Early outcomes of minimally invasive esophagectomy after neoadjuvant chemotherapy for esophageal squamous cell carcinoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Võ Vĩnh Lộc Nguyễn ◽  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Minimally Invasive ◽  
Lymph Nodes ◽  
Minimally Invasive Esophagectomy ◽  
Locally Advanced ◽  
Postoperative Mortality ◽  
Thoracic Esophagus ◽  
Invasive Esophagectomy ◽  
Stage Ib

Abstract Introduction: Neoadjuvant chemotherapy (NAC) is the standard treatment which recommended for resectable locally advanced esophageal cancer (EC), but the safety of minimally invasive esophagectomy (MIE) after neoadjuvant chemotherapy (NAC) for esophageal cancer has not been reported. We investigated the effect of NAC on the safety and feasibility of MIE for EC.The purpose of this study was to evaluate the morbidity, mortality and oncologic outcomes of MIE after neoadjuvant chemotherapy. Materials and Methods: This was a prospective study of the patients who underwent MIE after neoadjuvant chemotherapy between August 2018 and May 2020. Patients with clinical stage IB, IIA, IIB, IIIA, IIIB, or IIIC EC, and no active concomitant malignancy were included. The data regarding the intraoperative incident, postoperative morbidity and mortality as well as oncologic examination were collected and analyzed. Results: From August 2018 to May 2020, 68 patients with EC have been included into the study. There were 66 males and 2 females with mean age of 58.1 ± 13.9 (42 – 77). Sixty-two patients had neoadjuvant with DCX, four patients were indicated for EOX therapy, and remained two patients were treated by PAR-CAR. Two patients with stage IB, 23 with stage IIA, 22 with stage IIB, 14 with stage IIIA, one with stage IIIB, and 6 with stage IIIC. Tumor located in middle thoracic esophagus was 34 (50%), lower thoracic esophagus was 32 (47.1%) and upper thoracic esophagus was 2 cases. Median operation time was 420 minutes with minimal blood loss. Median hospitalization duration was 11 days (7 – 31). Median lymph nodes harvested in cervical, mediastinal and abdominal fields was 10, 16 and 7 respectively. Twenty-seven (42.2%) patients had metastatic lymph nodes. Postoperative mortality was 1.5% (1 case). Overall morbidity was 33.8% included 6 cases complicated pneumonia, 9 cases with anastomotic leak (conservative treatment), 1 case was re-operated due to cervical lymph leak, 16 cases with temporary hoarse voice. Conclusion: Results from our study to conclude that MIE is safe and effective for locally advanced EC, even after NAC. Key word: Neoadjuvant chemotherapy, minimally invasive esophagectomy, esophageal cancer. Tóm tắt Đặt vấn đề: Hóa trị tân hỗ trợ là điều trị tiêu chuẩn cho ung thư thực quản tiến triển tại chỗ, nhưng đến tính an toàn và khả thi của phẫu thuật nội soi cắt thực quản sau hóa trị tân hỗ trợ vẫn chưa được báo cáo. Chúng tôi đánh giá ảnh hưởng của hóa trị tân hỗ trợ lên tính an toàn và khả thi của phẫu thuật nội soi cắt thực quản sau hóa trị tân hỗ trợ. Nghiên cứu đánh giá tỉ lệ tai biến, biến chứng, tử vong và kết quả ung thư học của phẫu thuật nội soi cắt thực quản sau hóa trị tân hỗ trợ. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, đánh giá các người bệnh phẫu thuật nội soi cắt thực quản sau hóa trị tân hỗ trợ từ tháng 8 năm 2018 đến tháng 5 năm 2020. Chúng tôi chọn những người bệnh ung thư thực quản giai đoạn IB, IIA, IIB, IIIA, IIIB và IIIC và không có ung thư khác kèm theo. Tai biến, biến chứng, tử vong và kết quả ung thư học sẽ được đánh giá. Kết quả: Từ tháng 8 năm 2018 đến tháng 5 năm 2020, có 68 người bệnh đạt tiêu chuẩn nghiên cứu. Có 66 nam và 2 nữ, tuổi trung bình là 58,1 ± 13,9 (42 – 77). 62 người bệnh hóa trị với phác đồ DCX, 4 người bệnh hóa trị với phác đồ EOX và 2 người bệnh hóa trị với phác đồ PAR-CAR. Có 2 người bệnh giai đoạn IB, 23 người bệnh giai đoạn IIA, 22 người bệnh giai đoạn IIB, 14 người bệnh giai đoạn IIIA, 1 người bệnh giai đoạn IIIB và 6 người bệnh giai đoạn IIIC. U nằm ở thực quản ngực giữa ở 34 (50%) người bệnh, thực quản ngực dưới ở 32 (47,1%) người bệnh và thực quản ngực trên ở 2 người bệnh. Thời gian mổ trung vị là 420 phút, máu mất không đáng kể. Thời gian nằm viện trung vị là 11 ngày (7 – 31). Số hạch nạo được trung vị ở cổ là 10, trung thất là 16 và bụng là 7. Có 27 (42.2%) người bệnh có di căn hạch. Tử vong chu phẫu là 1,5% (1 người bệnh). Tỉ lệ biến chứng là 33,8% gồm 6 viêm phổi, 9 rò miệng nối (điều trị bảo tồn), 1 ca rò bạch huyết cần mổ lại và 16 ca khàn tiếng tạm thời. Kết luận: Từ những kết quả đạt được, phẫu thuật nội soi cắt thực quản sau hóa trị tân hỗ trợ là phẫu thuật an toàn và khả thi. Từ khóa: Hóa trị tân hỗ trợ, phẫu thuật nội soi cắt thực quản, ung thư thực quản.

