Minimally Invasive Ivor Lewis Esophagectomy after Induction Therapy Yields Similar Early Outcomes to Surgery Alone

2011 ◽  
Vol 6 (5) ◽  
pp. 331-336 ◽  
Author(s):  
Luis F. Tapias ◽  
Christopher R. Morse
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Neoadjuvant Therapy ◽  
Neoadjuvant Chemoradiotherapy ◽  
R0 Resection ◽  
Short Term ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Estimated Blood Loss ◽  
Short Term Mortality

Objective Although considered an integral part of treatment for regionally advanced esophageal cancer, there is conflicting literature regarding the effect of neoadjuvant chemoradiotherapy on esophagectomy. The objectives of this study are to examine the effect of neoadjuvant therapy in regard to perioperative parameters, morbidity, and short-term mortality in patients undergoing a minimally invasive Ivor Lewis esophagectomy (MIE). Methods This is a retrospective review of 39 patients undergoing MIE for esophageal cancer during 2007–2010. Results Of the 39 patients, 14 (36%) did not receive neoadjuvant therapy (NCR) and 25 (64%) did receive either chemoradiotherapy or chemotherapy (CR). On comparing NCR vs CR, there was no difference in operative time (361 vs 362 minutes; P = 0.94) or estimated blood loss (233 vs 190 mL; P = 0.06). All patients underwent an R0 resection, and there was no difference in the mean number of lymph nodes harvested (NCR 21.5 vs CR 21.6; P = 0.95). Both groups had mean intensive care unit stay of 1 day (P = 0.7), and there was no difference in length of stay (NCR 7.4 vs CR 8.2 days; P = 0.38). There were no deaths or anastomotic leaks in either group. The incidence of complications in the NCR group was 21% (3/14) while in the CR group was 48% (12/25). Complications were not associated with neoadjuvant therapy [CR vs NCR: odds ratio = 3.44 (0.72–16.38); P = 0.121], even after adjusting for comorbidities and age. Conclusions MIE can be performed safely following neoadjuvant therapy with similar perioperative results, morbidity, and short-term mortality when compared with MIE alone. Longer follow-up is required for oncologic validity.

RA03.01: A POPULATION-BASED STUDY ON LYMPH NODE RETRIEVAL IN PATIENTS WITH ESOPHAGEAL CANCER: RESULTS FROM THE DUTCH UPPER GASTROINTESTINAL CANCER AUDIT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 22-23
Author(s):  
Leonie Van Der Werf ◽  
Johan Dikken ◽  
Mark I Van Berge Henegouwen ◽  
Valery Lemmens ◽  
Grard A P Nieuwenhuijzen ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Neoadjuvant Therapy ◽  
Hospital Volume ◽  
Conflicts Of Interest ◽  
Neoadjuvant Chemoradiotherapy ◽  
Charlson Score ◽  
Short Term ◽  
Lymph Node Retrieval

Abstract Background For esophageal cancer, the number of retrieved lymph nodes (LNs) is often used as a quality indicator. The aim of this study was to analyze the number of retrieved LNs in the Netherlands, to assess factors associated with LN yield and to explore the association with short-term outcomes. Methods For this retrospective national cohort study, patients with an esophageal carcinoma who underwent esophagectomy between 2011–2016 were included. Primary outcome was the number of retrieved LNs. Associations were tested with univariable and multivariable regression analysis for the association with ≥ 15 LNs. Results 3970 patients were included. Between 2011–2016 the median number of LNs increased from 15 to 20. Factors independently associated with ≥ 15 LNs were: 0–10 kg preoperative weight loss (versus: unknown weight loss, odds ratio [95% confidence interval]: 0.71[0.57–0.88]), Charlson-score 0 (versus: Charlson-score 2: 0.76[0.63–0.92]), cN2-category (reference: cN0, 1.32[1.05–1.65]), no neoadjuvant therapy and neoadjuvant chemotherapy (reference: neoadjuvant chemoradiotherapy, 1.73[1.29–2.32], 2.15[1.54–3.01]), minimally invasive transthoracic (reference: open transthoracic, 1.46[1.15–1.85]), open transthoracic (versus open and minimally invasive transhiatal, 0.29[0.23–0.36] and 0.43[0.32–0.59], hospital volume of 26–50 or > 50 resections/year (reference: 0–25, 1.94[1.55–2.42], 3.01[2.36–3.83]) and year of surgery (reference: 2011, ORs: 1.48, 1.53, 2.28, 2.44, 2.54). There was no association of ≥ 15 LNs with short-term outcomes. Conclusion The number of LNs retrieved increased between 2011 and 2016. Weight loss, Charlson score, cN-category, neoadjuvant therapy, surgical approach, year of resection and hospital volume were all associated with increased LN yield. The retrieval of ≥ 15 LNs was not associated with increased postoperative morbidity/mortality. Disclosure All authors have declared no conflicts of interest.

