Learning Curve to Lymph Node Resection in Minimally Invasive Esophagectomy for Cancer

2014 ◽  
Vol 9 (4) ◽  
pp. 286-291 ◽  
Author(s):  
Ankit Dhamija ◽  
Joshua E. Rosen ◽  
Anish Dhamija ◽  
Bonnie E. Gould Rothberg ◽  
Anthony W. Kim ◽  
...  
Keyword(s):  
Lymph Node ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Minimally Invasive Esophagectomy ◽  
Invasive Approach ◽  
Lymph Node Yield ◽  
Invasive Esophagectomy ◽  
Surgeon Experience ◽  
Nodal Yield ◽  
The Impact

Objective Minimally invasive esophagectomy (MIE) is a safe alternative to open approaches, yet the impact of the minimally invasive approach on oncologic efficacy is unclear. The objectives of the current study were to compare lymph node yields and surgical margins during a single-surgeon series to examine the learning curve to oncologic aspects of MIE. Methods A retrospective review of a prospectively maintained institutional database was performed. The sequential MIE experience for esophageal cancer was subcategorized into terciles (first 25 MIEs as early, next 24 as middle, and most recent 24 as later). Results Seventy-three patients underwent MIE for cancer between 2008 and 2013. Complete resections (R0) were performed in 71 cases (93%), and there were no significant differences in the number of complete resections with negative margins during the MIE experience ( P = 0.54). The number of lymph nodes harvested during MIE increased significantly with progressive experience, with a mean of 22, 29, and 28 nodes recovered in the early, middle, and late subgroups, respectively ( P = 0.038). On multivariate analysis, only increasing surgeon experience (1.4-fold increase in nodal yield for the latter two thirds relative to the first third, P = 0.0011) and histology of high-grade dysplasia (0.54-fold decrease in nodal yield relative to adenocarcinoma or squamous cell carcinoma, P = 0.025) were significant predictors of lymph node yield. Conclusions The ability to execute a complete lymphadenectomy during MIE is affected by surgeon experience and improves over time, plateauing after the first 25 cases.

scholarly journals Learning Curve for Lymph Node Dissection Around the Recurrent Laryngeal Nerve in McKeown Minimally Invasive Esophagectomy

2021 ◽  
Vol 11 ◽  
Author(s):  
Zi-Yi Zhu ◽  
Rao-Jun Luo ◽  
Zheng-Fu He ◽  
Yong Xu ◽  
Shao-Hua Xu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Recurrent Laryngeal Nerve ◽  
Minimally Invasive Esophagectomy ◽  
Laryngeal Nerve ◽  
Stable Phase ◽  
Invasive Esophagectomy ◽  
Study Results ◽  
The Impact

BackgroundCompared to open esophagectomy (OE), minimally invasive esophagectomy (MIE) is associated with lower morbidity and mortality. However, lymph node (LN) dissection around the recurrent laryngeal nerve (RLN) is still an important factor that affects the length of the learning curve of MIE. This study aims to evaluate the surgical outcomes of the first nearly 5-year period and explore the learning curve for LN dissection around the RLN in McKeown MIE by a new single surgical team.MethodsA total of 285 consecutive patients who underwent McKeown MIE between March 2016 and September 2020 were included at our institution. According to the cumulative sum (CUSUM) analysis of LN dissection around the RLN, the patients were divided into three groups: exploration period, adjustment period, and stable period. We assessed the impact of surgical proficiency on postoperative outcomes and explored the learning curve for LN dissection around the RLN in McKeown MIE.ResultsThe CUSUM graph showed that a point of upward inflection for LN dissection around the RLN was observed in 151 cases. After 151 cases, LNs around the right and left RLNs were dissected thoroughly compared to the exploration and adjustment period (P = 0.010 and P = 0.012, respectively), and the postoperative incidence of hoarseness significantly decreased from 11.1 to 1.5% (P<0.001).ConclusionsOur study results revealed that not only are the LN, around the RLN, sufficiently dissected but also the incidence of hoarseness significantly decreased in the stable phase. Consequently, the learning curve length was approximately 151 cases for LN dissection around the RLN in McKeown MIE.

scholarly journals Safe Introduction of Minimally Invasive Esophagectomy at a Medium Volume Center

