scholarly journals Comparison of short-term outcomes between transthoracic and robot-assisted transmediastinal radical surgery for esophageal cancer: a prospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuntaro Yoshimura ◽  
Kazuhiko Mori ◽  
Motonari Ri ◽  
Susumu Aikou ◽  
Koichi Yagi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Respiratory Function ◽  
Large Scale ◽  
Vital Capacity ◽  
Radical Surgery ◽  
Perioperative Outcomes ◽  
Transthoracic Esophagectomy ◽  
Robot Assisted ◽  
Short Term ◽  
Transmediastinal Esophagectomy

Abstract Background The present study aimed to assess the lower invasiveness of robot-assisted transmediastinal radical esophagectomy by prospectively comparing this procedure with transthoracic esophagectomy in terms of perioperative outcomes, serum cytokine levels, and respiratory function after surgery for esophageal cancer. Methods Patients who underwent a robot-assisted transmediastinal esophagectomy or transthoracic esophagectomy between April 2015 and March 2017 were included. The perioperative outcomes, preoperative and postoperative serum IL-6, IL-8, and IL-10 levels, and respiratory function measured preoperatively and at 6 months postoperatively were compared in patients with a robot-assisted transmediastinal esophagectomy and those with a transthoracic esophagectomy. Results Sixty patients with esophageal cancer were enrolled. The transmediastinal esophagectomy group had a significantly lower incidence of postoperative pneumonia (p = 0.002) and a significantly shorter postoperative hospital stay (p < 0.0002). The serum IL-6 levels on postoperative days 1, 3, 5, and 7 were significantly lower in the transmediastinal esophagectomy group (p = 0.005, 0.0007, 0.022, 0.020, respectively). In the latter group, the serum IL-8 level was significantly lower immediately after surgery and on postoperative day 1 (p = 0.003, 0.001, respectively) while the serum IL-10 level was significantly lower immediately after surgery (p = 0.041). The reduction in vital capacity, percent vital capacity, forced vital capacity, and forced expiratory volume at 1.0 s 6 months after surgery was significantly greater in the transthoracic esophagectomy group (p < 0.0001 for all four measurements). Conclusions Although further, large-scale studies are needed to confirm our findings, robot-assisted transmediastinal esophagectomy may confer short-term benefits in radical surgery for esophageal cancer. Trial registration This trial was registered in the UMIN Clinical Trial Registry (UMIN000017565 14/05/2015).

Comparison of Short-Term Outcomes Between Transthoracic and Robot-Assisted Transmediastinal Radical Surgery for Esophageal Cancer: A Prospective Study

2020 ◽  
Author(s):  
Shuntaro Yoshimura ◽  
Kazuhiko Mori ◽  
Motonari Ri ◽  
PhD Susumu Aikou ◽  
Koichi Yagi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Prospective Study ◽  
Respiratory Function ◽  
Vital Capacity ◽  
Radical Surgery ◽  
Perioperative Outcomes ◽  
Transthoracic Esophagectomy ◽  
Robot Assisted ◽  
Radical Esophagectomy ◽  
Transmediastinal Esophagectomy

Abstract BackgroundThe present study aimed to assess the lower invasiveness of robot-assisted transmediastinal radical esophagectomy. We prospectively compared this procedure and the transthoracic esophagectomy in terms of perioperative outcomes, serum cytokine levels, and respiratory function after surgery for esophageal cancer.MethodsPatients who underwent a robot-assisted transmediastinal esophagectomy or transthoracic esophagectomy between April 2015 and March 2017 were included. The perioperative outcomes, preoperative and postoperative serum IL-6, IL-8, and IL-10 levels, and respiratory function measured preoperatively and at 6 months postoperatively were compared in patients with a robot-assisted transmediastinal esophagectomy and those with a transthoracic esophagectomy.ResultsSixty patients with esophageal cancer were enrolled. The transmediastinal esophagectomy group had a significantly lower incidence of postoperative pneumonia (p = 0.002) and a significantly shorter postoperative hospital stay (p<0.0002). The serum IL-6 levels on postoperative days 1, 3, 5, and 7 were significantly lower in the transmediastinal esophagectomy group (p=0.005, 0.0007, 0.022, 0.020, respectively). In the transmediastinal esophagectomy group, the serum IL-8 level was significantly lower immediately after surgery and on postoperative day 1 (p=0.003, 0.001, respectively) while the serum IL-10 level was significantly lower immediately after surgery (p=0.041). The reduction in vital capacity, percent vital capacity, forced vital capacity, and forced expiratory volume at 1.0s six months after surgery was significantly greater in the transthoracic esophagectomy group (p<0.0001 for all four measurements).ConclusionsThis prospective study demonstrated that robot-assisted transmediastinal radical esophagectomy can be a minimally invasive surgical procedure for use in radical surgery for esophageal cancer.Trial registrationsThis trial was registered in the UMIN Clinical Trial Registry (UMIN000017565 14/05/2015). https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000020358

