Micronutrient Deficiencies Following Minimally Invasive Esophagectomy for Cancer

Over the past decades, survival rates for patients with resectable esophageal cancer have improved significantly. Consequently, the sequelae of having a gastric conduit, such as development of micronutrient deficiencies, become increasingly apparent. This study investigated postoperative micronutrient trends in the follow-up of patients following a minimally invasive esophagectomy (MIE) for cancer. Patients were included if they had at least one postoperative evaluation of iron, ferritin, vitamins B1, B6, B12, D, folate or methylmalonic acid. Data were available in 83 of 95 patients. Of these, 78.3% (65/83) had at least one and 37.3% (31/83) had more than one micronutrient deficiency at a median of 6.1 months (interquartile range (IQR) 5.4–7.5) of follow-up. Similar to the results found in previous studies, most common deficiencies identified were: iron, vitamin B12 and vitamin D. In addition, folate deficiency and anemia were detected in a substantial amount of patients in this cohort. At 24.8 months (IQR 19.4–33.1) of follow-up, micronutrient deficiencies were still common, however, most deficiencies normalized following supplementation on indication. In conclusion, patients undergoing a MIE are at risk of developing micronutrient deficiencies as early as 6 up to 24 months after surgery and should therefore be routinely checked and supplemented when needed.

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Minimally invasive esophagectomy

10.1510/mmcts.2021.020 ◽

2021 ◽

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Respiratory Complications ◽

Invasive Esophagectomy ◽

Video Tutorial ◽

Complex Procedure ◽

Resectable Esophageal ◽

Resectable Esophageal Cancer ◽

Invasive Techniques

Minimally invasive esophagectomy is increasingly becoming the surgical treatment of choice for esophageal cancer. The goal of this technique is to reduce the rate of respiratory complications associated with thoracotomy while taking advantage of the benefits of reduced mortality associated with minimally invasive techniques. However, minimally invasive esophagectomy is still not considered the gold standard for resectable esophageal cancer worldwide because it is a highly technical and complex procedure. The goal of this video tutorial is to present an easy step-by-step approach to a minimally invasive esophagectomy and to address technical considerations and potential pitfalls.

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P176 MICRONUTRIENT DEFICIENCIES FOLLOWING MINIMAL INVASIVE ESOPHAGECTOMY FOR CANCER

Diseases of the Esophagus ◽

10.1093/dote/doz092.176 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

H J B Janssen Thijs ◽

F C Fransen Laura ◽

E H Ponten Jeroen ◽

A P Nieuwenhuijzen Grard ◽

D P Luyer Misha

Keyword(s):

Folic Acid ◽

Methylmalonic Acid ◽

Survival Rates ◽

Minimal Invasive ◽

Interquartile Range ◽

Folic Acid Deficiency ◽

Micronutrient Deficiencies ◽

Invasive Esophagectomy ◽

Resectable Esophageal ◽

Esophagectomy For Cancer

Abstract Aim To investigate the role of micronutrient deficiencies in patients undergoing an esophagectomy for cancer. Background & Methods Over the past decades survival rates for patients with resectable esophageal cancer have improved significantly. Consequently, the sequelae of having a gastric conduit such as development of micronutrient deficiencies become increasingly important. For this study, a systematic search of the literature was conducted, and postoperative hematological and nutritional parameters in the follow-up of patients that participated in the NUTRIENT II trial between October 2015 and May 2018 at the Catharina Hospital were investigated. Patients were included if they had at least one postoperative value for either iron, ferritin, vitamins B1, B6, B12, D, folic acid or methylmalonic acid. Results Data was available in 83 of 95 patients. Of these, 78.3% (65/83) had at least one and 37.3% (31/83) had more than one micronutrient deficiency at a median of 6.1 months (interquartile range 5.4-7.5) after surgery. Similar to the results found in previous studies, deficiencies included iron (including ferritin) in 42.2% (27/64), vitamin B12 (including methylmalonic acid) in 18.3% (15/82) and vitamin D in 50.6% (41/81) of patients, respectively. Moreover, folic acid deficiency was present in 28.8% (23/80) of patients. Anemia was present in 32% (16/50) of patients. At 24.8 months (interquartile range 19.4-33.1) after surgery, most micronutrient deficiencies normalized following supplementation. Conclusion Micronutrient deficiencies are common in patients as early as six months following an esophagectomy. Therefore, these patients should be routinely checked and supplementation provided when needed.

