Comparative outcomes of minimally invasive and robotic-assisted esophagectomy.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 167-167
Author(s):  
Kenneth L Meredith ◽  
Jamie Huston ◽  
Ravi Shridhar
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Oncologic Outcomes ◽  
R0 Resection ◽  
Resection Rate ◽  
Chi Square ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Invasive Esophagectomy ◽  
Patient Demographics

167 Background: Minimally invasive esophagectomy(MIE) has demonstrated superior outcomes compared to open approaches. The myriad of techniques has precluded the recommendation of a standard approach. The addition of robotics has potential to further improve outcomes. We sought to compare the outcomes of existing techniques for MIE with robotic assisted approaches. Methods: Utilizing a prospective esophagectomy database we identified patients who underwent (MIE) via Ivor Lewis(TT), transhiatal(TH) or robotic assisted Ivor Lewis(RAIL) techniques. Patient demographics, tumor characteristics and complications were analyzed via ANOVA, Chi-Square, and Fisher Exact where appropriate. Results: We identified 302 patients who underwent MIE: TT 95(31.5%), TH 63(20.8%), and RAIL 144(47.7%) with a mean age of 65±9.6. The length of operation was longer in the RAIL: TT(299±87), TH(231±65), RAIL(409±104 minutes), p < 0.001. However the EBL was lower in the RAIL patients: TT(189±188ml), TH(242±380ml), RAIL(155±107ml), p = 0.03. Conversion to open was also lower in the RAIL group: TT 7(7.4%), TH 8(12.7%), RAIL 0, p < 0.001. The R0 resection rate and lymph node (LN) harvest also favored the RAIL cohort :TT 86(93.5%), TH 60(96.8%), and RAIL 144(100%), p = 0.01. LN:TT 14±7, TH 9±6, and RAIL 20±9, p < 0.001. The overall morbidity was lower in RAIL patients: TT 29(30.5%), TH 39(61.9%), RAIL 34(23.6%), p < 0.001. Mortality was lower in the TT and RAIL approaches compared to TH but was not significant: TT 2 (2.1%), TH 2 (3.2%), and RAIL 2 (1.4%), p = 0.6. Conclusions: RAIL demonstrates lower EBL, conversion to open, and morbidity than other MIE techniques. Additionally the oncologic outcomes measured by R0 resections and LN harvest also favored the patients who underwent RAIL.

scholarly journals Robotic assisted minimally invasive esophagectomy: Ivor-Lewis approach

2021 ◽  
Vol 5 ◽  
pp. 21-21
Author(s):  
Kelsey Musgrove ◽  
Charlotte R. Spear ◽  
Jahnavi Kakuturu ◽  
Britney R. Harris ◽  
Fazil Abbas ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Invasive Esophagectomy

Relationship of drain amylase and anastomotic leak after esophagectomy.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 118-118 ◽  
Author(s):  
Joshua S. Hill ◽  
Erin Marie Hanna ◽  
Susie C. Hurley ◽  
Mark Reames ◽  
Jonathan C. Salo
Keyword(s):  
Minimally Invasive ◽  
Radiation Exposure ◽  
Anastomotic Leak ◽  
Minimally Invasive Esophagectomy ◽  
Locally Advanced ◽  
Chi Square ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Drain Amylase ◽  
Relationship Of