Short-term perioperative outcomes after robot-assisted and laparoscopic distal pancreatectomy

2013 ◽  
Vol 8 (2) ◽  
pp. 125-132 ◽  
Author(s):  
Emmanuel I. Benizri ◽  
Adeline Germain ◽  
Ahmet Ayav ◽  
Jean-Louis Bernard ◽  
Rasa Zarnegar ◽  
...  
Keyword(s):  
Distal Pancreatectomy ◽  
Laparoscopic Distal Pancreatectomy ◽  
Perioperative Outcomes ◽  
Robot Assisted ◽  
Short Term

scholarly journals The Necessity of Chest Physical Therapy for Thoracoscopic Oesophagectomy

2005 ◽  
Vol 33 (4) ◽  
pp. 434-442 ◽  
Author(s):  
T Nakatsuchi ◽  
M Otani ◽  
H Osugi ◽  
Y Ito ◽  
T Koike
Keyword(s):  
Physical Therapy ◽  
Respiratory Function ◽  
Radical Surgery ◽  
Thoracoscopic Surgery ◽  
Respiratory Complications ◽  
Short Term ◽  
Less Invasive ◽  
Before And After ◽  
Chest Physical Therapy

Radical surgery for thoracic oesophageal cancer is highly invasive and often leads to respiratory complications; thoracoscopic surgery is a less-invasive alternative. We examined the need for chest physical therapy (CPT) after thoracoscopic oesophagectomy. Thirty-six consecutive patients, randomly selected for either thoracotomy or thoracoscopic surgery, were included in a randomized clinical trial and received CPT under the same protocol. During short-term post-operative follow-up, both groups showed a marked reduction in respiratory function and responded to CPT to the same extent, although 2 weeks after surgery some parameters of respiratory function were significantly higher in the thoracoscopy group. Thoracoscopic surgery has been reported to be less invasive than standard thoracotomy, but our results suggest that the procedure is also invasive with respect to respiratory function and that CPT should be performed before and after thoracoscopic surgery.

P123 ROBOT ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE4) WITH INTRATHORACIC ANASTOMOSIS: PROMISING RESULTS AND LESSONS LEARNED IN 100 PATIENTS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
E Tagkalos ◽  
der Sluis P C van ◽  
E Hadzijusufovic ◽  
B Babic ◽  
E Uzun ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Case Series ◽  
Oncologic Outcomes ◽  
Robot Assisted ◽  
Short Term ◽  
Intrathoracic Anastomosis ◽  
Invasive Esophagectomy

Abstract Aim The aim of this study was to describe postoperative complications and short-term oncologic outcomes for RAMIE4 with intrathoracic anastomosis for esophageal cancer within our case series of 100 consecutive patients. Background & Methods Robot assisted minimally-invasive esophagectomy (RAMIE) with intrathoracic anastomosis is gaining popularity as a treatment for esophageal cancer. In this study, we present the results of 100 RAMIE procedures using the da Vinci Xi robotic system (RAMIE4). The aim of this study was to describe postoperative complications and short-term oncologic outcomes for RAMIE4 within our case series of 100 consecutive patients. Between January 2017 and February 2019, data of 100 consecutive patients with esophageal carcinoma undergoing modified Ivor-Lewis esophagectomy were prospectively collected. All operations were performed by the same surgeon using an identical intrathoracic anastomotic reconstruction technique with the same perioperative management and pain control regimen. Intra-operatively and post operatively complications were graded according to definitions stated by the Esophagectomy Complications Consensus Group (ECCG). Results Mean duration of the surgical procedure was 416 min (± 80). In total, 70 patients (70%) had an uncomplicated operative procedure and postoperative recovery. Pulmonary complications were most common and were observed in 17 patients (17 %). Anastomotic leakage was observed in 8 patients (8%). Median ICU stay was 1 day and median overall postoperative hospital stay was 11 days. 30 day mortality was 1%. A R0 resection was reached in 92% of patients with a median number of 29 dissected lymph nodes. Conclusion RAMIE4 with intrathoracic anastomosis for esophageal cancer or cancer located in the esophagus was technically feasible and safe. Postoperative complications and short term oncologic results were comparable to the highest international standards nowadays. These results could only be obtained due to a structured RAMIE training pathway. The superiority of RAMIE compared to conventional minimally invasive esophagus is currently investigated in multiple randomized controlled trials. Results of these trials will define the role for RAMIE for patients with esophageal cancer in the future.

