Robotic-assisted Ivor Lewis esophagectomy with or without neoadjuvant chemoradiation therapy for esophageal cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 117-117
Author(s):  
Franz Omar Smith ◽  
Sarah Hoffe ◽  
Khaldoun Almhanna ◽  
Ravi Shridhar ◽  
Richard C. Karl ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemoradiation ◽  
Chemoradiation Therapy ◽  
Gastric Conduit ◽  
Anastomotic Leaks ◽  
Short Term ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Ivor Lewis Esophagectomy ◽  
The Mean

117 Background: Neoadjuvant chemoradiation therapy (NT) has become standard of care for patients with locally advanced esophageal cancer. In selected patients, robotic-assisted Ivor Lewis esophagectomy (RAIL) is a safe and feasible operative strategy in the management of esophageal cancer. This study was designed to determine potential differences in peri-operative morbidity and short term outcomes in patients with esophageal cancer treated with RAIL with or without NT. Methods: A retrospective review of consecutive patients with esophageal cancer who underwent RAIL esophagectomy between October 2010 and June 2012 with and without NT was performed. Clinical and pathological variables were analyzed with two-sided student t-test assuming equal variance. Data were considered significant at a p-value <0.05. Results: Eighty-nine patients underwent RAIL during the study period. Seventy-seven patients (87%) received NT and twenty-two patients did not (13%). The median age was 66 years (range 44 – 84) and the median BMI was 28 kg/m2(range 16.7 – 40.1). All patients had a R0 resection. There were no differences in the mean estimated blood loss (149 vs.153 mL; p = 0.52) and mean operative times (434 vs. 427 minutes; p = 1.0). There were no differences in the incidence of pneumonia or atrial fibrillation, lengths of stay in the ICU, or length of hospitalization. In total, there were two anastomotic leaks and one leak from the gastric conduit. The anastomotic leaks occurred in the group that did not receive NT and the gastric conduit leak occurred in the group that received NT. There were no mortalities in either group. There was no difference in the mean number of lymph nodes harvested in the NT group (22 ± 11 vs. 20 ± 8, p = 0.41). Conclusions: RAIL can be safely performed following neoadjuvant chemoradiation therapy.In this series there were similar perioperative, morbidity and short-term mortality outcomes in patients who received NT compared with RAIL alone. Longer follow-up is required in order to determine long term oncologic outcome.

PS01.135: PROGNOSTIC ANALYSIS OF TLE-CHEST SURGERY IN ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 88-88
Author(s):  
Renquan Zhang ◽  
Yunlong Huang
Keyword(s):  
Quality Of Life ◽  
Overall Survival ◽  
Esophageal Cancer ◽  
Tumor Size ◽  
Operative Time ◽  
Ivor Lewis ◽  
Total Operative Time ◽  
Ivor Lewis Esophagectomy ◽  
The Mean

