scholarly journals Technical and early outcomes of Ivor Lewis minimally invasive oesophagectomy for gastric tube construction in the thoracic cavity

2013 ◽  
Vol 18 (1) ◽  
pp. 86-91 ◽  
Author(s):  
W. Wu ◽  
Q. Zhu ◽  
L. Chen ◽  
J. Liu
Keyword(s):  
Minimally Invasive ◽  
Gastric Tube ◽  
Thoracic Cavity ◽  
Ivor Lewis ◽  
Minimally Invasive Oesophagectomy

VS03.02: TOTALLY MINIMALLY INVASIVE IVORL LEWIS ESOPHAGECTOMY (TMIE) INDOCYANINE COLOR GREEN (ICG) FLUORESCENCE ANGIOGRAPHY ASSISTED

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 48-48
Author(s):  
Andrea Cossu ◽  
Paolo Parise ◽  
Francesco Puccetti ◽  
Leonardo Garutti ◽  
Carlo Ferrari ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Oncologic Outcomes ◽  
Fluorescence Angiography ◽  
Technical Problems ◽  
Ivor Lewis ◽  
Experienced Surgeon ◽  
Ivor Lewis Esophagectomy ◽  
Overall Mortality

Abstract Description Totally Minimally Invasive Ivor Lewis Esophagectomy has been proven feasible and safe in terms of overall mortality, morbidity and oncologic outcomes. Technical problems still exist in anastomotic fashioning and esophagogastric leakage represents the most feared complication. Its incidence is strictly related to technical difficulties and to the ischemia of the tissue involved in the anastomosis. We think angiography with Indocyanine Color Green can help the experienced surgeon to better evaluate the adequacy of the gastric tube therefore reducing the incidence of anastomotic leak. Disclosure All authors have declared no conflicts of interest.

scholarly journals Gastric tube necrosis following minimally invasive oesophagectomy is a learning curve issue

2013 ◽  
Vol 95 (5) ◽  
pp. 329-334 ◽  
Author(s):  
L Ramage ◽  
J Deguara ◽  
A Davies ◽  
A Hamouda ◽  
K Tsigritis ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Learning Curve ◽  
Gastric Tube ◽  
Invasive Technique ◽  
Ischaemic Preconditioning ◽  
Inpatient Mortality ◽  
Key Factors ◽  
Ultrasonic Dissector ◽  
Prophylactic Measures ◽  
Minimally Invasive Oesophagectomy

Introduction Gastric tube necrosis following oesophagectomy is thought to have an increased association with a minimally invasive technique. Some suggest gastric ischaemic preconditioning may reduce ischaemic complications. We discuss our series of 155 consecutive minimally invasive oesophagectomies (MIOs), including a number of cases of gastric tube ischaemia, of which 4 (2.6%) developed conduit necrosis. Methods Data were collected prospectively of MIOs carried out by a single surgeon between 2005 and 2011. Cases of gastric tube necrosis were identified. Results Overall, 155 patients were identified. The inpatient mortality rate was 2.6%. Gastric tube necrosis occurred in four patients (2.6%). An ultrasonic dissector injury to the gastroepiploic arcade had occurred in two cases. In another case, the gastric tube was strangulated in the hiatus. In the remaining case, no clear mechanical cause was identified. All 4 cases occurred within the first 73 cases. The gastric tube necrosis rate of the first 50 cases versus cases 51–155 was 4% and 2% respectively (p=0.5948). The anastomotic leak rate in these two cohorts was 18% and 7% respectively (p=0.0457). There was a significant reduction in overall gastric tube complications from 22% to 10% following the learning curve of the initial 50 cases (p=0.0447). Conclusions In our series, gastric tube necrosis appears to be a learning curve issue. Prophylactic measures such as ischaemic preconditioning become less relevant as the operating surgeon’s experience increases. Instead, meticulous attention to preserving the gastroepiploic arcade, avoidance of tension in the tube and careful positioning of the gastric conduit through an adequately sized hiatus are key factors.

