The Comparisons of Three Stapler Placement Methods for Intrathoracic Mechanistic Circular Stapling in Ivor Lewis Minimally Invasive Esophagectomy

2021 ◽  
Author(s):  
Bo Zhang ◽  
Zi xiang Wu ◽  
Qi Wang ◽  
Sai Bo Pan ◽  
Lian Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Minimally Invasive Esophagectomy ◽  
Multivariable Analysis ◽  
Esophageal Reconstruction ◽  
Ivor Lewis ◽  
Anastomotic Complications ◽  
Invasive Esophagectomy ◽  
The Impact

Abstract Objectives: To analyze the impact of the reversal penetrating technique (RPT) for intrathoracic gastroesophageal mechanical anastomosis on the development of anastomotic complications in Ivor Lewis minimally invasive esophagectomy (ILMIE) and further identify the risk factors for the development of anastomotic leakage and stricture.Methods: A retrospective observational study was conducted using clinical data of 316 patients with esophageal carcinoma (EC) who underwent ILMIE from January 2012 to December 2019. The participants were divided into three groups of RPT, transoral Orvil technique (TOT), or purse-string technique (PST) according to the different stapler placenent methods for intrathoracic mechanistic circular stapling. Multivariable analysis was performed to investigate the association of risk factors with anastomotic leakage and stricture.Results: There were 154 patients with RPT, 78 with TOT and 84 with PST intrathoracic gastroesophageal circular stapling in ILMIE. There was no differences in intraoperative anastomosis related conditions inclouding conversion of open operations, ways of esophageal reconstruction, lymph nodes harvested between the three groups. Whereas, The mean total operative time, and gastroesophageal anastomosis time in the RPT group were significantly shorter than those in other groups (both p<0.05). The rates of anastomotic leakage and stricture showed no statistical differences between three groups, respectively (Leakage: p=0.941; Stricture: p=0.942). Multivariate analysis revealed that the PRT method of the anvil placement does not increase the probability of anastomotic leakage (PRT: reference; TOT: odds ratio(OR) 2.845, P=0.255; PST: OR 2.234, p=0.242) and stricture (PRT: reference; TOT: OR 1.976, P=0.556; PST: OR 1.872, p=0.284).Conclusions: The PRT method of the anvil placement for intrathoracic gastroesophageal circular stapling does not increase the risk of anastomotic complications in ILMIE, but had significantly shorter surgical time and anastomosis time.

scholarly journals Complications, Not Minimally Invasive Surgical Technique, Are Associated with Increased Cost after Esophagectomy

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Sue J. Fu ◽  
Vanessa P. Ho ◽  
Jennifer Ginsberg ◽  
Yaron Perry ◽  
Conor P. Delaney ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Hospital Cost ◽  
Minimally Invasive Esophagectomy ◽  
Multivariable Analysis ◽  
Hospital Costs ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Invasive Esophagectomy ◽  
The Impact

Background. Minimally invasive esophagectomy (MIE) techniques offer similar oncological and surgical outcomes to open methods. The effects of MIE on hospital costs are not well documented. Methods. We reviewed the electronic records of patients who underwent esophagectomy at a single academic institution between January 2012 and December 2014. Esophagectomy techniques were grouped into open, hybrid, MIE, and transhiatal (THE) esophagectomy. Univariate and multivariate analyses were performed to assess the impact of surgery on total hospital cost after esophagectomy. Results. 80 patients were identified: 11 THE, 11 open, 41 hybrid, and 17 MIE. Median total cost of the hospitalization was $31,375 and was similar between surgical technique groups. MIE was associated with higher intraoperative costs, but not total hospital cost. Multivariable analysis revealed that the presence of a complication, increased age, American Society of Anesthesiologists class IV (ASA4), and preoperative coronary artery disease (CAD) were associated with significantly increased cost. Conclusions. Despite the association of MIE with higher operation costs, the total hospital cost was not different between surgical technique groups. Postoperative complications and severe preoperative comorbidities are significant drivers of hospital cost associated with esophagectomy. Surgeons should choose technique based on clinical factors, rather than cost implications.