2019 ◽  
Vol 109 (2) ◽  
pp. 121-126 ◽  
Author(s):  
G. Linder ◽  
C. Jestin ◽  
M. Sundbom ◽  
J. Hedberg
Keyword(s):  
Lymph Node ◽  
Minimally Invasive ◽  
Multivariate Regression ◽  
Minimally Invasive Esophagectomy ◽  
Radical Resection ◽  
Tertiary Referral ◽  
Lymph Node Yield ◽  
Tertiary Referral Center ◽  
Invasive Esophagectomy ◽  
Node Yield

Background and Aims: Minimally invasive esophagectomy is a favored alternative in high-volume centers. We evaluated the introduction of, and transition to, minimally invasive esophagectomy at a medium volume tertiary referral center (10–20 esophagectomies annually) with focus on surgical results. Material and Methods: Patients who underwent minimally invasive esophagectomy or open transthoracic surgery for carcinoma of the esophagus or gastroesophageal junction (Siewert I and II) during 2007–2016 were retrospectively studied. Sorted on surgical approach, perioperative data, surgical outcomes, and postoperative complications were analyzed and multivariate regression models were used to adjust for possible confounders. Results: One hundred and sixteen patients were included, 51 minimally invasive esophagectomy (21 hybrid and 30 totally minimally invasive) and 65 open resections. The groups were well matched. However, higher body mass index, neoadjuvant chemoradiotherapy, and cervical anastomosis were more frequent in the minimally invasive esophagectomy group. Minimally invasive esophagectomy was associated with less peroperative bleeding (384 vs 607 mL, p = 0.036) and reduced length of stay (14 vs 15 days, p = 0.042). Duration of surgery, radical resection rate, and postoperative complications did not differ between groups. Lymph node yield was higher in the minimally invasive esophagectomy group, 18 (13–23) vs 12 (8–16), p < 0.001, confirmed in a multivariate regression model (adjusted odds ratio 3.15, 95% class interval 1.11–8.98, p = 0.032). Conclusion: The introduction of minimally invasive esophagectomy at a medium volume tertiary referral center resulted in superior lymph node yield, less peroperative blood loss and shorter length of stay, without compromising the rate of radical resection, or increasing the complication rate.

P141 IVOR LEWIS MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER : IMPACT OF THORACOSCOPY ON POST-OPERATIVE MORBIDITY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Martin Louis ◽  
Voron Thibault ◽  
Drubay Vincent ◽  
Messier Marguerite ◽  
Eveno Clarisse ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Open Approach ◽  
Respiratory Complications ◽  
Invasive Approach ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Significant Difference ◽  
The Impact ◽  
Hybrid Group

Abstract The aim of this study is to assess the impact of thoracoscopy versus conventional thoracotomy on postoperative and oncological outcomes in patients undergoing Ivor Lewis esophagectomy with laparoscopic gastric mobilisation for esophageal resectable cancer. Background & Methods Esophagectomy for cancer is a complexe procedure associated with a high rate of mortality and morbidity1,2, especially respiratory, despite recent improvements in perioperative cares and advances in surgical techniques. Recently, minimally invasive esophagectomy has shown a benefit in decreasing postoperative respiratory complications in 2 randomized trials comparing firstly the hybrid approach (Ivor Lewis with laparoscopy and right thoracotomy) to the open approach (MIRO trial3) and secondly the totally minimally invasive approach with cervical anastomosis (McKeown with laparoscopy and thoracospy) to the open approach (TIME trial4). Few studies have focused on comparing specifically thoracosopic(TMIE) versus conventional thoracotomy approach(HYBRID) for intra-thoracic anastomosis. We performed a single-center retrospective study, including all patients undergoing either Ivor Lewis HYBRID or TMIE in our high-volume center between 2010 and 2019. The primary endpoint was major postoperative complications within 30 days (Dindo-Clavien grade≥III). Secondary endpoints included operative parameters, postoperative morbidity and mortality within 90 days and quality of oncological resection. Results 498 patients were included, 440 underwent HYBRID and 58 TMIE. Ninety-six patients(19.3%) had major postoperative complication, 11 patients(19%) in TMIE and 85 patients(19.3%) in HYBRID. Anastomotic leak (AL) rate was significantly higher in TMIE (36.2% versus 10.8%,p<0.001). However AL in TMIE group were frequently less severe than in the HYBRID group (rate of AL type 2/3 respectively 23.8% and 50%;p=0.044). Respiratory complications were observed in 202 patients (45.9%) in the HYBRID group and in 14 patients (24.1%;p=0.002) in TMIE group, without significant difference in severe respiratory complications rate. The complete resection rate (R0 resection) (5.3% vs 3.7%) and the number of lymph nodes retrieved (25.26 vs 25.92) were comparable in both groups. Conclusion The TMIE approach is burdened with a significant AL rate, probably related to an unreached learning curve, which mitigates the benefit of this approach to respiratory complications. The technical difficulty caused by intrathoracic anastomosis, whose modalities are not well-established, remains a major concern.