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Robotic Minimally Invasive Esophagectomy (RAMIE) vs. Open Esophagectomy (OE) for Resectable Esophageal Cancer

Difficult Decisions in Surgery: An Evidence-Based Approach - Difficult Decisions in Thoracic Surgery ◽

10.1007/978-3-030-47404-1_31 ◽

2020 ◽

pp. 361-368

Author(s):

John J. Brady ◽

Tadeusz Witek ◽

Inderpal S. Sarkaria

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Invasive Esophagectomy ◽

Open Esophagectomy ◽

Resectable Esophageal ◽

Resectable Esophageal Cancer

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Minimally Invasive Esophagectomy

Digestive Surgery ◽

10.1159/000497456 ◽

2019 ◽

Vol 37 (2) ◽

pp. 93-100 ◽

Cited By ~ 1

Author(s):

Pieter Christiaan van der Sluis ◽

Dimitrios Schizas ◽

Theodore Liakakos ◽

Richard van Hillegersberg

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Invasive Procedure ◽

Current Status ◽

Invasive Esophagectomy ◽

Laparoscopic Esophagectomy ◽

Resectable Esophageal ◽

Resectable Esophageal Cancer ◽

Invasive Techniques

Minimally invasive esophagectomy (MIE) was introduced in the 1990s with the aim to decrease the rate of respiratory complications associated with thoracotomy, along with the benefits of reduced morbidity and a quicker return to normal activities provided by minimally invasive techniques. However, MIE is not routinely applied as a standard approach for esophageal cancer worldwide, due to the high technical complexity of this minimally invasive procedure. Therefore, the open transthoracic esophagectomy is considered to be the gold standard for resectable esophageal cancer worldwide nowadays. In this article, the current status of conventional MIE and robot-assisted minimally invasive thoraco-laparoscopic esophagectomy will be reviewed.

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Matched-pair comparisons of minimally invasive esophagectomy versus open esophagectomy for resectable esophageal cancer

Medicine ◽

10.1097/md.0000000000011447 ◽

2018 ◽

Vol 97 (28) ◽

pp. e11447 ◽

Cited By ~ 1

Author(s):

Wei Wang ◽

Feiyu Liu ◽

Tao Hu ◽

Chaoyang Wang

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Matched Pair ◽

Invasive Esophagectomy ◽

Open Esophagectomy ◽

Pair Comparisons ◽

Resectable Esophageal ◽

Resectable Esophageal Cancer

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696 LONG-TERM OUTCOMES OF MINIMALLY INVASIVE ESOPHAGECTOMY COMPARED TO OPEN ESOPHAGECTOMY: A RETROSPECTIVE ANALYSIS OF 2958 CASES IN SINGLE CANCER CENTER

Diseases of the Esophagus ◽

10.1093/dote/doab052.696 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Xue-feng Leng ◽

Kexun Li ◽

Qifeng Wang ◽

Wenwu He ◽

Kun Liu ◽

...