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 Minimally invasive esophagectomy for cancer: Single center experience after 44 consecutive cases

2015 ◽  
Vol 143 (7-8) ◽  
pp. 410-415 ◽  
Author(s):  
Milos Bjelovic ◽  
Tamara Babic ◽  
Dragan Gunjic ◽  
Milan Veselinovic ◽  
Bratislav Spica
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Laparoscopic Approach ◽  
Standard Of Care ◽  
High Volume ◽  
Thoracic Esophagus ◽  
Digestive Surgery ◽  
Invasive Esophagectomy ◽  
Open Esophagectomy

Introduction. At the Department of Minimally Invasive Upper Digestive Surgery of the Hospital for Digestive Surgery in Belgrade, hybrid minimally invasive esophagectomy (hMIE) has been a standard of care for patients with resectable esophageal cancer since 2009. As a next and final step in the change management, from January 2015 we utilized total minimally invasive esophagectomy (tMIE) as a standard of care. Objective. The aim of the study was to report initial experiences in hMIE (laparoscopic approach) for cancer and analyze surgical technique, major morbidity and 30-day mortality. Methods. A retrospective cohort study included 44 patients who underwent elective hMIE for esophageal cancer at the Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia in Belgrade from April 2009 to December 2014. Results. There were 16 (36%) middle thoracic esophagus tumors and 28 (64%) tumors of distal thoracic esophagus. Mean duration of the operation was 319 minutes (approximately five hours and 20 minutes). The average blood loss was 173.6 ml. A total of 12 (27%) of patients had postoperative complications and mean intensive care unit stay was 2.8 days. Mean hospital stay after surgery was 16 days. The average number of harvested lymph nodes during surgery was 31.9. The overall 30-day mortality rate within 30 days after surgery was 2%. Conclusion. As long as MIE is an oncological equivalent to open esophagectomy (OE), better relation between cost savings and potentially increased effectiveness will make MIE the preferred approach in high-volume esophageal centers that are experienced in minimally invasive procedures.

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 < 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.

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.