scholarly journals Quality of life after robot-assisted transmediastinal radical surgery for esophageal cancer

2018 ◽  
Vol 32 (5) ◽  
pp. 2249-2254 ◽  
Author(s):  
Shuntaro Yoshimura ◽  
Kazuhiko Mori ◽  
Yukinori Yamagata ◽  
Susumu Aikou ◽  
Koichi Yagi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Esophageal Cancer ◽  
Radical Surgery ◽  
Robot Assisted

436 PRONE THORACOSCOPIC ESOPHAGECTOMY FOR PATIENTS WITH LOW PULMONARY FUNCTION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Gosuke Takiguchi ◽  
Taro Oshikiri ◽  
Manabu Horikawa ◽  
Yu Kitamura ◽  
Kazumasa Horie ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Respiratory Function ◽  
Operation Time ◽  
Thoracoscopic Esophagectomy ◽  
Control Group ◽  
Respiratory Disorder ◽  
Short Term ◽  
Postoperative Respiratory Complications ◽  
Posterior Mediastinal ◽  
Posterior Mediastinal Route

Abstract   Thoracoscopic esophagectomy in the prone position (TEP) for esophageal cancer is reported to have superiority in preserving postoperative respiratory function and reducing postoperative respiratory complications. In Japan, the majority of patients with esophageal cancer are smokers and have obstructive ventilation disorders. But, the feasibirity and safety of TEP for patients with low respiratory function is unclear. Objectives To clarify the feasibirity and safety of TEP for esophageal cancer patients with obstructive respiratory function. Methods The 95 patients with obstructive respiratory disorder who underwent TEP and gastric tube reconstruction via posterior mediastinal route for esophageal cancer from January 2016 to April 2019 were divided into the two groups, low respiratory function (LRF) group and the control group. Short-term outcomes were compared between two groups. Results The control group was 73 cases, and the LRF group was 22 cases. Propensity score matching using age, gender, cT, and cN as covariates was used to identify matched patients (22 per group) in both groups. There were no differences in operation time of overall and intrathoracic part, or blood loss in each group. In the postoperative complications, pneumonia (13.6% vs. 9.1%), recurrent laryngeal palsy (18.2% vs. 22.7%), anastomotic leakage (13.6% vs. 13.6%) and hospital stay (36.3 days vs 27.5 days) were no differences in both groups. Conclusion TEP can be feasible and safe for the patients with obstructive ventilation disorder and low respiratory function.

Safety and feasibility of salvage robot-assisted radical prostatectomy for recurrent prostate cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15171-e15171
Author(s):  
Andre Luis de Castro Abreu ◽  
Sanket Chauhan ◽  
Adrian Stuart Fairey ◽  
Ignacio Camacho ◽  
Alvin Goh ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Erectile Function ◽  
Cancer Control ◽  
Biochemical Failure ◽  
Perioperative Outcomes ◽  
Urinary Continence ◽  
Recurrent Prostate Cancer ◽  
Robot Assisted ◽  
Short Term