118 Background: Esophagectomy is considered the only curative approach in patients with esophageal cancers without locally advanced or metastasis. Anastomotic leak can lead to significant morbidity and mortality. CT esophagram (CTE) is a sensitive method of evaluating for leak; however this test carries with it financial cost and radiation exposure. This study evaluates the utility of drain amylase in the prediction of anastomotic leak. Methods: Fifty-nine patients underwent esophagectomy between 3/10 and 8/12; serial drain amylases and CTE were obtained in 50. Leak was defined by extravasation of contrast or the presence of empyema on CTE. Elevated drain amylase was defined as any level > 400 IU/L. Chi-square and descriptive statistics were performed and the sensitivity of drain amylase >400 IU/L in predicting leak was calculated. Results: A minimally invasive esophagectomy was performed in 47, and an open Ivor-Lewis in 2 and a minimally invasive Ivor-Lewis in 1. Stapled intra-thoracic anastomoses were performed in 47, 3 had a cervical anastomoses. Average age was 61 years and 84% were males. Leak occurred in 6 patients (12.5%). One patient with a late leak was excluded from analysis as they did not have concurrent drain amylase values. This patient had low amylase levels and a normal CTE, though later presented with leak. The overall peri-operative mortality rate was 4.2% (2/48). Mortality in the non-leak and leak cohorts were 0% & 33%. Drain amylase was an accurate marker of anastomotic leak. Of 6 patients with an elevated drain amylase, 5 had an anastomotic leak (sensitivity 83.3%). 40/41 patients with low drain amylase had no leak. Using a cut-off value of 400 IU/L, the negative predictive value of drain amylase in predicting leak after esophagectomy was 97.6% (95%CI; 85.6, 99.9). Conclusions: Drain amylase is a simple and inexpensive test that has excellent sensitivity and negative prediction for the detection of anastomotic leak after esophagectomy. To our knowledge, this is the first study to demonstrate this finding. Routine evaluation of drain amylase may safely replace CTE in the management of patients after esophagectomy, thus reducing radiation exposure and overall cost.

Outcomes associated with minimally invasive esophagectomy techniques.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 171-171
Author(s):  
Andrea M. Abbott ◽  
Matthew Doepker ◽  
Ravi Shridhar ◽  
Sarah E. Hoffe ◽  
Khaldoun Almhanna ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Surgical Techniques ◽  
Esophageal Resection ◽  
Oncologic Outcomes ◽  
Surgical Approaches ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Operative Outcomes ◽  
Estimated Blood Loss

171 Background: Surgery is pivotal in the management of patients with esophageal cancer. Recent prospective data demonstrates advantages of minimally invasive techniques. However, varying surgical techniques precludes the recommendation of a standard approach. We sought to examine our outcomes with differing approaches to minimally invasive esophagectomy. Methods: We queried a prospective esophageal database to identify patients who underwent minimally invasive esophagectomy (MIE) from 1994 and 2014. Surgical approaches included trans-hiatal (TH), Ivor Lewis (IVL), and robotic assisted Ivor Lewis (RAIL). Demographics, operative variables and post-operative complications were all compared. Results: We identified 280 patients who underwent MIE with a mean age of 65.65 ± 10.5 and a median follow-up of 48 months. Fifty-seven patients underwent IVL, 78 underwent TH, and 145 underwent RAIL. The length of operation was significantly longer in IVL and RAIL approaches compared to TH (TH=242, IVL=320, RAIL=415, p=0.001). Estimated blood loss did not differ between cohorts (TH=150, IVL=125, RAIL=158, p=0.8). Anastomotic leakage, stricture, pneumonia, and wound infections were all higher in the TH compared to the trans-thoracic approaches p=0.04, p=0.02, p=0.01, and p<0.001 respectively. Operative mortality was low for each cohort and did not differ between approaches (TH=2.6%, IVL=0%, RAIL=2%, p=0.2). The median length of hospitalization also did not differ between groups (TH=10 days, IVL=8.5 days, and RAIL=9 days, p=0.15). Adequacy of oncologic resection was measured by margins and nodal harvest. There was decreased R1 resections in both the IVL and RAIL compared to TH (TH=8%, IVL=0%, and RAIL=0% p=0.04). Additionally, the mean number of lymph nodes harvested was lower in patients undergoing TH compared to IVL and RAIL groups (TH=9.2, IVL=12.8, and RAIL=20.6, p=0.05). Conclusions: In our large series comparing minimally invasive approaches to esophageal resection we have demonstrated improved operative outcomes and oncologic outcomes in trans-thoracic approaches compared to trans-hiatal approaches. We recommend that patients undergoing minimally invasive esophagectomy be strongly considered for a trans-thoracic approach.