Learning Curve to Lymph Node Resection in Minimally Invasive Esophagectomy for Cancer

2014 ◽  
Vol 9 (4) ◽  
pp. 286-291
Author(s):  
Ankit Dhamija ◽  
Joshua E. Rosen ◽  
Anish Dhamija ◽  
Bonnie E. Gould Rothberg ◽  
Anthony W. Kim ◽  
...  
Keyword(s):  
Lymph Node ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Minimally Invasive Esophagectomy ◽  
Invasive Esophagectomy ◽  
Lymph Node Resection ◽  
Esophagectomy For Cancer

Survival and quality of life after minimally invasive esophagectomy: a single-surgeon experience

2011 ◽  
Vol 26 (1) ◽  
pp. 168-176 ◽  
Author(s):  
Abhishek Sundaram ◽  
Juan C. Geronimo ◽  
Brittany L. Willer ◽  
Masato Hoshino ◽  
Zachary Torgersen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Invasive Esophagectomy ◽  
Surgeon Experience

Learning Curve and Associated Morbidity of Minimally Invasive Esophagectomy

2019 ◽  
Vol 269 (1) ◽  
pp. 88-94 ◽  
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

Costs and benefits of different methods of esophagectomy for esophageal cancer

2017 ◽  
Vol 25 (7-8) ◽  
pp. 513-517 ◽  
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.

scholarly journals Impact of nasogastric decompression on gastric tube size after McKeown minimally invasive esophagectomy: A retrospective controlled cohort study

2021 ◽  
Author(s):  
Duo Jiang ◽  
Xian-Ben Liu ◽  
Wen-Qun Xing ◽  
Pei-Nan Chen ◽  
Shao-Kang Feng ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Gastric Tube ◽  
Enhanced Recovery ◽  
Minimally Invasive Esophagectomy ◽  
Tube Size ◽  
Invasive Esophagectomy ◽  
Chest X Ray ◽  
The Right ◽  
The Impact ◽  
Nasogastric Decompression

Abstract Purpose: This retrospective study evaluated the impact of nasogastric decompression (NGD) on gastric tube size to optimize the Enhanced Recovery After Surgery protocol after McKeown minimally invasive esophagectomy (MIE). Methods: Overall, 640 patients were divided into two groups according to nasogastric tube (NGT) placement intraoperatively. Using propensity score matching, 203 pairs of individuals were identified for gastric tube size comparisons on postoperative days (PODs) 1 and 5. Results: Gastric tubes were larger in the non-NGD group than the NGD group on POD 1 (vertical distance from the right edge of the gastric tube to the right edge of the thoracic vertebra, 22.2 [0–34.7] vs. 0 [0–22.5] mm, p <0.001). No difference was noted between the groups on POD 5 (18.5 [0–31.7] vs. 18.0 [0–25.4] mm, p =0.070). Univariate and multivariate analyses showed that non-NGD was an independent risk factor for gastric tube distention on POD 1. No difference in the incidence of complications (Clavien–Dindo（CD）≥2) (40 (23.0%) vs. 46 (19,8%), p =0.440), pneumonia (CD≥2) (29 [16.8%] vs. 30 [12.9%], p =0.280) or anastomotic leakage (CD≥3) (3 [1.7%] vs. 6 [2.6%], p =0.738) were noted between the without gastric tube distention group and with gastric tube distention group. Conclusion: Intraoperative NGT placement reduces gastric tube distention rates after McKeown MIE on POD 1, but the complications are similar to those of unconventional NGT placement. This finding is based on NGT placement or replacement at the appropriate time postoperatively through bedside chest X-ray examination.

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