O102 FINDING FACTORS ASSOCIATED WITH SAFE IMPLEMENTATION OF IVOR LEWIS TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
◽  
Linda Claassen ◽  
Frans van Workum ◽  
Maroeska M Rovers ◽  
Gerjon Hannink ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Minimally Invasive Esophagectomy ◽  
Learning Curves ◽  
Secondary Outcome ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Factors Associated ◽  
Surgeon Experience ◽  
Efficient Learning

Abstract Aim To define factors associated with more efficient learning after implementation of Ivor Lewis totally minimally invasive esophagectomy (TMIE). Background and Methods It is unknown which factors are associated with more efficient learning after implementation of Ivor Lewis TMIE. Prospectively collected data of 15 European expert centers are retrospectively analyzed. Consecutive patients undergoing Ivor Lewis TMIE are included. The primary outcome is anastomotic leakage and the secondary outcome is textbook outcome (TBO). The pre-defined level of acceptance for anastomotic leakage is set at 8% with a 5% margin. Trends in outcome parameters are plotted using weighted moving average to define when the pre-defined level of acceptance is reached. Outcome trends are compared between groups of hospitals for the following factors: hospital volume, surgeon experience, overall TMIE experience, expert clinic visit, Ivor Lewis TMIE course followed and Ivor Lewis TMIE proctor supervision during implementation. Results This study included 1718 patients. Hospitals with a volume >50 cases per year reached the pre-defined level of acceptance for anastomotic leakage at case 114, hospitals with a volume <50 cases did not reach the pre-defined level of acceptance. Hospitals with surgeon experience >10 years and <10 years reached the pre-defined level of acceptance at case 112 and 135, respectively. Hospitals with overall TMIE experience >50 cases and <50 cases reached the pre-defined level of acceptance at case 45 and 112, respectively. Visiting an expert clinic, followed a TMIE course, or implementation under a proctor’s supervision did not contribute to reaching the level of acceptance earlier. Conclusion Learning curves are shorter and the level of acceptance is reached earlier if Ivor Lewis TMIE is implemented in a high-volume hospital, if the procedure is implemented in a hospital with a surgeon with >10 years of experience, or if the surgeon has experience in other types of TMIE of >50 cases. These findings can inform surgeons and can contribute to formulate evidence-based training programs.

P141 IVOR LEWIS MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER : IMPACT OF THORACOSCOPY ON POST-OPERATIVE MORBIDITY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Martin Louis ◽  
Voron Thibault ◽  
Drubay Vincent ◽  
Messier Marguerite ◽  
Eveno Clarisse ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Open Approach ◽  
Respiratory Complications ◽  
Invasive Approach ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Significant Difference ◽  
The Impact ◽  
Hybrid Group