End to side circular stapled anastomosis during robotic-assisted Ivor Lewis minimally invasive esophagectomy (RAMIE)

2022 ◽  
Author(s):  
Giovanni Capovilla ◽  
Edin Hadzijusufovic ◽  
Evangelos Tagkalos ◽  
Caterina Froiio ◽  
Felix Berlth ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Primary Outcome ◽  
Minimally Invasive Esophagectomy ◽  
Postoperative Mortality ◽  
The Other ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Intrathoracic Anastomosis ◽  
Invasive Esophagectomy

Abstract Robotic-assisted minimally invasive esophagectomy (RAMIE) represents an established approach for the treatment of esophageal cancer. Aim of this study is to evaluate the feasibility and safety of our technique for performing the intrathoracic anastomosis during RAMIE.All the procedures were performed by the same surgeon using the same technique for performing the intrathoracic anastomosis. Intraoperative and postoperative outcomes were recorded. Postoperative complications were classified according to the Esophagectomy Complications Consensus Group (ECCG); the primary outcome was the evaluation of the feasibility and safety of our technique. From 2016 to 2021, 204 patients underwent Ivor Lewis RAMIE at our Center. Two patients (0.9%) were converted during the thoracic phase. The anastomosis was completed in all the other patients forming complete anastomotic rings. The median duration for the robotic-assisted thoracoscopic phase was 224 minutes. Twenty-two of the RAMIE-Ivor Lewis patients had an anastomotic leakage (10.3%). The overall 90-day postoperative mortality was 1.9%. The procedure resulted to be feasible and safe in our cohort of patients.

scholarly journals Ivor Lewis robotic assisted minimally invasive esophagectomy technique

2021 ◽  
Vol 6 ◽  
pp. 9-9
Author(s):  
Brian Yoo ◽  
James D. Luketich ◽  
Inderpal S. Sarkaria
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Invasive Esophagectomy

464 IS OPEN LEFT THORACO-ABDOMINAL ESOPHAGECTOMY A VIABLE OPTION IN THE ERA OF MINIMALLY INVASIVE ESOPHAGECTOMY?

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Fredrik Klevebro ◽  
Piers R Boshier ◽  
Carmen Mueller ◽  
Jonathan Cools-Lartigue ◽  
Lorenzo Ferri ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Lymph Nodes ◽  
Minimally Invasive Esophagectomy ◽  
Gastroesophageal Junction ◽  
Neoadjuvant Treatment ◽  
Postoperative Mortality ◽  
R0 Resection ◽  
Resection Rate ◽  
Short Term ◽  
Invasive Esophagectomy

Abstract   The aim of the study was to evaluate short-term and oncological outcomes of left thoracoabdominal esophagectomy (LTE) compared to minimally invasive esophagectomy for cancer of the esophagus and gastroesophageal junction. LTE facilitates complete resection of esophageal cancer particularly for bulky tumors, but there are concerns that this approach is associated with significant morbidity. Methods Prospectively entered esophagectomy databases from two high volume North American centers were reviewed for patients undergoing LTE or MIE in the 2012–2018. Patient demographics, tumour characteristics, operative outcomes, postoperative outcomes, and pathologic surrogates of oncologic efficacy (R0 resection rate, and number of resected lymph nodes) were compared. In total 247 patients were included in the study, LTE was applied in 170 (68.8%) patients, and MIE in 77 (31.2%) patients. Results LTE patients had more neoadjuvant treatment (LTE = 78.2%, MIE = 34.2%, P &lt; 0.001). There was no difference in overall postoperative complications (LTE = 56.9%, MIE = 55.0%, P = 0.799), severe complications (Clavien Dindo&gt;2—LTE = 26.1%, MIE17.0%, P = 0.184), pulmonary complications (LTE = 31.9%, MIE = 20.0%, P = 0.085), pneumonia (LTE = 15.2%, MIE = 13.6%, P = 0.768), anastomotic leak (LTE = 7%, MIE = 10%, P = 0.396), or postoperative mortality (LTE = 0%, MIE = 1.3%, P = 0.140). Median length of stay was 7 days in both groups. R0 resection rate was 93.8% and 95.5% respectively (P = 0.631). Median number of resected lymph nodes was 24 for LTE and 22 for MIE (P = 0.226). LTE had more stage II-IV tumors (LTE = 67.8%, MIE = 40.7%, P &lt; 0.001), and more node positive resections (LTE = 52.5%, MIE = 31.4%, P = 0.003). Conclusion LTE was used for larger tumors with greater lymph node burden in patients that were more likely to have received neoadjuvant treatment compared to MIE. Despite this the postoperative morbidity was equal to that of MIE, with no difference in short-term or oncological results in this cohort.