PS01.220: COMPARISON OF SHORT-TERM OUTCOMES BETWEEN RAMIE AND VAMIE IN TREATMENT MIDDLE THORACIC ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 112-112
Author(s):  
Yidan Lin ◽  
Hanyu Deng
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Operation Time ◽  
Short Term ◽  
Thoracic Esophageal Cancer ◽  
Comparable Rate ◽  
Invasive Esophagectomy

Abstract Background Whether robot-assisted minimally invasive esophagectomy (RAMIE) has any advantages over video-assisted minimally invasive esophagectomy (VAMIE) remains controversial. In this study, we tried to compare the short-term outcomes of RAMIE with that of VAMIE in treating middle thoracic esophageal cancer from a single medical center. Methods Consecutive patients undergoing RAMIE or VAMIE for middle thoracic esophageal cancer from April 2016 to April 2017 were prospectively included for analysis. Baseline data and pathological findings as well as short-term outcomes of these two group (RAMIE group and VAMIE group) patients were collected and compared. A total of 84 patients (RAMIE group: 42 patients, VAMIE group: 42 patients) were included for analysis. Results The baseline characteristics between the two groups were comparable. RAMIE yielded significantly larger numbers of total dissected lymph nodes (21.9 and 17.8, respectively; P = 0.042) and right recurrent laryngeal nerve (RLN) lymph nodes (2.1 and 1.2, respectively; P = 0.033) as well as abdominal lymph nodes (10.8 and 7.7, respectively; P = 0.041) than VAMIE. Even though RAMIE may consume more overall operation time, it could significant decrease total blood loss compared to VAMIE (97 and 161 ml, respectively; P = 0.015). Postoperatively, no difference of the risk of major complications or hospital stay was observed between the two groups. Conclusion RAMIE had significant advantage of lymphadenectomy especially for dissecting RLN lymph nodes over VAMIE with comparable rate of postoperative complications. Further randomized controlled trials are badly needed to confirm and update our conclusions. Disclosure All authors have declared no conflicts of interest.

scholarly journals Influence of Neoadjuvant Chemotherapy on Short-term Outcomes After Minimally Invasive Esophagectomy for Esophageal Cancer

2018 ◽  
Vol 39 (1) ◽  
pp. 471-475
Author(s):  
DAICHI NOMOTO ◽  
NAOYA YOSHIDA ◽  
TAKAHIKO AKIYAMA ◽  
YUKI KIYOZUMI ◽  
KOJIRO ETO ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Short Term ◽  
Invasive Esophagectomy

P29 COMPARISON BETWEEN MINIMALLY INVASIVE AND OPEN ESOPHAGECTOMY IN PATIENTS AGED ≥75 YEARS: A NATIONWIDE PROPENSITY-SCORE MATCHED COHORT STUDY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Baranov Nikolaj ◽  
Claassen Linda ◽  
van Workum Frans ◽  
Rosman Camiel
Keyword(s):  
Esophageal Cancer ◽  
Cohort Study ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Locally Advanced ◽  
Advanced Esophageal Cancer ◽  
Perioperative Mortality ◽  
Invasive Esophagectomy ◽  
Open Esophagectomy ◽  
Locally Advanced Esophageal Cancer

Abstract Aim To compare postoperative outcome in elderly undergoing either open or minimally invasive esophagectomy. Background & Methods Randomized controlled trials have shown improved short term outcome in patients undergoing minimally invasive compared with open esophagectomy. However, all of them have excluded patients aged 75 years or older. Evidence regarding this patient group, therefore, remains scarce. A propensity score matched retrospective cohort study was performed in a Dutch nationwide cohort from the period of april 2011 to april 2016 of patients aged ≥75 years diagnosed with local and locally advanced esophageal cancer who underwent either minimally invasive or open esophagectomy. Primary outcomes consisted of anastomotic leakage and perioperative mortality. Secondary outcomes were the rate of other complications, reintervention and hospital/ICU readmission. Results After matching, 322 patients were included, 161 in the open esophagectomy and 161 in the minimally invasive esophagectomy group. In the minimally invasive group, a significantly higher incidence occurend of Clavien-Dindo ≥3 complications (RR 1.63, CI-95% 1.24—2.13), anastomotic leaks (RR 1.60, CI-95% 1.12—2.29) and reinterventions (RR 1.70, CI-95% 1.19—2.42). There were no significant differences regarding perioperative mortality, other complications and readmission rate. Conclusion Elderly patients diagnosed with locally advanced esophageal cancer should undergo minimally invasive esophagectomy in favor of open esophagectomy. Keywords Elderly, minimally invasive esophagectomy, open esophagectomy, esophageal cancer, clinical outcome, perioperative mortality.

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