Abstract Background Esophageal cancer was the ninth most common malignant tumor and ranked sixth for death globally, especially in developing country[1]. Standardized esophagectomy followed by chemotherapy or chemoradiotherapy remains the curative treatment for esophageal cancer[2]. Ivor Lewis esophageal resection, including two-stage approach for carcinoma of the middle third of the esophagus, was proposed in 1946[3]. Meanwhile, to avoid the risk of anastomotic leakage in Ivor Lewis surgery, three-stage approach with cervical anastomosis was introduced by McKeown[4]. However, considering the less complications of minimally invasive Ivor Lewis esophagectomy and the increased incidence of distal esophageal and gastroesophageal junction adenocarcinoma, two-stage approach with intrathoracic anastomosis was gaining more attention. Recent years, thoracoscopic laparoscopic esophagectomy with intrathoracic anastomosis (TLE-chest) has gradually become the mainstream approach of minimally invasive Ivor Lewis esophagectomy for the treatment of middle and lower esophageal cancers. In the previous study, we described the technique strategies of TLE-chest, which was featured with improved anastomosis layer by layer and embedding of the anastomosis with preserved mediastinal pleura[5]. In this study, we presented the perioperative data, complications and long-term survivals of TLE-chest in esophageal cancers. Methods The clinical data of 201 patients, who underwent TLE-chest for primary esophageal cancer in the First Affiliated Hospital of Anhui Medical University (FAHAMU) from November 2011 to December 2015, was analyzed retrospectively. Postoperative patients’ life quality by the European Organization into Research and Treatment of Cancer (EORTC) quality of life questionnaire for esophageal cancer and overall survivals were analyzed using Kaplan–Meier curve. The normal distribution of the measured data is expressed in terms of x ± s. Cox's hazard regression model was used for single factor and multi-factor analysis. Results Overall, 168 (83.6%) patients were males and 33 (16.4%) were females. The mean age of patients was 62.7 years old (range from 40 to 88). 150 (74.6%) patients’ tumors were located in the middle of esophagus, whereas 50 (24.9%) and 1 (0.5%) tumors were in the low and up. 194 (96.5%) esophageal tumors were confirmed as squamous carcinoma expect 7 (3.5%) adenocarcinomas. The mean of tumor size was 3.7 cm and the numbers of postoperative pathological TNM classification I, II, III and IV were 38 (18.9%), 72 (35.8%), 73 (36.3%) and 18 (9%) respectively. The average of total operation time was 293.9 min. Among them, the means of VATS and LS time were 156.9 min and 116.5 min respectively. The mean of intraoperative blood loss was 77.5 ml. The number of resected lymph nodes was 22.9 ± 9.7 (maximum: 58).7 (3.5%) patients suffered from anastomotic fistula, 5 (2.5%) patients occurred RRLN injury in lymph nodes dissection and 5 (2.5%) suffered chylothorax. Pulmonary complications were observed in 21 (10.4%) patients. Meanwhile, the rates of other complications containing anastomotic stenosis, bleeding and delayed gastric empty were 0.5% (1/201), 1.5% (3/201) and 0.5% (1/201) respectively. The score of quality of patients’ life was 85 ± 6.5. And at the 12 months, quality of life was improved by 4.1%. Until up to the 24 months, patients’ quality of life was recovered to 90 ± 7.5. The 1, 2 and 3 years overall survival of 100 patients was 94%, 79% and 74% respectively. Univariate analysis showed that the pT stage (P = 0.040), pN stage (P = 0.001), pTNM stage(P = 0.001) and Total operative time(P = 0.000) were associated with 3-year overall survival (3-OS). Further, multivariate analysis affirmed that the operative time (≥ 311 min), tumor size (≥ 3.5 cm) and pTNM stage were independent prognostic factors for 3-OS (P < 0.05). Conclusion TLE-chest surgery in esophageal cancer was safe and effective. And the total operative time, tumor size and TNM stage could be used as independent prognostic indicators in esophageal cancer patients after the TLE-chest. 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

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.

Long-term outcomes after robotic-assisted Ivor Lewis esophagectomy

2021 ◽  
Author(s):  
Pridvi Kandagatla ◽  
Ali Hussein Ghandour ◽  
Ali Amro ◽  
Andrew Popoff ◽  
Zane Hammoud
Keyword(s):  
Long Term Outcomes ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Ivor Lewis Esophagectomy

scholarly journals There is no correlation between a delayed gastric conduit emptying and the occurrence of an anastomotic leakage after Ivor-Lewis esophagectomy

2022 ◽  
Author(s):  
Benjamin Babic ◽  
Lars Mortimer Schiffmann ◽  
Hans Friedrich Fuchs ◽  
Dolores Thea Mueller ◽  
Thomas Schmidt ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
High Volume ◽  
Gastric Conduit ◽  
Common Finding ◽  
Type Ii ◽  
Ivor Lewis ◽  
Stapling Device ◽  
Ivor Lewis Esophagectomy ◽  
Cervical Reconstruction ◽  
Prolonged Hospital