O184 MINIMALLY INVASIVE OESOPHAGECTOMY: A LONG LEARNING CURVE FOR BETTER ONCOLOGICAL RESECTION AND IMPROVED SURVIVAL OUTCOME

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Francesco Di Maggio ◽  
Ai Ru Lee ◽  
Harriet Deere ◽  
Zoi Vrakopoulou ◽  
Abrie Botha
Keyword(s):  
Minimally Invasive ◽  
Learning Curve ◽  
Resection Margins ◽  
Anatomical Resection ◽  
Term Survival ◽  
Ivor Lewis ◽  
Long Term Survival ◽  
Neo Adjuvant Chemotherapy ◽  
Minimally Invasive Oesophagectomy

Abstract Aim We wanted to investigate whether the established perioperative benefits of minimally invasive techniques, along with defined anatomical resection of the primary tumour (TARC), translate into long term survival benefit in a specialized high volume center. Background & Methods Minimally invasive oesophagectomy is technically demanding but benefits perioperative morbidity and intra-hospital mortality. We previously described open total adventitial resection of the cardia (TARC) as an optimal anatomical resection technique for lower oesophageal and gastro-esophageal junction cancers1. Long-term survival outcomes across our learning curve in adopting laparoscopic TARC are hereby assessed. Data from 198 consecutive patients undergoing oesophagectomy by a single surgeon across two institutions was collected prospectively. Patient stratification was made to chronologically reflect four main stages of our learning curve: open surgery, Laparoscopic Ivor Lewis, laparoscopy/thoracoscopy with mini-thoracotomy and laparoscopic TARC. Primary outcomes included five-year survival rate, operating time, hospital stay, specimen lymphnodes. Peri-operative complications and mortality are also described. Results 158 patients were male (79.8%); age was 63 +/- 10 years. 159 (78%) patients had neo-adjuvant chemotherapy. Overall five-year survival rate was 45%; peri-operative mortality rate was 1.5% (n=3). 13 patients were returned to theatre for surgical complications. Hospital stay was 22+/-23 days. Pathological specimen lymphnodes were 21+/- 8 (median: 20). Resection margins were negative (ACP) in 193 cases (97.4%); further than 1mm (RCPath) in 138 cases (69.7%). The first 45 patients had open TARC surgery (26 Ivor Lewis, 17 trans-hiatal, one three-stage and one left thoracotomy). Laparoscopy (n=50) was initiated after two years, and thoracoscopic dissection (n=56) was introduced after case 94. Laparoscopic TARC was performed for the last 47 patients. Patients in the four groups had similar demographics, histological diagnosis, pre-operative and pathological staging, although the ones in the lap TARC group had a lower uptake of neo-adjuvant chemotherapy (64% versus 83%), mainly due to patient choice and co-morbidities. Specimen lymph nodes for the four groups were: open = 20.5 +/-9.5; Lap = 19.5+/- 7; mini-tho = 19.9 +/- 7; lap TARC = 25 +/- 10 (p = 0.027). Resection margins were >1mm in 68.1% (open), 67.3% (lap), 64.2 (mini-tho) and 79.5% (lap TARC). Patients five-year survival rates during the 4 phases of the learning curve were 38.6%, 44.9%, 42.8% and 59% respectively, showing a benefit trend towards the end of the learning curve (p=0.03, log Rank Test). Conclusion Laparoscopic Anatomical resection of cancers of the OGJ requires a long learning curve. The evolution of performance and surgical technique through open and minimally invasive learning phases, along with the progress in oncological science, result in improved long-term survival.

scholarly journals Challenging delayed bleeding after an Ivor Lewis oesophagectomy

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Sean Liddle ◽  
Anirudh Mirakhur ◽  
Estifanos Debru
Keyword(s):  
Minimally Invasive ◽  
Circular Stapler ◽  
Oesophageal Adenocarcinoma ◽  
Terminal Portion ◽  
Ivor Lewis ◽  
Delayed Bleeding ◽  
Radiology Suite ◽  
Upper Gastrointestinal Bleed ◽  
Minimally Invasive Oesophagectomy ◽  
Upper Gastrointestinal

Abstract A 66-year-old man underwent a minimally invasive oesophagectomy for oesophageal adenocarcinoma. Surgery and recovery were routine; however, he represented 8 days later with a massive upper gastrointestinal bleed. He was stabilized, but over a 2-week period experienced several bleeds requiring transfusion and multiple endoscopies, all showing a prominent luminal vessel at the oesophago-gastric (OG) anastomosis. Haemostatic clipping was attempted resulting in pulsatile bleeding and transfer to the radiology suite where angiography showed extravasation of contrast at the OG anastomosis from the terminal portion of the gastro-epiploic arcade. Coil embolization was successful and did not result in ischaemia. It was our standard to construct the OG anastomosis with the end-to-end anastomosis circular stapler (DST™ Series EEA™), 4.8-mm staple height. However, we now use the 3.5-mm staple height for improved haemostasis and ensure that the area for anastomosis is cleared of omental tissue so as not to incorporate a visible vessel.

