D Vetter ◽  
H M Schmidt ◽  
P C Müller ◽  
B Morell ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Postoperative Morbidity ◽  
Minimally Invasive Esophagectomy ◽  
Anastomotic Healing ◽  
Vacuum Therapy ◽  
Safe Procedure ◽  
Comprehensive Complication Index ◽  
Invasive Esophagectomy ◽  
Severe Comorbidity ◽  
Novel Concept

Summary Endoluminal vacuum therapy (EVT) is an accepted treatment for anastomotic leakage (AL) after esophagectomy. A novel concept is to use this technology in a preemptive setting, with the aim to reduce the AL rate and postoperative morbidity. Preemptive EVT (pEVT) was performed intraoperatively in 19 consecutive patients undergoing minimally invasive esophagectomy, immediately after completion of esophagogastrostomy. Twelve patients (63%) were high-risk cases with severe comorbidity. The EVT device was removed routinely three to six (median 5) days after esophagectomy. The endpoints of this study were AL rate and postoperative morbidity. There were 20 anastomoses at risk in 19 patients. One patient (5.3%) experienced major morbidity (Clavien–Dindo grade IIIb) unrelated to anastomotic healing. He underwent open reanastomosis at postoperative day 12 with pEVT for redundancy of the gastric tube and failure of transition to oral diet. Mortality after 30 days was 0% and anastomotic healing was uneventful in 19/20 anastomoses (95%). One minor contained AL healed after a second course of EVT. Except early proximal dislodgement in one patient, there were no adverse events attributable to pEVT. The median comprehensive complication index 30 days after surgery was 20.9 (IQR 0–26.2). PEVT appears to be a safe procedure that may have the potential to improve surgical outcome in patients undergoing esophagectomy.

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.

P103 A HAND-SEWN INTRATHORACIC ANASTOMOSIS IN ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE): A DETAILED DESCRIPTION OF TECHNIQUE AND OUTCOMES

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
E M de Groot ◽  
B F Kingma ◽  
R van Hillegersberg ◽  
J P Ruurda
Keyword(s):  
Anastomotic Leakage ◽  
Moving Average ◽  
Minimally Invasive Esophagectomy ◽  
Leakage Rate ◽  
Gastric Conduit ◽  
Robot Assisted ◽  
Intrathoracic Anastomosis ◽  
Invasive Esophagectomy ◽  
Anastomotic Leakage Rate ◽  
Technical Details

Abstract Aim The aim of this study was to describe a technique that was developed and refined to construct a hand-sewn intrathoracic anastomosis during robot-assisted minimally invasive esophagectomy (RAMIE). Background & Methods Whilst some case series have reported promising results of a hand-sewn intrathoracic anastomosis during RAMIE, the exact techniques were often not described in detail. Therefore, the current single-center retrospective study was designed to provide a detailed and reproducible technical description of a hand-sewn, intrathoracic anastomosis that was developed and refined for patients who underwent RAMIE in a high volume center for esophageal cancer surgery (2016-2018). Video recordings were reviewed to evaluate technical details regarding the anastomosis, including number of sutures and distances between the anastomosis and the longitudinal staple line or gastric conduit tip. Technical details and distances were extracted and measured by using video analysis software. Moving average analyses were performed to evaluate whether the anastomotic leakage rate changed over the consecutive cases. Results A total of 68 patients were included in the study. For creation of the anastomosis, the gastric conduit was opened on a median distance of 19 millimeters (range 0-66) from the gastric conduit tip. After initially performing end-to-end anastomoses, a switch was made to an end-to-side anastomosis for the majority of 55 patients (81%). A median total of 27 sews (range 20-38) were required to close the anastomosis. In the last 22 patients of the cohort (32%), 4 tension release stitches were placed after circular suturing of the anastomosis. A re-inforcing omental wrap was positioned around the anastomosis in 64 patients (94%). The moving average curve for anastomotic leakage started at a rate of 40% (cases 1-10) and ended at 10% (cases 59-68). Conclusion This is the first study to report technical features and outcomes of a hand-sewn intrathoracic anastomosis during RAMIE in detail. Although an acceptable anastomotic leakage rate was observed in the final inclusion phase, a hand-sewn intrathoracic anastomosis during RAMIE may carry a substantial learning curve.

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.

