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.

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.

Results of the Introduction of a Minimally Invasive Esophagectomy Program in a Tertiary Referral Center

2011 ◽  
Vol 140 (5) ◽  
pp. S-1049-S-1050
Author(s):  
Rachel L. Blom ◽  
Markus W. Hollmann ◽  
Jean H. Klinkenbijl ◽  
Thomas M. Van Gulik ◽  
Olivier R. Busch ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Invasive Esophagectomy ◽  
Referral Center

O100 WORLDWIDE TECHNIQUES AND OUTCOMES OF ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE): RESULTS FROM THE INTERNATIONAL UGIRA REGISTRY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
B F Kingma ◽  
P P Grimminger ◽  
M J van Det ◽  
Y K Chao ◽  
P Chiu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Operating Time ◽  
Case Series ◽  
Radical Resection ◽  
Pulmonary Complications ◽  
Cardiac Complications ◽  
Robot Assisted ◽  
Invasive Esophagectomy ◽  
The Mean

Abstract Aim The aim of this study was to gain insight in the techniques and outcomes of RAMIE worldwide. Background & Methods Although robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted. The current literature on RAMIE mainly consists of single-center case series with considerable variation in reported techniques and outcomes. To gain an overview of the worldwide practice in RAMIE, an online registry was established by the Upper GI International Robotic Association (UGIRA). The collected data involve patient- and treatment characteristics, as well as postoperative outcomes that include complications as defined by the Esophageal Complications Consensus Group, length of stay, re-admissions (i.e. <30 days after discharge), mortality (i.e. in-hospital or <30 days after surgery), and pathological results. The outcomes were descriptively analyzed for this interim report. Results A total of 434 patients who underwent RAMIE for esophageal cancer between 2016-2019 were included in this interim analysis. The mean age was 63 years (SD ±9.7), the majority was male (n=359, 83%), and nearly all patients had an ASA score ≥2 (n=398, 92%). Adenocarcinoma (n=253, 58%) and squamous cell carcinoma (n=162, 37%) were most prevalent. The usual surgical approach was transthoracic (n=428, 99%) with the patient in semiprone position (n=393, 91%). Gastric conduit reconstruction was performed in all except one patient, who received a colonic interposition. The anastomosis was created by hand-sewing (n=207, 48%), circular stapling (n=142, 32%), or linear stapling (n=85, 20%). The median intraoperative blood loss was 120 milliliters (IQR 70-280) and the median operating time was 392 minutes (IQR 353-455). Postoperative complications occurred in 251 patients (59%) and mainly involved pulmonary complications (n=138, 32%), anastomotic leakage (n=80, 18%), and cardiac complications (n=55, 13%). Mortality occurred in 9 patients (2%) and re-admission because of complications was required in 57 patients (14%). A median of 28 lymph nodes (IQR 21-35) were removed and a radical resection was achieved in 400 patients (92%). Conclusion The presented results are the first to provide an overview of the techniques that are commonly used in RAMIE. By demonstrating results that are in line with recent benchmarking literature, this study demonstrates the safety and feasibility of RAMIE.

P210 HYBRID LAPAROSCOPIC ROBOT-ASSISTED MINIMALLY-INVASIVE ESOPHAGECTOMY: A PROSPECTIVE EXPERIENCE IN A REFERRAL CENTER

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
S Santi ◽  
M Belluomini ◽  
S D'Imporzano ◽  
G Pallabazzer ◽  
B Solito ◽  
...  
Keyword(s):  
Lymph Node ◽  
Minimally Invasive ◽  
Esophageal Neoplasms ◽  
Minimally Invasive Esophagectomy ◽  
Robot Assisted ◽  
Invasive Esophagectomy ◽  
Referral Center ◽  
Extubation Time ◽  
Oncological Results ◽  
The Mean

