O187 ANASTOMOTIC TECHNIQUES AND ASSOCIATED MORBIDITY IN TOTAL MINIMALLY-INVASIVE TRANSTHORACIC ESOPHAGECTOMY – RESULTS FROM THE ESOBENCHMARK DATABASE

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
W Schroeder ◽  
D Raptis ◽  
H Schmidt ◽  
S Gisbertz ◽  
J Moons ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Surgical Complication ◽  
Multivariable Analysis ◽  
Current Status ◽  
Transthoracic Esophagectomy ◽  
Purse String ◽  
Comprehensive Complication Index ◽  
Double Stapling ◽  
Anastomotic Techniques

Abstract Background Total minimally-invasive transthoracic esophagectomy (ttMIE) faces increasing application in surgical treatment of esophageal cancer. For esophago-gastric reconstruction, different anastomotic techniques are currently used, but their impact on postoperative anastomotic leakage and morbidity has not been investigated. The aim of this retrospective multicenter analysis was to describe anastomotic techniques used for ttMIE and to analyze the associated morbidity. Patients and Methods Patients were selected from a basic dataset, collected over a 5-year period from 13 international surgical high-volume centers. Endpoints were anastomotic leakage rate and postoperative morbidity in correlation to anastomotic techniques, measured by the CD classification and the Comprehensive Complication Index® (CCI). Results Five anastomotic techniques were identified in 966 patients after ttMIE: Intrathoracic end-to-side circular-stapled technique in 427 patients (double-stapling n=90, purse-string n=337), intrathoracic (n=109) or cervical (n=255) side-to-side linear-stapled, and cervical end-to-side hand-sewn (n=175). Leakage rates were similar in intrathoracic and cervical anastomoses (15.9% vs. 17.2%, P=0.601), but overall complications (56.7%% vs. 63.7%, P=0.029) and median 90-day CCI (21 (IQR 0-36) vs. 29 (IQR 0-40), P=0.019) favored intrathoracic reconstructions. Leakage rates after intrathoracic end-to-side double-stapling (23.3%) and cervical end-to-side hand-sewn (25.1%) techniques were significantly higher compared with intrathoracic side-to-side linear (15.6%), end-to-side purse-string (13.9%) and cervical side-to-side linear-stapled esophago-gastrostomies (11.8%) (P<0.001). Multivariable analysis confirmed anastomotic technique as independent predictor of leakage after ttMIE. Conclusion Results of this analysis present the current status of the technical evolution of ttMIE with anastomotic leakage as predominant surgical complication. However, technique-related morbidity requires cautious interpretation considering the long learning curve of this complex surgical procedure.

Anastomotic Techniques and Associated Morbidity in Total Minimally Invasive Transthoracic Esophagectomy

2019 ◽  
Vol 270 (5) ◽  
pp. 820-826 ◽  
Author(s):  
Wolfgang Schröder ◽  
Dimitri A. Raptis ◽  
Henner M. Schmidt ◽  
Suzanne S. Gisbertz ◽  
Johnny Moons ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Transthoracic Esophagectomy ◽  
Anastomotic Techniques

The Comparisons of Three Stapler Placement Methods for Intrathoracic Mechanistic Circular Stapling in Ivor Lewis Minimally Invasive Esophagectomy

2021 ◽  
Author(s):  
Bo Zhang ◽  
Zi xiang Wu ◽  
Qi Wang ◽  
Sai Bo Pan ◽  
Lian Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Minimally Invasive Esophagectomy ◽  
Multivariable Analysis ◽  
Esophageal Reconstruction ◽  
Ivor Lewis ◽  
Anastomotic Complications ◽  
Invasive Esophagectomy ◽  
The Impact