O3 DIRECT ORAL FEEDING FOLLOWING MINIMALLY INVASIVE ESOPHAGECTOMY (NUTRIENT II TRIAL): AN INTERNATIONAL, MULTICENTER, OPEN-LABEL RANDOMIZED CONTROLLED TRIAL

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Gijs H K Berkelmans ◽  
Laura F C Fransen ◽  
Annemarie C P Dolmans-Zwartjes ◽  
Ewout A Kouwenhoven ◽  
Marc J van Det ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Functional Recovery ◽  
Controlled Trial ◽  
Minimally Invasive Esophagectomy ◽  
Standard Of Care ◽  
Oral Feeding ◽  
Control Group ◽  
P Value ◽  
Invasive Esophagectomy ◽  
And Control

Abstract Aim Patients undergoing an esophagectomy are often kept nil-by-mouth postoperatively out of fear for increasing anastomotic leakage and pulmonary complications. This study investigates the effect of direct start of oral feeding following minimally invasive esophagectomy (MIE) compared to standard of care. Background & Methods Elements of enhanced recovery after surgery (ERAS) protocols have been successfully introduced in patients undergoing an esophagectomy. However, start of oral intake, which is an essential part of the ERAS protocols, remains a matter of debate. Patients in this multicenter, international randomized controlled trial were randomized to directly start oral feeding (intervention) after a MIE with intrathoracic anastomosis or to receive nil-by-mouth and tube feeding for five days postoperative (control group). Primary outcome was time to functional recovery. Secondary outcome parameters included anastomotic leakage, pneumonia rate and other surgical complications scored by predefined definitions. Results Baseline characteristics were similar in the intervention (n=65) and control (n=67) group. Functional recovery was seven days for patients receiving direct oral feeding compared to eight days in the control group (p-value 0.436). Anastomotic leakage rate did not differ in the intervention (18.5%) and control group (16.4%, p-value 0.757). Pneumonia rates were comparable between the intervention (24.6%) and control group (34.3%, p-value 0.221). Other morbidity rates were similar, except for chyle leakage which was more prevalent in the standard of care group (p-value 0.032). Conclusions Direct oral feeding after an esophagectomy does not affect functional recovery and did not increase incidence or severity of postoperative complications.

scholarly journals The 3-Hole Minimally Invasive Esophagectomy: A Safe Procedure Following Neoadjuvant Chemotherapy and Radiation

2015 ◽  
Vol 27 (2) ◽  
pp. 205-215 ◽  
Author(s):  
Rona Spector ◽  
Yifan Zheng ◽  
Beow Y. Yeap ◽  
Jon O. Wee ◽  
Abraham Lebenthal ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Safe Procedure ◽  
Invasive Esophagectomy

scholarly journals Anastomotic reinforcement with omentoplasty reduces anastomotic leakage for minimally invasive esophagectomy with cervical anastomosis

2018 ◽  
Vol Volume 10 ◽  
pp. 257-263 ◽  
Author(s):  
Dong Zhou ◽  
Quan-Xing Liu ◽  
Xu-Feng Deng ◽  
Hong Zheng ◽  
Xiao Lu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Minimally Invasive Esophagectomy ◽  
Cervical Anastomosis ◽  
Invasive Esophagectomy

687 ADVERSE EVENTS DURING MINIMALLY INVASIVE ESOPHAGECTOMY IN PRONE POSITION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Norberto Daniel Velasco Hernandez ◽  
Lucas Alberto Rivaletto ◽  
Alan Erasmo Saenz ◽  
Maria Micaela Zicavo ◽  
Carla Peña ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Prone Position ◽  
Minimally Invasive Esophagectomy ◽  
Intraoperative Complications ◽  
P Value ◽  
Nerve Lesion ◽  
Recurrent Nerve ◽  
Safe Procedure ◽  
Invasive Esophagectomy ◽  
Vessel Injury

Abstract   Since the initial description of laparoscopic fundoplication in 1991 for the treatment of gastroesophageal reflux disease, different minimally invasive procedures have been developed until nowadays, when esophagectomy is performed using combined thoracoscopy and laparoscopy. Objective: The aim of our study is to analyze the intraoperative complications of minimally invasive esophagectomy in prone position. Methods Between November 2011 and January 2021, 70 patients underwent minimally invasive esophagectomy in prone position in the Hospital Interzonal General de Agudos General San Martín and private practice of La Plata city. Results During the abdominal stage one patient presented coronary vessel injury and the other with short vessel injury. The complications occurring in the thoracic stage included lung injury, azygos arch injury, thoracic duct section, laryngeal recurrent nerve lesion, main stem bronchus injury, and pericardium lesion, during lymph node resection. Most of these complications occurred in the first 30 patients, while in the remaining 40 cases only two complications (p value = 0.4). Conclusion Minimally invasive esophagectomy in prone position is a feasible and safe procedure that can cause serious intraoperative complications due to its complexity. Although the results of our series did not show statistically significant differences, the number of complications during surgeries performed by the same team showed an important reduction associated with better training.

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