Abstract Introduction Esophagectomy is the gold standard in the surgical therapy of esophageal cancer. It is either performed thoracoabdominal with a intrathoracic anastomosis or in proximal cancers with a three-incision esophagectomy and cervical reconstruction. Delayed gastric conduit emptying (DGCE) is the most common functional postoperative disorder after Ivor-Lewis esophagectomy (IL). Pneumonia is significantly more often in patients with DGCE. It remains unclear if DGCE anastomotic leakage (AL) is associated. Aim of our study is to analyze, if AL is more likely to happen in patients with a DGCE. Patients and methods 816 patients were included. All patients have had an IL due to esophageal/esophagogastric-junction cancer between 2013 and 2018 in our center. Intrathoracic esophagogastric end-to-side anastomosis was performed with a circular stapling device. The collective has been divided in two groups depending on the occurrence of DGCE. The diagnosis DGCE was determined by clinical and radiologic criteria in accordance with current international expert consensus. Results 27.7% of all patients suffered from DGCE postoperatively. Female patients had a significantly higher chance to suffer from DGCE than male patients (34.4% vs. 26.2% vs., p = 0.040). Pneumonia was more common in patients with DGCE (13.7% vs. 8.5%, p = 0.025), furthermore hospitalization was longer in DGCE patients (median 17 days vs. 14d, p < 0.001). There was no difference in the rate of type II anastomotic leakage, (5.8% in both groups DGCE). All patients with ECCG type II AL (n = 47; 5.8%) were treated successfully by endoluminal/endoscopic therapy. The subgroup analysis showed that ASA ≥ III (7.6% vs. 4.4%, p = 0.05) and the histology squamous cell carcinoma (9.8% vs. 4.7%, p = 0.01) were independent risk factors for the occurrence of an AL. Conclusion Our study confirms that DGCE after IL is a common finding in a standardized collective of patients in a high-volume center. This functional disorder is associated with a higher rate of pneumonia and a prolonged hospital stay. Still, there is no association between DGCE and the occurrence of an AL after esophagectomy. The hypothesis, that an DGCE results in a higher pressure on the anastomosis and therefore to an AL in consequence, can be refuted. DGCE is not a pathogenetic factor for an AL.

scholarly journals Simplified nutritional scoring system predicts complicated outcomes of upper gastrointestinal surgery

2017 ◽  
Author(s):  
Juyong Cheong ◽  
Gregory Leighton Falk ◽  
Jigar Darji
Keyword(s):  
Postoperative Complications ◽  
Gastrointestinal Surgery ◽  
Subtotal Gastrectomy ◽  
Postoperative Outcome ◽  
Bowel Function ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
The Mean ◽  
The Relationship ◽  
Upper Gastrointestinal

Abstract Introduction: Postoperative complications after major upper gastrointestinal surgery can be devastating. Malnutrition has been found to be an important risk factor for postoperative complications. However, attempts at trying to detect malnourished patients preoperatively can be cumbersome and complex and are often not done. One simplified way of assessing nutritional status is the ANS system. The aim of this study was to show the relationship between ANS score and the postoperative outcome. Methodology: Medical record of all patients undergoing major EG and HB surgeries at Concord Hospital between 2010 and 2012 were retrospectively analysed. Results: 83 patients were operated and included (1) Whipples' procedure (20.5%), (2) total/subtotal gastrectomy (44.6%), (3) Ivor-Lewis esophagectomy (18%), and (4) distal pancreatectomy (14.5%). The mean ANS score was 1.58. Patients with higher ANS score (2 or more) were found to have significantly higher rates of wound infection (41% vs 12%, p&lt;0.002), anastomotic leaks (13.7% vs 1.92%, p=0.034), unexpected return to operating theatre (31% vs 3.9%, p&lt;0.001), slower return of bowel function as compared to patients with low ANS score (0 or 1). Conclusion: This study demonstrates the importance of screening for malnourished patients prior to their operation. Given its simplicity and effective predictive value, we recommend use of ANS system.

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