Abstract Objectives: To analyze the impact of the reversal penetrating technique (RPT) for intrathoracic gastroesophageal mechanical anastomosis on the development of anastomotic complications in Ivor Lewis minimally invasive esophagectomy (ILMIE) and further identify the risk factors for the development of anastomotic leakage and stricture.Methods: A retrospective observational study was conducted using clinical data of 316 patients with esophageal carcinoma (EC) who underwent ILMIE from January 2012 to December 2019. The participants were divided into three groups of RPT, transoral Orvil technique (TOT), or purse-string technique (PST) according to the different stapler placenent methods for intrathoracic mechanistic circular stapling. Multivariable analysis was performed to investigate the association of risk factors with anastomotic leakage and stricture.Results: There were 154 patients with RPT, 78 with TOT and 84 with PST intrathoracic gastroesophageal circular stapling in ILMIE. There was no differences in intraoperative anastomosis related conditions inclouding conversion of open operations, ways of esophageal reconstruction, lymph nodes harvested between the three groups. Whereas, The mean total operative time, and gastroesophageal anastomosis time in the RPT group were significantly shorter than those in other groups (both p<0.05). The rates of anastomotic leakage and stricture showed no statistical differences between three groups, respectively (Leakage: p=0.941; Stricture: p=0.942). Multivariate analysis revealed that the PRT method of the anvil placement does not increase the probability of anastomotic leakage (PRT: reference; TOT: odds ratio(OR) 2.845, P=0.255; PST: OR 2.234, p=0.242) and stricture (PRT: reference; TOT: OR 1.976, P=0.556; PST: OR 1.872, p=0.284).Conclusions: The PRT method of the anvil placement for intrathoracic gastroesophageal circular stapling does not increase the risk of anastomotic complications in ILMIE, but had significantly shorter surgical time and anastomosis time.

scholarly journals Value of protective stoma in rectal cancer surgery

2016 ◽  
Vol 69 (3-4) ◽  
pp. 73-78 ◽  
Author(s):  
Ivana Fratric ◽  
Zoran Radovanovic ◽  
Dragana Radovanovic ◽  
Ferenc Vicko ◽  
Tomislav Petrovic ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Surgical Complications ◽  
Rectal Resection ◽  
Surgical Complication ◽  
Primary Anastomosis ◽  
Rectal Surgery ◽  
Rectal Cancer Surgery ◽  
Double Stapling ◽  
Protective Stoma

Introduction. Anastomotic leakage is the most serious surgical complication in rectal surgery. The aim of this study was to find out whether a protective stoma was capable of lowering the rate of clinical anastomotic leakage and to evaluate the rate of anastomotic leakages requiring re-surgery. Material and Methods. A retrospective study included a sample of 149 consecutive patients with rectal cancer who had undergone elective rectal resection with primary anastomosis. After total mesorectal excision, the anastomosis was created using either the single stapling or double stapling anastomotic technique. Anastomotic integrity was verified by transanal air insufflations with the pelvis filled with saline. A protective covering colostomy was added in selected cases and according to the surgeon?s preference. Results. A protective stoma was created in 31% of patients. Clinical anastomotic leakage occurred in 6.7% of patients (10/149). Anastomotic leakage occurred in 8.5% of the patients with a protective stoma (4/47) and in 5.9% of those without a protective stoma (6/102), which was not statistically significant. Surgery lasted significantly longer when a stoma had to be created than in case when it was not needed (p=0.024). The overall rate of re-surgery due to postoperative surgical complications was 5.3% and in three cases this happened because of anastomotic leakage. All patients with a protective stoma and clinical anastomotic leakage were treated conservatively, compared to 50% of patients without a protective stoma who suffered anastomotic leakage and had to be operated. Conclusion. A stoma cannot prevent but it can surely minimize surgical complications related to anastomotic leakage and it does reduce the rate of re-surgery.

scholarly journals Survival in endometrial cancer in relation to minimally invasive surgery or open surgery – a Swedish Gynecologic Cancer Group (SweGCG) study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christer Borgfeldt ◽  
Erik Holmberg ◽  
Janusz Marcickiewicz ◽  
Karin Stålberg ◽  
Bengt Tholander ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Endometrial Cancer ◽  
Minimally Invasive ◽  
Cancer Patients ◽  
Surgical Approach ◽  
Open Surgery ◽  
Gynecologic Cancer ◽  
Multivariable Analysis ◽  
Figo Stage