e15171 Background: The safety and feasibility of salvage robot-assisted radical prostatectomy (sRARP) for recurrent prostate cancer is unclear. Herein we report short-term cancer control, functional, and perioperative outcomes in a multi-institutional cohort. Methods: Between July 2007 and October 2011, 38 consecutive men underwent sRARP for recurrent prostate cancer at the University of Southern California (n=14) or Global Robotics Institute (n=24). Failed primary therapy was varied (external beam radiotherapy [EBRT; n=14]; interstitial brachytherapy [IBT; n=11]; EBRT + IBT [n=5]; high-intensity focused ultrasound [n=3]; cryoablation [n=3]; other [n=2]). The main outcomes were immediate biochemical failure (IBF), positive surgical margins (PSM), urinary continence and erectile function at 3 months, and complications within 90 days of surgery. Immediate biochemical failure was defined as a PSA > 0.2 ng/ml. Urinary continence was defined as the use of no pads and erectile function was defined as a SHIM score > 21. Complications were classified and graded using the Clavien system. Results: The median age was 68 years (50-83 years) and median preoperative PSA was 4.1 ng/ml (0.4-15.2 ng/ml). Preoperative biopsy Gleason score was ≤6 (n=7), 7 (n=18), and ≥8 (n=12). All procedures were completed without the need for open conversion. No patient experienced an intra-operative complication. Median estimated blood loss was 100 ml (30-300 ml) and operative time was 1.5 h (1-6h). Median length of hospital stay was 1 day (1-7 days). The median duration of urethral catheterization was 12 days (4-48 days). IBF occurred in 9 (29%) patients and PSM occurred in 7 (18%) patients. Urinary continence and erectile function occurred in 9 (34%) and 0 patients, respectively. One or more postoperative complications occurred in 12 (31%) patients. Low grade (I-II) and high grade (III-IV) complications occurred in 8 (21%) and 4 (10%) patients, respectively. No patient died. Conclusions: Salvage robot-assisted radical prostatectomy is safe and feasible. Short-term cancer control and perioperative morbidity were acceptable; however, functional recovery was poor. To date, this is the largest series worldwide.

P101 THE IMPACT OF PARATRACHEAL LYMPHADENECTOMY ON LYMPH NODE YIELD AND SHORT-TERM OUTCOMES IN ESOPHAGECTOMY: A NATIONAL PROPENSITY SCORE MATCHED ANALYSIS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
B F Kingma ◽  
E R C Hagens ◽  
M I van Berge Henegouwen ◽  
A S Borggreve ◽  
J P Ruurda ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Transthoracic Esophagectomy ◽  
Short Term ◽  
Lymph Node Yield ◽  
Ivor Lewis ◽  
Esophagectomy For Cancer ◽  
Mckeown Esophagectomy ◽  
The Impact ◽  
Node Yield

Abstract Aim This study aimed to investigate the impact of paratracheal lymphadenectomy on lymph node yield and short-term outcomes in patients undergoing esophagectomy for cancer. Background & Methods Although the addition of paratracheal lymphadenectomy to a standard two-field lymphadenectomy possibly may provide survival benefits for patients undergoing esophagectomy for esophageal cancer, the required dissection along the recurrent laryngeal nerves might be associated with increased morbidity. To investigate the impact of paratracheal lymphadenectomy on short-term oncological outcomes and postoperative complications, this nation-wide population-based cohort study included esophageal cancer patients who underwent neoadjuvant chemoradiotherapy followed by elective transthoracic esophagectomy with at least subcarinal and para-esophageal lymphadenectomy from the Dutch Upper Gastrointestinal Cancer Audit (DUCA). After propensity score matching Ivor Lewis and McKeown approaches separately, the lymph node yield and clinical outcomes were compared between patients who underwent paratracheal lymphadenectomy versus patients who did not. Results Between 2011-2017, a total of 2128 patients were included. A total of 770 patients (n=385 vs. n=385) and 516 patients (n=258 vs. n=258) were matched for the Ivor Lewis and McKeown approaches, respectively. Paratracheal lymphadenectomy was associated with a higher total lymph node yield in both Ivor Lewis (23 vs. 19 nodes, P<0.001) and McKeown (21 vs. 19 nodes, P=0.015) esophagectomy. In McKeown esophagectomy, paratracheal lymphadenectomy was associated with significantly more advanced pathological nodal staging (pN0; 57% vs. 69%, pN1; 25% vs. 16%, pN2; 12% vs. 11%, pN3; 6% vs. 3%, P=0.006). No significant differences were observed regarding recurrent laryngeal nerve injury, other postoperative complications, and mortality, although a higher re-intervention rate was found after paratracheal lymphadenectomy during McKeown esophagectomy (30% vs. 18%, P=0.002) In patients undergoing Ivor Lewis esophagectomy, paratracheal lymphadenectomy was associated with increased length of stay (12 vs. 11 days, P<0.048). Conclusion In patients undergoing transthoracic esophagectomy for cancer, the addition of paratracheal lymphadenectomy results in a higher lymph node yield with comparable complication and mortality rates.

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