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

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).

Perioperative decrement of factor XIII as a predictor of anastomotic leakage after esophagectomy in patients with esophageal cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 32-32
Author(s):  
Hiroya Takeuchi ◽  
Masazumi Inoue ◽  
Satoru Matsuda ◽  
Kazumasa Fukuda ◽  
Rieko Nakamura ◽  
...  
Keyword(s):  
Wound Healing ◽  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Prospective Study ◽  
Anastomotic Leakage ◽  
Factor Xiii ◽  
Transthoracic Esophagectomy ◽  
Background Factor ◽  
Last Stage ◽  
A Prospective Study

32 Background: Factor XIII(F13), or fibrin stabilizing factor, is involved in the last stage of blood coagulation. Although F13 is also known to be activated in wound healing after surgery, the association between F13 levels and postoperative complications after surgery remains unknown. In this study, we hypothesized that the F13 levels during perioperative periods may be related to the postoperative complications after esophagectomy in patients with esophageal cancer. Methods: A prospective study has been conducted for patients with esophageal cancer at our institution (UMIN000011658). Preoperative and postoperative (1st, 3rd, 5th, and 7th postoperative days) F13 levels were examined in 73 patients with primary esophageal cancer who underwent transthoracic esophagectomy. We investigated the association of F13 levels with clinicopathological background factors and the postoperative complications after esophagectomy. Results: The average age of the patients who underwent esophagectomy was 64.8 years, and 66 patients (90%) were males. Major postoperative complications included anastomotic leakage (C-D grade ≥ I: 19%), and pneumonia (C-D grade ≥ I: 34%). F13 level in preoperative esophageal cancer patients ranged from 36 to 155% (median 102%). In general, F13 levels markedly decreased after esophagectomy and gradually recovered after the 5th postoperative day. Preoperative and postoperative F13 levels at each point did not correlate with occurrence of any postoperative complications. However, the patients with 35% or more reduction of F13 level in the 1st postoperative day compared to the preoperative F13 level significantly correlated with higher incidence of anastomotic leakage. The incidence of anastomotic leakage of the patients with F13 change≥35% was 27% while that of the patients with F13 change<35% was only 4% (p = 0.013). Conclusions: This study revealed that perioperative decrement of factor XIII may be a promising predictor of anastomotic leakage after esophagectomy in patients with esophageal cancer.

scholarly journals Evaluation of subcarinal lymph node dissection and metastasis in transmediastinal radical esophagectomy

Esophagus ◽  
2021 ◽  
Author(s):  
Jun Shibamoto ◽  
Hitoshi Fujiwara ◽  
Hirotaka Konishi ◽  
Atsushi Shiozaki ◽  
Takuma Ohashi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Transthoracic Esophagectomy ◽  
Node Dissection ◽  
Radical Esophagectomy ◽  
Node Metastasis ◽  
Subcarinal Lymph Node

Abstract Background The aim of the present study was to evaluate subcarinal lymph node dissection in transmediastinal radical esophagectomy and subcarinal lymph node metastasis in patients with esophageal cancer. Methods Three hundred and twenty-three patients with primary esophageal cancer who underwent transmediastinal or transthoracic esophagectomy with radical two- or three-field lymph node dissection were retrospectively investigated. The clinicopathological characteristics of patients with subcarinal lymph node metastasis were analyzed in detail. Results The median of dissected subcarinal lymph nodes in transmediastinal and transthoracic esophagectomy groups was 6 and 7, respectively, and there was no significant difference between the two groups (p = 0.12). Of all patients, 26 (8.0%) were pathologically diagnosed as positive for subcarinal lymph node metastasis, whereas only 7 (26.9%) of those with metastasis were preoperatively diagnosed as positive. In addition, all patients with subcarinal lymph node metastasis had other non-subcarinal lymph node metastasis. By univariate analysis, subcarinal lymph node metastasis was found in larger (≥ 30 mm) and deeper (T3/T4a) primary lesions (p = 0.02 and 0.02, respectively), but it was not found in 49 patients with the primary lesion located in the upper thoracic esophagus. Conclusions Subcarinal lymph nodes can be dissected in transmediastinal esophagectomy, almost equivalent to transthoracic esophagectomy. The tumor size, depth, and location may be predictive factors for subcarinal lymph node metastasis.

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

FA01.05: EARLY RESULTS OF ROBOT ASSISTED ESOPHAGECTOMY COMPARED WITH CONVENTIONAL THORACOSCOPIC APPROACH FOR ESOPHAGEAL CANCER: A RANDOMIZED CLINICAL TRIAL