Abstract Aim To report the prospective experience in Hybrid Laparoscopic Robot-assisted Minimally-invasive Esophagectomy (HLRAMIE) in a referral Center. Background & Methods The minimally-invasive esophagectomy (MIE) is an attractive and established technique to improve the reduction of post-operative morbility with sound oncological results. The hybrid combination of laparoscopy and full robotic thoracic phase (HLRAMIE) is an approach aimed to be as effective as MIE to treat esophageal neoplasms. Inclusion criteria: patients undergone to multimodal medical advice panel, affected from non-cT4, from mid thoracic to cardia, esophageal neoplasms, with and without neoadjuvant treatment, fit for minimally-invasive surgery. HLRAMIE: laparoscopic stage plus full robotic thoracic stage by Da Vinci Xi® (Intuitive Surgical, US), with gastric-pull first-choice conduit. Prospective, dedicated database. Results From October 2015 to April 2019, 33 patients underwent to HLRAMIE (site of neoplasm: 1 mid thoracic; 9 inferior; 23 cardia). 5 out 33 were converted to open. 27/28 underwent to a Ivor Lewis esophagectomy, 1/28 to McKeown procedure. The mean total surgical time was 517 minutes, mean robotic docking time 12 min with mean thoracic time 269 min (positive trend). Gastric pull-up was performed in 28/28. In 23/28 patients the esophago-gastric anastomosis was performed full robotic after the fashion of hand, in 5/28 was performed by circular stapler. The mean extubation time was 12 hours. The mean number of lymph node removed was: overall fields 32.4 (range 15-58), thorax 9.8 (3-27). The mean number of metastatic lymph node was 3.8 (0-18). 100% were R0 resections. The mean hospital-stay was 15 days. The perioperative mortality and 30-day mortality were both 0%. The overall post-operative morbility was 32.1%. 4/28 (14.2%) patients developed an anastomotic leakage, 75% were managed by endoscopy. 11/28 (39.2%) patients developed a late anastomotic stenosis (all in the hand made group). Conclusion In our experience, HLRAMIE is surgically reproducible with the principle of learning curve; oncologically adequate in relation to radical dissection; safe and effective in relation to post-operative early morbility and mortality. Long-term follow up and more powerful, randomized series are needed to establish the definitive clinical and oncological results of HLRAMIE.

FA04.03: MIE VERSUS RAMIE: PROMISING RESULTS OF A SINGLE-CENTER AND SINGLE-SURGEON ANALYSIS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 8-8
Author(s):  
Peter Grimminger ◽  
Evangelos Tagkalos ◽  
Edin Hadzijusufovic ◽  
Benjamin Babic ◽  
Hauke Lang
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Demographic Data ◽  
Circular Stapler ◽  
Reconstruction Technique ◽  
Invasive Esophagectomy ◽  
Icu Stay

Abstract Background Robot assisted surgery for esophageal cancer is rapidly increasing, especially high-volume centers with access to a robot. The fully robotic minimally invasive esophagectomy using 4 robotic arms in the abdomen and thorax (RAMIE4) is performed as standard procedure in our department. In this analysis we compare the results of our first 50 RAMIE4 procedures with our last 50 fully minimally-invasive esophagectomies (MIE), which was our standard prior the robotic era. Methods Between April 2016 and March 2018, the data from 100 consecutive patients with esophageal carcinoma undergoing modified Ivor-Lewis esophagectomy, performed by the same surgeon using the identical intrathoracic anastomotic reconstruction technique (circular stapler). 50 patients were treated with MIE and the other 50 with RAMIE4. Demographic data, extracted lymph nodes and R-status were compared. Complications occurred were compered according to the Dindo-Clavien classification. Results Demographic data did not show significant differences between the groups. The overall 30- and 90- mortality rates were 1% (1/100) and 3% (3/100) respectively (P = 0.305 and P = 0.499 respectively). In the RAMIE group the median lymph node harvest was significantly higher (27 vs. 23; P = 0.045), the median hospital stay was less in the RAMIE group, however not significantly (11.5d vs 13d; P = 0.112), the median ICU stay was significantly lower in the RAMIE group compared to MIE (1d vs 2.5d; P = 0.002). The complications according to the Dindo-Calvien classification were not significantly different between the two groups (P = 0.091). Conclusion In this study we were able to demonstrate the superiority of robotic assisted lymph node dissection for esophageal cancer surgery in a highly comparable setting. In addition the perioperative parameters, especially ICU stay seem to be in favor of RAMIE. The future potential of standardized RAMIE and RAMIE4 seems to be high. Disclosure All authors have declared no conflicts of interest.

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&lt;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.

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