P72 IS OPEN LEFT THORACO-ABDOMINAL ESOPHAGECTOMY A VIABLE OPTION IN THE ERA OF MINIMALLY INVASIVE ESOPHAGECTOMY?

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
F Klevebro ◽  
P Boshier ◽  
C Mueller ◽  
J Cools-Lartigue ◽  
L Ferri ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Lymph Nodes ◽  
Minimally Invasive Esophagectomy ◽  
Gastroesophageal Junction ◽  
Neoadjuvant Treatment ◽  
Postoperative Mortality ◽  
R0 Resection ◽  
Resection Rate ◽  
Short Term ◽  
Invasive Esophagectomy

Abstract Aim To evaluate short-term and oncological outcomes of left thoracoabdominal esophagectomy compared to minimally invasive esophagectomy for cancer of the esophagus and gastroesophageal junction Background and Methods Left thoracoabdominal esophagectomy (LTE) facilitates complete resection of esophageal cancer particularly for bulky tumors, but there are concerns that this approach is associated with significant morbidity. Prospectively entered esophagectomy databases from two high volume North American centers were reviewed for patients undergoing LTE or MIE in the 2012-2018. Patient demographics, tumour characteristics, operative outcomes, postoperative outcomes, and pathologic surrogates of oncologic efficacy (R0 resection rate, and number of resected lymph nodes) were compared. Results In total 247 patients were included in the study, LTE was applied in 170 (68.8%) patients, and MIE in 77 (31.2%) patients. LTE patients had more neoadjuvant treatment (LTE=78.2%, MIE=34.2%, P<0.001). There was no difference in overall postoperative complications (LTE=56.9%, MIE=55.0%, P=0.799), severe complications (Clavien Dindo>2 - LTE=26.1%, MIE17.0%, P=0.184), pulmonary complications (LTE=31.9%, MIE=20.0%, P=0.085), pneumonia (LTE=15.2%, MIE=13.6%, P=0.768), anastomotic leak (LTE=7%, MIE=10%, P=0.396), or postoperative mortality (LTE=0%, MIE=1.3%, P=0.140). Median length of stay was 7 days in both groups. R0 resection rate was 93.8% and 95.5% respectively (P=0.631). Median number of resected lymph nodes was 24 for LTE and 22 for MIE (P=0.226). LTE had more stage II-IV tumors (LTE=67.8%, MIE=40.7%, P<0.001), and more node positive resections (LTE=52.5%, MIE=31.4%, P=0.003). Conclusion LTE was used for larger tumors with greater lymph node burden in patients that were more likely to have received neoadjuvant treatment compared to MIE. Despite this the postoperative morbidity was equal to that of MIE, with no difference in short-term or oncological results in this cohort.

scholarly journals Ivor Lewis robotic assisted minimally invasive esophagectomy: different approaches

2019 ◽  
Vol 5 ◽  
pp. 77-77
Author(s):  
Matthew C. Black ◽  
Nicholas R. Hess ◽  
Olugbenga T. Okusanya ◽  
James D. Luketich ◽  
Inderpal S. Sarkaria
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Invasive Esophagectomy

scholarly journals Technical details of the abdominal part during full robotic-assisted minimally invasive esophagectomy

2020 ◽  
Vol 33 (Supplement_2) ◽  
Author(s):  
Felix Berlth ◽  
Carolina Mann ◽  
Eren Uzun ◽  
Evangelos Tagkalos ◽  
Edin Hadzijusufovic ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Medical Center ◽  
Minimally Invasive Esophagectomy ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Invasive Esophagectomy ◽  
Potential Benefits ◽  
Optimal Setting ◽  
Thoracic Part ◽  
Technical Details

Abstract The full robotic-assisted minimally invasive esophagectomy (RAMIE) is an upcoming approach in the treatment of esophageal and junctional cancer. Potential benefits are seen in angulated precise maneuvers in the abdominal part as well as in the thoracic part, but due to the novelty of this approach the optimal setting of the trocars, the instruments and the operating setting is still under debate. Hereafter, we present a technical description of the ‘Mainz technique’ of the abdominal part of RAMIE carried out as Ivor Lewis procedure. Postoperative complication rate and duration of the abdominal part of 100 consecutive patients from University Medical Center in Mainz are illustrated. In addition, the abdominal phase of the full RAMIE is discussed in general.

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