Short-Term Outcomes of Minimally Invasive Ivor-Lewis Esophagectomy for Esophageal Cancer

2014 ◽  
Vol 97 (5) ◽  
pp. 1721-1727 ◽  
Author(s):  
Ming-ran Xie ◽  
Chang-qing Liu ◽  
Ming-fa Guo ◽  
Xin-yu Mei ◽  
Xiao-hui Sun ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Short Term ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

Modified Intrathoracic Esophagogastrostomy with Minimally Invasive Robot-Assisted Ivor-Lewis Esophagectomy for Cancer

2018 ◽  
Vol 36 (3) ◽  
pp. 218-225 ◽  
Author(s):  
Wen-Ping Wang ◽  
Long-Qi Chen ◽  
Han-Lu Zhang ◽  
Yu-Shang Yang ◽  
Song-Lin He ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Circular Stapler ◽  
Purse String Suture ◽  
Robot Assisted ◽  
Purse String ◽  
Ivor Lewis ◽  
Intrathoracic Anastomosis ◽  
Ivor Lewis Esophagectomy ◽  
Estimated Blood Loss ◽  
Esophagectomy For Cancer

Background: Intrathoracic esophagogastrostomy plays an important role in minimally invasive Ivor-Lewis esophagectomy for cancer. Intrathoracic anastomosis with robot-assisted Ivor-Lewis esophagectomy (RAILE) includes hand-sewn and circular stapler methods, which remain technically challenging. In this study, we modified the techniques for intrathoracic anastomosis at RAILE, in order to simplify the complex procedures. Methods: “Side-insertion” technique was used for anvil placement and purse string suture for intrathoracic anastomosis at RAILE. Medical records for consecutive patients who had undergone robot-assisted minimally invasive Ivor-Lewis esophagectomy for cancer between January 2015 and June 2018 were analyzed. Results: A total of consecutive 31 patients were enrolled. There was no conversion to open thoracotomy in this cohort. Mean operation duration in the robotic group was 387.4 ± 68.2 min. Median estimated blood loss was 110 mL (range 50–400 mL). Two patients (6.5%) had postoperative anastomotic leak. No postoperative reoperation was needed and there were no mortality. Six patients (19.4%) had anastomotic stricture and 2 patients of them needed endoscopic dilation. Conclusion: RAILE is safe and feasible. Our modified procedure highlighting the “side-insertion” method may simplify the process of intrathoracic anvil placement and purse string suture for anastomosis at RAILE.

scholarly journals Totally mechanical linear stapled anastomosis for minimally invasive Ivor Lewis esophagectomy: Operative technique and short‐term outcomes

2020 ◽  
Vol 11 (3) ◽  
pp. 769-776 ◽  
Author(s):  
Hui‐Jiang Gao ◽  
Ju‐Wei Mu ◽  
Wei‐Min Pan ◽  
Malcolm Brock ◽  
Mao‐Long Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Operative Technique ◽  
Stapled Anastomosis ◽  
Short Term ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Linear Stapled Anastomosis

scholarly journals Outcomes With Open and Minimally Invasive Ivor Lewis Esophagectomy After Neoadjuvant Therapy

2016 ◽  
Vol 101 (3) ◽  
pp. 1097-1103 ◽  
Author(s):  
Luis F. Tapias ◽  
Douglas J. Mathisen ◽  
Cameron D. Wright ◽  
John C. Wain ◽  
Henning A. Gaissert ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Neoadjuvant Therapy ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

scholarly journals Hand-sewn anastomosis for minimally invasive laparoscopic Ivor Lewis esophagectomy—how to do it: operative technique and short-term outcomes

2021 ◽  
Vol 0 ◽  
pp. 0-0
Author(s):  
Mauricio Ramirez ◽  
Matias Turchi ◽  
Federico Llanos ◽  
Adolfo Badaloni ◽  
Alejandro Nieponice
Keyword(s):  
Minimally Invasive ◽  
Operative Technique ◽  
Short Term ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

scholarly journals Side-to-side esophagogastric anastomosis for minimally invasive Ivor-Lewis esophagectomy: operative technique and short-term outcomes

2021 ◽  
Author(s):  
Manrica Fabbi ◽  
Stefano De Pascale ◽  
Filippo Ascari ◽  
Wanda Luisa Petz ◽  
Uberto Fumagalli Romario
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Anastomotic Stricture ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Open Approach ◽  
Short Term ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

AbstractTotally minimally invasive Ivor-Lewis esophagectomy (TMIIL) is associated to lower rate of post-operative complication, decreases length of hospital stay and improves quality of life compared to open approach. Nevertheless, adaptation of TMIIL still proceeds at slow pace, mainly due to the difficulty to perform the intra-thoracic anastomosis and heterogeneity of surgical techniques. We present our experience with TMIIL utilizing a stapled side-to-side anastomosis. We retrospectively evaluated 36 patients who underwent a planned TMIIL from January 2017 to September 2020. Esophagogastric anastomoses were performed using a 3-cm linear-stapled side-to-side technique. General features, operative techniques, pathology data and short-term outcomes were analyzed. The median operative time was 365 min (ranging from 240 to 480 min) with a median blood loss of 100 ml (50–1000 ml). The median overall length of stay was 13 (7–64) days and in-hospital mortality rate was 2.8%. Two patients (5.6%) had an anastomotic leak, without need for operative intervention and another patient developed an anastomotic stricture, resolved with a single endoscopic dilation. Chylothorax occurred in three patients; two of these required a surgical intervention. Pulmonary complications occurred in six patients (16.7%). Based on Comprehensive Complications Index (CCI), median values of complications were 27.9 (ranging from 20.9 to 100). The results of our study suggest that TMIIL with a 3-cm linear-stapled anastomosis seems to be safe and effective, with low rates of post-operative anastomotic leak and stricture.

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