Abstract The aim of this study is to assess the impact of thoracoscopy versus conventional thoracotomy on postoperative and oncological outcomes in patients undergoing Ivor Lewis esophagectomy with laparoscopic gastric mobilisation for esophageal resectable cancer. Background & Methods Esophagectomy for cancer is a complexe procedure associated with a high rate of mortality and morbidity1,2, especially respiratory, despite recent improvements in perioperative cares and advances in surgical techniques. Recently, minimally invasive esophagectomy has shown a benefit in decreasing postoperative respiratory complications in 2 randomized trials comparing firstly the hybrid approach (Ivor Lewis with laparoscopy and right thoracotomy) to the open approach (MIRO trial3) and secondly the totally minimally invasive approach with cervical anastomosis (McKeown with laparoscopy and thoracospy) to the open approach (TIME trial4). Few studies have focused on comparing specifically thoracosopic(TMIE) versus conventional thoracotomy approach(HYBRID) for intra-thoracic anastomosis. We performed a single-center retrospective study, including all patients undergoing either Ivor Lewis HYBRID or TMIE in our high-volume center between 2010 and 2019. The primary endpoint was major postoperative complications within 30 days (Dindo-Clavien grade≥III). Secondary endpoints included operative parameters, postoperative morbidity and mortality within 90 days and quality of oncological resection. Results 498 patients were included, 440 underwent HYBRID and 58 TMIE. Ninety-six patients(19.3%) had major postoperative complication, 11 patients(19%) in TMIE and 85 patients(19.3%) in HYBRID. Anastomotic leak (AL) rate was significantly higher in TMIE (36.2% versus 10.8%,p<0.001). However AL in TMIE group were frequently less severe than in the HYBRID group (rate of AL type 2/3 respectively 23.8% and 50%;p=0.044). Respiratory complications were observed in 202 patients (45.9%) in the HYBRID group and in 14 patients (24.1%;p=0.002) in TMIE group, without significant difference in severe respiratory complications rate. The complete resection rate (R0 resection) (5.3% vs 3.7%) and the number of lymph nodes retrieved (25.26 vs 25.92) were comparable in both groups. Conclusion The TMIE approach is burdened with a significant AL rate, probably related to an unreached learning curve, which mitigates the benefit of this approach to respiratory complications. The technical difficulty caused by intrathoracic anastomosis, whose modalities are not well-established, remains a major concern.

scholarly journals European consensus on essential steps of Minimally Invasive Ivor Lewis and McKeown Esophagectomy through Delphi methodology

2021 ◽  
Author(s):  
Yassin Eddahchouri ◽  
◽  
Frans van Workum ◽  
Frits J. H. van den Wildenberg ◽  
Mark I. van Berge Henegouwen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Expert Panel ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Round Table Discussion ◽  
Ivor Lewis ◽  
Delphi Methodology ◽  
Invasive Esophagectomy ◽  
European Consensus ◽  
Mckeown Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure with a long learning curve, which is associated with increased morbidity and mortality. To master MIE, training in essential steps is crucial. Yet, no consensus on essential steps of MIE is available. The aim of this study was to achieve expert consensus on essential steps in Ivor Lewis and McKeown MIE through Delphi methodology. Methods Based on expert opinion and peer-reviewed literature, essential steps were defined for Ivor Lewis (IL) and McKeown (McK) MIE. In a round table discussion, experts finalized the lists of steps and an online Delphi questionnaire was sent to an international expert panel (7 European countries) of minimally invasive upper GI surgeons. Based on replies and comments, steps were adjusted and rephrased and sent in iterative fashion until consensus was achieved. Results Two Delphi rounds were conducted and response rates were 74% (23 out of 31 experts) for the first and 81% (27 out of 33 experts) for the second round. Consensus was achieved on 106 essential steps for both the IL and McK approach. Cronbach’s alpha in the first round was 0.78 (IL) and 0.78 (McK) and in the second round 0.92 (IL) and 0.88 (McK). Conclusions Consensus among European experts was achieved on essential surgical steps for both Ivor Lewis and McKeown minimally invasive esophagectomy.

792 OUTCOMES AFTER TOTALLY MINIMALLY INVASIVE VERSUS HYBRID OR OPEN IVOR LEWIS ESOPHAGECTOMY: RESULTS FROM THE INTERNATIONAL ESODATA STUDY GROUP.

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Berend Van Der Wilk ◽  
Eliza R C Hagens ◽  
Ben M Eyck ◽  
Suzanne S Gisbertz ◽  
Richard Hillegersberg ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Hospital Length Of Stay ◽  
Mortality Data ◽  
Study Group ◽  
Ivor Lewis ◽  
Open Esophagectomy ◽  
Ivor Lewis Esophagectomy ◽  
The Impact

