scholarly journals Anastomotic reinforcement with omentoplasty reduces anastomotic leakage for minimally invasive esophagectomy with cervical anastomosis

2018 ◽  
Vol Volume 10 ◽  
pp. 257-263 ◽  
Author(s):  
Dong Zhou ◽  
Quan-Xing Liu ◽  
Xu-Feng Deng ◽  
Hong Zheng ◽  
Xiao Lu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Minimally Invasive Esophagectomy ◽  
Cervical Anastomosis ◽  
Invasive Esophagectomy

RA04.07: A NOVEL TECHNIQUE FOR CERVICAL GASTROESOPHAGEAL ANASTOMOSIS DURING MINIMALLY INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 26-26
Author(s):  
Yuequan Jiang
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Minimally Invasive Esophagectomy ◽  
Occurrence Rate ◽  
Controlled Study ◽  
Cervical Anastomosis ◽  
Anastomotic Technique ◽  
Invasive Esophagectomy ◽  
Postoperative Leakage

Abstract Background Anastomotic leakage, fibrous stricture and gastroesophageal reflux are three major complications of gastroesophageal anastomosis, particularly in cervical anastomosis. Our aim was to evaluate the safety and efficacy of a novel cervical anastomosis technique (NA) by comparing it to the traditional side-to-side anastomosis (SS), and the end-to-side anastomosis using a circular stapler (CS) in terms of postoperative leakage, stricture and reflux. Methods A total of 390 patients with thoracic esophageal cancer underwent a minimally invasive esophagectomy with cervical anastomosis (192 with NA, 34 with SS and 164 with CS) in our institute from January 2013 and May 2016. The new anastomotic technique was improved from a type of side-to-side anastomosis technique which was reported by Collard et al. The difference of our new technique is that the part of the anastomotic stump was pushed into the tubular stomach. It let the end part of esophagus was embedded in the gastric tube while the end portion of the stomach was also reversed into the gastric tube (figure 1, 2, 3). The major postoperative complications including postoperative leakage, stricture and reflux were compared using three armed controlled study. Results With regard to the incidence of anastomotic leakage and reflux, the patients who underwent Jiang's anastomosis had a significantly lower rate than those in the SS group and CS group (Leaks: 1.0% vs. 8.8% and 8.5%, P = 0.025, 0.001; Reflux: 5.7% vs. 23.5% and 18.3%, P = 0.003, 0.001). The incidence of dysphagia was 10.4% with an occurrence rate of 1.5% for anastomotic strictures in the NA group. It was significant lower than that in the CS group (41.5% vs. 18.9%, P < 0.05) but not significantly different from that in SS group (11.8% vs. 2.9%). Conclusion The novel anastomotic technique remarkably reduced the incidence of gastroesophageal-anastomotic leakage, stricture and reflux and was a safe and effective technique for minimally invasive esophagectomy. Disclosure All authors have declared no conflicts of interest.

PS01.159: THE IMPROVED POSTOPERATIVE RECOVERY OUTCOMES FROM MINIMALLY INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 94-94
Author(s):  
Xiaobin Zhang ◽  
Zhigang Li
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Conflicts Of Interest ◽  
Perioperative Complications ◽  
Minimally Invasive Esophagectomy ◽  
Postoperative Recovery ◽  
Open Group ◽  
Recurrent Nerve ◽  
Invasive Esophagectomy ◽  
Open Esophagectomy

Abstract Background The minimally invasive esophagectomy (MIE) has been developed in the past three decades. In our institution, the MIE was first introduced in 2012, and the proportion of MIE was used for over 70% in 2016–2017. This study aimed to compare the postoperative recovery outcomes between MIE and open esophagectomy in different period. Methods A total of 725 patients were enrolled in this study including 248 patients who underwent open esophagectomy within 2012–2013 and 477 patients who underwent MIE within 2016–2017. All patients received McKeown esophagectomy with two-field lymphadenectomy. And the perioperative complications were recorded according to the Esophagectomy Complications Consensus Group (ECCG) complication definitions. Results There was no statistically difference between OPEN and MIE groups with regard to preoperative characters except for age (60.8 ± 7.2 vs. 62.7 ± 7.7, P < 0.001) and body mass index (22.4 ± 3.0 vs. 23.1 ± 3.0, P = 0.002). One (0.2%) patient in the MIE group died within 90 days from anastomotic leakage, compared to 6 (2.4%) patients in the OPEN group (P = 0.004). The length of hospital stay was shorter in the MIE group (11 range 6–131 days, vs. 15 range 9–164 days, P < 0.001). The MIE group was in favor of lower complications (32.3% vs. 46.4%, P < 0.001). Pneumonia was the most common complications in both groups (12.6% in MIE vs. 27.4% in OPEN, P < 0.001). 15 (3.1%) patients in the MIE group experienced atrial arrhythmias compared with 30 (12.1%) in the OPEN group (P < 0.001). Lower anastomotic leakage was noted in the MIE group (11.5% vs. 25.4%, P < 0.001), as well as the wound infection (0.2% vs. 2.8%, P = 0.001), than in the OPEN group. The recurrent nerve injury was higher in the MIE group (11.7% vs. 6.5%, P = 0.024) but with more lymph nodes dissection along the recurrent laryngeal nerve (3.8 ± 2.8 vs. 1.4 ± 2.0, P < 0.001). Conclusion The MIE was associated with better postoperative recovery outcomes and lower mortality. MIE technique should be considered as the mainstay surgical treatment for esophageal cancer in the current and future period. Disclosure All authors have declared no conflicts of interest.

scholarly journals Improved Functional Results After Minimally Invasive Esophagectomy: Intrathoracic Versus Cervical Anastomosis

