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.

Costs and benefits of different methods of esophagectomy for esophageal cancer

2017 ◽  
Vol 25 (7-8) ◽  
pp. 513-517 ◽  
Author(s):  
Alongkorn Yanasoot ◽  
Kamtorn Yolsuriyanwong ◽  
Sakchai Ruangsin ◽  
Supparerk Laohawiriyakamol ◽  
Somkiat Sunpaweravong
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Pain ◽  
Minimally Invasive ◽  
Operative Time ◽  
Minimally Invasive Esophagectomy ◽  
Laparoscopic Approach ◽  
Costs And Benefits ◽  
Invasive Approach ◽  
Invasive Esophagectomy ◽  
Open Esophagectomy

Background A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of the costs and benefits of minimally invasive, hybrid, and open esophagectomy approaches for esophageal cancer surgery. Methods The data of 83 consecutive patients who underwent a McKeown’s esophagectomy at Prince of Songkla University Hospital between January 2008 and December 2014 were analyzed. Open esophagectomy was performed in 54 patients, minimally invasive esophagectomy in 13, and hybrid esophagectomy in 16. There were no differences in patient characteristics among the 3 groups Minimally invasive esophagectomy was undertaken via a thoracoscopic-laparoscopic approach, hybrid esophagectomy via a thoracoscopic-laparotomy approach, and open esophagectomy by a thoracotomy-laparotomy approach. Results Minimally invasive esophagectomy required a longer operative time than hybrid or open esophagectomy ( p = 0.02), but these patients reported less postoperative pain ( p = 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 3 groups. Minimally invasive esophagectomy incurred higher operative and surgical material costs than hybrid or open esophagectomy ( p = 0.01), but there were no significant differences in inpatient care and total hospital costs. Conclusion Minimally invasive esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain. Hybrid esophagectomy had a shorter learning curve while sharing the advantages of minimally invasive esophagectomy.

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

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.

Long-term survival in esophageal cancer after minimally invasive esophagectomy compared to open esophagectomy

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Eivind Gottlieb-Vedi ◽  
Joonas H. Kauppila ◽  
Fredrik Mattsson ◽  
Mats Lindblad ◽  
Magnus Nilsson ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Term Survival ◽  
Long Term Survival ◽  
Invasive Esophagectomy ◽  
Open Esophagectomy

623 MINIMALLY INVASIVE VERSUS OPEN MCKEOWN FOR PATIENTS WITH ESOPHAGEAL CANCER: A RETROSPECTIVE STUDY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Yan Zheng ◽  
Wenqun Xing ◽  
Xianben Liu ◽  
Haibo Sun
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Group 14 ◽  
Term Survival ◽  
Long Term Survival ◽  
Invasive Esophagectomy ◽  
Open Esophagectomy ◽  
Surgery Department

Abstract   McKeown Minimally invasive esophagectomy(McKeown-MIE) offers advantages in short-term outcomes compared with McKeown open esophagectomy(McKeown-OE). However, debate as to whether MIE is equivalent or better than OE regarding survival outcomes is ongoing. The aim of this study was to compare long-term survival between McKeown-MIE and McKeown-OE in a large cohort of esophageal cancer(EC) patients. Methods We used a prospective database of the Thoracic Surgery Department at our Cancer Hospital and included patients who underwent McKeown-MIE and McKeown-OE for EC during January 1, 2015, to January 6, 2018. The perioperative data and overall survival(OS) rate in the two groups were retrospectively compared. Results We included 502 patients who underwent McKeown-MIE (n = 306) or McKeown-OE (n = 196) for EC. The median age was 63 years. All baseline characteristics were well-balanced between two groups. There was a significantly shorter mean operative time (269.76 min vs. 321.14 min, P < 0.001) in OE group. The 30-day and in hospital mortality were 0 and no difference for 90-day mortality (P = 0.116). The postoperative stay was shorter in MIE group, 14 days and 18 days in the MIE and OE groups(P < 0.001). The OS at 32 months was 76.82% and 64.31% in the MIE and OE groups (P = 0.001); hazard ratio(HR) (95% CI): 2.333 (1.384–3.913). Conclusion These results showed the McKeown-MIE group was associated with a better long-term survival, compared with open-MIE for patients with resectable EC.

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.

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