Abstract   To compare complications following totally minimally invasive (TMIE), laparoscopically assisted (hybrid) and open Ivor Lewis esophagectomy in patients with esophageal cancer. Three randomized trials have reported benefits for minimally invasive esophagectomy. Two studies compared TMIE versus open esophagectomy and another compared hybrid versus open Ivor Lewis esophagectomy. Only small retrospective studies compared TMIE with hybrid Ivor Lewis esophagectomy. Methods Data were used from the International Esodata Study Group assessing patients undergoing TMIE, hybrid or open Ivor Lewis esophagectomy. Primary outcome was pneumonia, secondary outcomes included incidence and severity of anastomotic leakage, (major) complications, length of stay, escalation of care and 90-day mortality. Data were analyzed using multivariate multilevel models. Results In total, 4733 patients were included in this study (TMIE:1472, hybrid:1364 and open:1897). Patients undergoing TMIE had lower incidence of pneumonia compared to hybrid (10.9% vs 16.3%, Odds Ratio (OR):0.56, 95%CI: 0.40–0.80) and open esophagectomy (10.9% vs 17.4%, OR:0.60, 95%CI: 0.42–0.84) and had shorter length of stay (median 10 days (IQR 8–16)) compared to hybrid (14 (11–19), p = 0.041) and open esophagectomy (11 (9–16), p = 0.027). Patients undergoing TMIE had higher rate of anastomotic leakage compared to hybrid (15.1% vs 10.7%, OR:1.47, 95%CI: 1.01–2.13) and open esophagectomy (7.3%, OR:1.73, 95%CI: 1.26–2.38). No differences were reported between hybrid and open esophagectomy. Conclusion Compared to hybrid and open Ivor Lewis esophagectomy, TMIE resulted in a lower pneumonia rate, a shorter hospital length of stay but a higher anastomotic leakage rate. The impact of these individual complications on survival and long-term quality of life should be further investigated.

scholarly journals Impact of nasogastric decompression on gastric tube size after McKeown minimally invasive esophagectomy: A retrospective controlled cohort study

2021 ◽  
Author(s):  
Duo Jiang ◽  
Xian-Ben Liu ◽  
Wen-Qun Xing ◽  
Pei-Nan Chen ◽  
Shao-Kang Feng ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Gastric Tube ◽  
Enhanced Recovery ◽  
Minimally Invasive Esophagectomy ◽  
Tube Size ◽  
Invasive Esophagectomy ◽  
Chest X Ray ◽  
The Right ◽  
The Impact ◽  
Nasogastric Decompression

Abstract Purpose: This retrospective study evaluated the impact of nasogastric decompression (NGD) on gastric tube size to optimize the Enhanced Recovery After Surgery protocol after McKeown minimally invasive esophagectomy (MIE). Methods: Overall, 640 patients were divided into two groups according to nasogastric tube (NGT) placement intraoperatively. Using propensity score matching, 203 pairs of individuals were identified for gastric tube size comparisons on postoperative days (PODs) 1 and 5. Results: Gastric tubes were larger in the non-NGD group than the NGD group on POD 1 (vertical distance from the right edge of the gastric tube to the right edge of the thoracic vertebra, 22.2 [0–34.7] vs. 0 [0–22.5] mm, p <0.001). No difference was noted between the groups on POD 5 (18.5 [0–31.7] vs. 18.0 [0–25.4] mm, p =0.070). Univariate and multivariate analyses showed that non-NGD was an independent risk factor for gastric tube distention on POD 1. No difference in the incidence of complications (Clavien–Dindo（CD）≥2) (40 (23.0%) vs. 46 (19,8%), p =0.440), pneumonia (CD≥2) (29 [16.8%] vs. 30 [12.9%], p =0.280) or anastomotic leakage (CD≥3) (3 [1.7%] vs. 6 [2.6%], p =0.738) were noted between the without gastric tube distention group and with gastric tube distention group. Conclusion: Intraoperative NGT placement reduces gastric tube distention rates after McKeown MIE on POD 1, but the complications are similar to those of unconventional NGT placement. This finding is based on NGT placement or replacement at the appropriate time postoperatively through bedside chest X-ray examination.

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
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