scholarly journals European consensus on essential steps of Minimally Invasive Ivor Lewis and McKeown Esophagectomy through Delphi methodology

2021 ◽  
Author(s):  
Yassin Eddahchouri ◽  
◽  
Frans van Workum ◽  
Frits J. H. van den Wildenberg ◽  
Mark I. van Berge Henegouwen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Expert Panel ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Round Table Discussion ◽  
Ivor Lewis ◽  
Delphi Methodology ◽  
Invasive Esophagectomy ◽  
European Consensus ◽  
Mckeown Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure with a long learning curve, which is associated with increased morbidity and mortality. To master MIE, training in essential steps is crucial. Yet, no consensus on essential steps of MIE is available. The aim of this study was to achieve expert consensus on essential steps in Ivor Lewis and McKeown MIE through Delphi methodology. Methods Based on expert opinion and peer-reviewed literature, essential steps were defined for Ivor Lewis (IL) and McKeown (McK) MIE. In a round table discussion, experts finalized the lists of steps and an online Delphi questionnaire was sent to an international expert panel (7 European countries) of minimally invasive upper GI surgeons. Based on replies and comments, steps were adjusted and rephrased and sent in iterative fashion until consensus was achieved. Results Two Delphi rounds were conducted and response rates were 74% (23 out of 31 experts) for the first and 81% (27 out of 33 experts) for the second round. Consensus was achieved on 106 essential steps for both the IL and McK approach. Cronbach’s alpha in the first round was 0.78 (IL) and 0.78 (McK) and in the second round 0.92 (IL) and 0.88 (McK). Conclusions Consensus among European experts was achieved on essential surgical steps for both Ivor Lewis and McKeown minimally invasive esophagectomy.

792 OUTCOMES AFTER TOTALLY MINIMALLY INVASIVE VERSUS HYBRID OR OPEN IVOR LEWIS ESOPHAGECTOMY: RESULTS FROM THE INTERNATIONAL ESODATA STUDY GROUP.

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Berend Van Der Wilk ◽  
Eliza R C Hagens ◽  
Ben M Eyck ◽  
Suzanne S Gisbertz ◽  
Richard Hillegersberg ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Hospital Length Of Stay ◽  
Mortality Data ◽  
Study Group ◽  
Ivor Lewis ◽  
Open Esophagectomy ◽  
Ivor Lewis Esophagectomy ◽  
The Impact

Abstract   To compare complications following totally minimally invasive (TMIE), laparoscopically assisted (hybrid) and open Ivor Lewis esophagectomy in patients with esophageal cancer. Three randomized trials have reported benefits for minimally invasive esophagectomy. Two studies compared TMIE versus open esophagectomy and another compared hybrid versus open Ivor Lewis esophagectomy. Only small retrospective studies compared TMIE with hybrid Ivor Lewis esophagectomy. Methods Data were used from the International Esodata Study Group assessing patients undergoing TMIE, hybrid or open Ivor Lewis esophagectomy. Primary outcome was pneumonia, secondary outcomes included incidence and severity of anastomotic leakage, (major) complications, length of stay, escalation of care and 90-day mortality. Data were analyzed using multivariate multilevel models. Results In total, 4733 patients were included in this study (TMIE:1472, hybrid:1364 and open:1897). Patients undergoing TMIE had lower incidence of pneumonia compared to hybrid (10.9% vs 16.3%, Odds Ratio (OR):0.56, 95%CI: 0.40–0.80) and open esophagectomy (10.9% vs 17.4%, OR:0.60, 95%CI: 0.42–0.84) and had shorter length of stay (median 10 days (IQR 8–16)) compared to hybrid (14 (11–19), p = 0.041) and open esophagectomy (11 (9–16), p = 0.027). Patients undergoing TMIE had higher rate of anastomotic leakage compared to hybrid (15.1% vs 10.7%, OR:1.47, 95%CI: 1.01–2.13) and open esophagectomy (7.3%, OR:1.73, 95%CI: 1.26–2.38). No differences were reported between hybrid and open esophagectomy. Conclusion Compared to hybrid and open Ivor Lewis esophagectomy, TMIE resulted in a lower pneumonia rate, a shorter hospital length of stay but a higher anastomotic leakage rate. The impact of these individual complications on survival and long-term quality of life should be further investigated.

Sign in / Sign up

Export Citation Format

Share Document