Abstract Background The aim of this study was to analyze overall survival in endometrial cancer patients’ FIGO stages I-III in relation to surgical approach; minimally invasive (MIS) or open surgery (laparotomy). Methods A population-based retrospective study of 7275 endometrial cancer patients included in the Swedish Quality Registry for Gynecologic Cancer diagnosed from 2010 to 2018. Cox proportional hazard models were used in univariable and multivariable survival analyses. Results In univariable analysis open surgery was associated with worse overall survival compared with MIS hazard ratio, HR, 1.39 (95% CI 1.18–1.63) while in the multivariable analysis, surgical approach (MIS vs open surgery) was not associated with overall survival after adjustment for known risk factors (HR 1.12, 95% CI 0.95–1.32). Higher FIGO stage, non-endometrioid histology, non-diploid tumors, lymphovascular space invasion and increasing age were independent risk factors for overall survival. Conclusion The minimal invasive or open surgical approach did not show any impact on survival for patients with endometrial cancer stages I-III when known prognostic risk factors were included in the multivariable analyses.

scholarly journals Liquid Biopsy in Pancreatic Cancer: Are We Ready to Apply It in the Clinical Practice?

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1986
Author(s):  
Victoria Heredia-Soto ◽  
Nuria Rodríguez-Salas ◽  
Jaime Feliu
Keyword(s):  
Pancreatic Cancer ◽  
Clinical Practice ◽  
Early Diagnosis ◽  
Minimally Invasive ◽  
Liquid Biopsy ◽  
Genetic Material ◽  
Current Status ◽  
Ductal Adenocarcinoma ◽  
Disease Monitoring ◽  
Global Status

Pancreatic ductal adenocarcinoma (PDAC) exhibits the poorest prognosis of all solid tumors, with a 5-year survival of less than 10%. To improve the prognosis, it is necessary to advance in the development of tools that help us in the early diagnosis, treatment selection, disease monitoring, evaluation of the response and prognosis. Liquid biopsy (LB), in its different modalities, represents a particularly interesting tool for these purposes, since it is a minimally invasive and risk-free procedure that can detect both the presence of genetic material from the tumor and circulating tumor cells (CTCs) in the blood and therefore distantly reflect the global status of the disease. In this work we review the current status of the main LB modalities (ctDNA, exosomes, CTCs and cfRNAs) for detecting and monitoring PDAC.

scholarly journals Current status of minimally invasive surgery for gastric cancer: A literature review to highlight studies limits

2015 ◽  
Vol 17 ◽  
pp. 34-40 ◽  
Author(s):  
Amilcare Parisi ◽  
Ninh T. Nguyen ◽  
Daniel Reim ◽  
Shu Zhang ◽  
Zhi-Wei Jiang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Minimally Invasive Surgery ◽  
Literature Review ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Current Status

scholarly journals Minimally Invasive Therapies for Female Stress Urinary Incontinence: the Current Status of Bioinjectables/New Devices (Adjustable Continence Therapy, Urethral Submucosal Collagen Denaturation by Radiofrequency)

2009 ◽  
Vol 9 ◽  
pp. 466-478 ◽  
Author(s):  
Simone Crivellaro ◽  
John J. Smith
Keyword(s):  
Clinical Trials ◽  
Urinary Incontinence ◽  
Clinical Practice ◽  
Stress Urinary Incontinence ◽  
Minimally Invasive ◽  
Emerging Technologies ◽  
Current Status ◽  
Female Stress Urinary Incontinence ◽  
Salvage Procedure ◽  
Collagen Denaturation

The aim of this review is to provide an update on the current status of evolving minimally invasive therapies for stress urinary incontinence. Bioinjectables have been available for some time and their current status is reviewed. The adjustable continence device has been used as a salvage procedure for females for a number of years in clinical trials, yet many are unfamiliar with it. Lastly, radiofrequency via a transurethral route has also been utilized in small numbers and will be updated. These later two emerging technologies need further exposure to better define their role in our clinical practice.

Sign in / Sign up

Export Citation Format

Share Document