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 2-2
Author(s):  
Bin Li ◽  
Zhigang Li
Keyword(s):  
Esophageal Cancer ◽  
Lymph Nodes ◽  
Clinical Characteristics ◽  
Operation Time ◽  
Perioperative Outcomes ◽  
Robot Assisted ◽  
Term Survival ◽  
Thoracoscopic Approach ◽  
Early Results ◽  
Laparoscopic Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) has become increasingly adopted as a standard surgical approach for esophageal cancer because of less tissue damage and a more rapid recovery. Recent developments in robotic technology have made robot-assisted minimally esophagectomy as another surgical option for MIE. The aim of the study was to compare early results between robot-assisted thoraco-laparoscopic esophagectomy (RATLE) and conventional thoraco-laparoscopic esophagectomy(CTLE) for the treatment of esophageal squamous cell carcinoma (ESCC). Methods We designed a randomized controlled parallel-group trial study. Patients aged 18–75 years with histologically proven surgically resectable (cT1b-3, N0–2, M0) ESCC of the intrathoracic esophagus were randomly assigned to receive either RATLE or CTLE. All patients received McKeown esophagectomy. Clinical characteristics and perioperative outcomes between the two groups were compared. Results Seventy patients were randomly assigned to RATLE group(n = 36) and CTLE group(n = 34). The two groups were comparable in preoperative clinical characteristics. Patients who underwent RATLE had shorter total operation time than the CTLE group (217.3 ± ± 44.5 vs. 261.5 ± 62.1 minutes, P = 0.001), particularly in thoracoscopic time (74.0 ± 23.6 vs. 104.1 ± 34.2 minutes, P < 0.001). The incidence of recurrent laryngeal palsy is higher in RATLE group(25%) than CTLE group(11.8%), but it was not statistically significant (P = 0.155). Intraoperative blood loss, length of hospital stay and the incidence of postoperative complications were not statistically different between the two groups. Four (11.1%) patients have anastomotic leakage in the RATLE group, compared to 4 (11.8%) patients in the CTLE group (P = 0.772). The RATLE and CTLE groups did not differ significantly with regard to the total number of harvested lymph nodes (18.8 ± 7.0 vs. 20.1 ± 8.3, P = 0.468), the numbers of lymph nodes dissected from recurrent laryngeal nerve chains(4.7 ± 3.1 vs. 4.9 ± 3.4, P = 0.779) and the abdomen(5.9 ± 3.5 vs. 5.1 ± 3.1, P = 0.354). Conclusion There is technical superiority with shorter operation time and similar short-term surgical results for RATLE compared with CTLE. Though the incidence of postoperative recurrent laryngeal palsy is slightly higher for RATLE, it doesn’t affect postoperative recovery. Long-term survival data should be followed in the future to compare the oncological outcome between the two groups. Disclosure All authors have declared no conflicts of interest.

RA02.09: THE EFFECT OF PREOPERATIVE BREATHING EXERCISE IN PATIENTS UNDERGOING ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 22-22
Author(s):  
Hamakawa Takuya ◽  
Motohiro Hirao ◽  
Kazuhiro Nishikawa ◽  
Ayako Fujiwara ◽  
Sakae Maeda ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Respiratory Function ◽  
Vital Capacity ◽  
Conflicts Of Interest ◽  
Forced Expiratory Volume ◽  
Pulmonary Complications ◽  
Transhiatal Esophagectomy ◽  
Postoperative Pulmonary Complications ◽  
Breathing Exercise ◽  
Subtotal Esophagectomy

Abstract Background Patients with esophageal cancer often have impaired respiratory function. Postoperative pulmonary complications frequently occur in patients undergoing esophagectomy. We instructed patients undergoing esophagectomy to do breathing exercise with Incentive Spirometer Coach 2 (Smiths medical) for at least two weeks before surgery, as well as smoking cessation. Methods We retrospectively reviewed medical records of 52 esophageal cancer patients who underwent spirometry both pre- and post- Coach 2 exercise between 2009 and 2017. We evaluated the change of respiratory function and postoperative complications. The influence of exercise was analyzed between patients who underwent neoadjuvant chemotherapy (NAC group, n = 36) and those treated without NAC (non-NAC group, n = 16). Results 39 males and 13 females were included. Median age was 65 (45–82). Surgical procedures were 48 subtotal esophagectomy, 3 transhiatal esophagectomy, and 1 pharyngo-laryngo-esophagectomy. Vital capacity (VC) and forced expiratory volume in one second (FEV1.0) were significantly improved through exercise; 3405 to 3600ml (P = 0.021) and 2485 to 2555 ml (P = 0.008), respectively. NAC group included more advanced-staged cases but age and baseline respiratory function were not significantly different from non-NAC group. Interval between first and second spirometry was 31 days for non-NAC group, 69 days for NAC group. After exercise, non-NAC group showed significant improvement in VC (3135 to 3600ml, P = 0.006), FEV1.0 (2255 to 2565ml, P = 0.004), whereas NAC group showed little change in VC (3560 to 3630ml, P = 0.514), FEV1.0 (2585 to 2555ml, P = 0.514). Postoperative complication occurred in 27 of 52 cases. Postoperative pneumonia occurred in 7 (13.5%) in the present cohort, which was less frequent than 42% in the historical control cohort without breathing exercise. Conclusion Preoperative breathing exercise with Coach 2 improved respiratory function in patients without NAC. In patients with NAC, the effect of exercise was smaller than non-NAC group, still exercise might suppress the decrease of respiratory function during NAC. Breathing exercise may reduce postoperative pulmonary complications. Disclosure All authors have declared no conflicts of interest.

Robot-assisted Minimally Invasive Thoracolaparoscopic Esophagectomy Versus Open Transthoracic Esophagectomy for Resectable Esophageal Cancer

2019 ◽  
Vol 269 (4) ◽  
pp. 621-630 ◽  
Author(s):  
Pieter C. van der Sluis ◽  
Sylvia. van der Horst ◽  
Anne M. May ◽  
Carlo Schippers ◽  
Lodewijk A. A. Brosens ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Transthoracic Esophagectomy ◽  
Robot Assisted ◽  
Resectable Esophageal ◽  
Resectable Esophageal Cancer
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