2017 ◽  
Vol 103 (1) ◽  
pp. 267-273 ◽  
Author(s):  
Frans van Workum ◽  
Jolijn van der Maas ◽  
Frits J.H. van den Wildenberg ◽  
Fatih Polat ◽  
Ewout A. Kouwenhoven ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Functional Results ◽  
Cervical Anastomosis ◽  
Invasive Esophagectomy

scholarly journals Efficacy of Indocyanine Green Fluorescence Angiography in Preventing Anastomotic Leakage After McKeown Minimally Invasive Esophagectomy

2021 ◽  
Vol 10 ◽  
Author(s):  
Rao-Jun Luo ◽  
Zi-Yi Zhu ◽  
Zheng-Fu He ◽  
Yong Xu ◽  
Yun-Zheng Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Anastomotic Leakage ◽  
Minimally Invasive Esophagectomy ◽  
Fluorescence Angiography ◽  
Perioperative Outcomes ◽  
Vascular Perfusion ◽  
Indocyanine Green Fluorescence ◽  
Invasive Esophagectomy ◽  
Patient Demographics

BackgroundIndocyanine green (ICG) fluorescence angiography (FA) was introduced to provide real-time intraoperative evaluation of the vascular perfusion of the gastric conduit during esophagectomy. However, its efficacy has not yet been proven. The aim of this study was to assess the usefulness of ICG-FA in the reduction of the rates of anastomotic leakage (AL) in McKeown minimally invasive esophagectomy (MIE).MethodsFrom June 2017 to December 2019, patients aged between 18 and 80 years with esophageal carcinoma were enrolled in the study and each patient underwent McKeown MIE. Patients were divided into two groups, those with or without ICG-FA. The patient demographics and perioperative outcomes were comparable between the two groups. The primary outcome was the rate of AL.ResultsA total of 192 patients were included: 86 in the ICG-FA group and 106 in the non-ICG-FA group. Overall, 12 patients (6.3%) had AL; the rate of AL was 10.4% in the non-ICG-FA group, which was significantly higher than the 1.2% in the ICG-FA group.ConclusionsICG-FA has the potential to reduce the rate of AL in McKeown MIE.

P113 ESOPHAGECTOMY-SPECIFIC OBJECTIVE STRUCTURED ASSESSMENT OF TECHNICAL SKILL (E-OSATS): CONSENSUS ON ESSENTIAL IVOR-LEWIS AND MCKEOWN STEPS TROUGH DELPHI METHODOLOGY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Yassin Eddahchouri ◽  
Workum Frans van ◽  
Bastiaan Klarenbeek ◽  
den Wildenberg Frits van ◽  
Berge Henegouwen Mark van ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Learning Curve ◽  
Assessment Tool ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Cervical Anastomosis ◽  
International Consensus ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Specific Objective

Abstract Aim The objective of this study was to determine expert consensus on essential steps in MIE to develop an ‘Esophagectomy-specific Objective Structured Assessment of Technical Skills’ tool (E-OSATS). Background & Methods Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure. Studies have shown that MIE has a long learning curve which is associated with increased morbidity and mortality. To master MIE training of procedural steps is crucial. Yet, no consensus regarding the essential steps nor a structured way of assessment of MIE are available. Essential steps were defined for both Ivor-Lewis (IL) and McKeown (MCK) approach, based on expert opinion and peer-reviewed literature. In round table discussions experts finalized the list, 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 94 and 98 steps for the IL and MCK approach respectively. Cronbach’s alpha in the first round was 0,77 (IL) and 0,77 (MCK), and in the second round 0,91 (IL) and 0,87 (MCK). Conclusion International consensus on essential surgical steps for MIE with both intrathoracic- and cervical anastomosis was achieved. Validation of the assessment tool allows for specific and structured feedback and will potentially shorten the learning curve and decrease learning associated morbidity consequently.

PS01.246: ESOPHAGECTOMY-SPECIFIC OBJECTIVE STRUCTURED ASSESSMENT OF TECHNICAL SKILL (E-OSATS): CONSENSUS ON ESSENTIAL STEPS THROUGH DELPHI METHODOLOGY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 119-119
Author(s):  
Yassin Eddahchouri ◽  
Suzanne Gisbertz ◽  
Mark I Van Berge Henegouwen ◽  
Bastiaan Klarenbeek ◽  
Camiel Rosman
Keyword(s):  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Round Table Discussion ◽  
Cervical Anastomosis ◽  
Invasive Esophagectomy ◽  
Delphi Round ◽  
Specific Objective ◽  
International Experts

Abstract Background Minimally invasive esophagectomy (MIE) is a technically demanding procedure, but without consensus regarding essential steps and assessment of surgical technique. The objective of this study was to determine expert consensus on essential steps in MIE as a first step in the development of an ‘esophagectomy-specific objective structured assessment of technical skills’ tool (E-OSATS). Methods Essential steps were defined for both MIE with intrathoracic- and cervical anastomosis, based on local expert opinion, peer-reviewed literature and surgical textbooks. In round table discussion disparities between experts were resolved, and an online Delphi questionnaire was sent to an international expert panel of minimally invasive upper GI surgeons. Based on replies and comments steps were adjusted and resent in iterative fashion. Results A total of 137 and 138 essential steps were identified for the MIE with intrathoracic- and cervical anastomosis respectively. After the first Delphi round 24 out of 36 (67%) invited international experts replied, and consensus was reached in 99 out of 137 (72%) and 95 out of 138 steps for both procedures respectively. Conclusion A Delphi method seems feasible in determining essential steps as a first step in the development of an E-OSATS for both MIE with intrathoracic- and cervical anastomosis. The second Delphi round is currently pending. Disclosure All authors have declared no conflicts of interest.

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.

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