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Cancer Center ◽

Term Survival ◽

Invasive Esophagectomy ◽

Open Esophagectomy ◽

Single Cancer

Abstract Esophageal cancer is the fourth primary cause of cancer-related death in the male in China.The cornerstone of treatment for resectable esophageal cancer is surgery. With the development of minimally invasive esophagectomy (MIE), it is gradually adopted as an alternative to open esophagectomy (OE) in real-world practice. The purpose of this study is to explore whether MIE vs. OE will bring survival benefits to patients with the advancement of treatment techniques and concepts. Methods Data were obtained from the Sichuan Cancer Hospital & Institute Esophageal Cancer Case Management Database (SCH-ECCM Database). We retrospective analyzed esophageal cancer patients who underwent esophagectomy from Jan. 2010 to Nov. 2017. Patients were divided into two groups: MIE and OE groups. Clinical outcome and survival data were compared using TNM stages of AJCC 8th edition. Results After 65.3 months of median follow-up time, 2958 patients who received esophagectomy were included. 1106 of 2958 patients (37.4%) were underwent MIE, 1533 of 2958 patients (51.8%) were underwent OE. More than half of the patients (56.7%, 1673/2958) were above stage III. The median overall survival (OS) of 2958 patients was 51.6 months (95% CI 45.2–58.1). The MIE group's median OS was 74.6 months compared to 42.4 months in the OE group (95% CI 1.23–1.54, P < 0.001). The OS at 1, 3, and 5 years were 90%, 68%, 58% in the MIE group; 85%, 54%, 42% in the OE group,respectively (P<0.001). Conclusion The nearly 8-year follow-up data from this single cancer center suggests that with the advancement of minimally invasive surgical technology, MIE can bring significant benefits to patients' long-term survival compared with OE. Following the continuous progression of minimally invasive surgery and establishing a mature surgical team, MIE should be encouraged.

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PS01.138: EXPERIENCE FROM 102 PATIENTS WITH CONTINUOUS INTRAOPERATIVE VAGUS NERVE STIMULATION DURING MINIMALLY INVASIVE ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.138 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 89-89

Author(s):

Ian Yu Hong Wong ◽

Raymond King Yin Tsang ◽

Desmond Kwan Kit Chan ◽

Claudia Lai Yin Wong ◽

Tsz Ting Law ◽

...

Keyword(s):

Minimally Invasive ◽

Vocal Cord ◽

Nerve Stimulation ◽

Vocal Cord Paralysis ◽

Minimally Invasive Esophagectomy ◽

Intraoperative Complications ◽

Early Recovery ◽

Invasive Esophagectomy ◽

Assessment And Treatment

Abstract Background The incidence of recurrent laryngeal nerve (RLN) injury after esophagectomy can be as high as 60–70% especially when lymphadenectomy is performed along bilateral RLN. Vocal cord paralysis is associated with increased pulmonary complication rate, longer hospital stay, and impaired quality-of-life. The authors have modified the Continuous Intraoperative Nerve Monitoring (CIONM) method for minimally invasive esophagectomy. This study reviews our experience in the first 102 patients. Methods From May 2014 to January 2018, patients who underwent thoracoscopic esophagectomy were recruited. CIONM and intermittent nerve stimulation were routinely used during left RLN lymphadenectomy. For right RLN dissection, only intermittent nerve stimulation was used because of much lower chance of nerve injury. Routine direct laryngoscopy was performed on postoperative day one to assess the vocal cord status. Patients with RLN palsy are referred to otorhinolaryngologist for assessment and treatment. Surgical outcome, especially RLN palsy and recovery rates were documented. Results 102 patients were recruited and 73 patients had more than one year follow up. Twenty-two patients had RLN palsy (21.6%); right side in 3, left side in 18, and bilateral in one. Thirty-eight patients (37%) had only unilateral or no RLN dissection performed. This was because of R2 resection negating the benefits of RLN dissection (15.6%), poor pulmonary exposure (9.8%), other technical difficulties (7.8%), preoperative vocal cord palsy (2%), intraoperative complications (1%) and uncertain contralateral nerve integrity (1%). For those 90 patients with successful CIONM, 20 RLN palsy (22.2%), 10 of whom underwent injection thyroplasty within 2–80 days. Thyroplasty was not performed in 12 patients as they had good compensation from the contralateral cord (58.3%), early recovery within 2 weeks (16.7%) tracheostomized status (16.7%) or refusal (8.3%). Thirteen patients (59%) recovered within 2–72 weeks (Median 6 weeks). For the 73 patients with more than 1 year follow up, only 4 has residual vocal cord paralysis, making a genuine cord palsy rate of 5.5%. Conclusion Lymphadenectomy along bilateral RLN is technically demanding. CIONM is a sensitive tool to guide surgeons for safer dissection. Proper patient selection, postoperative assessment and treatment protocol can reduce the morbidity of RLN injury. Majority of the vocal cord paralysis is temporary Disclosure All authors have declared no conflicts of interest.

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