Which is the best approach for minimally invasive oesophagectomy?

2021 ◽  
Author(s):  
Marcello Migliore
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Oesophagectomy

PS01.211: IMPLEMENTATION OF A TOTALLY MINIMALLY INVASIVE OESOPHAGECTOMY PROGRAMME IN A UK SPECIALIST CENTRE: INITIAL EXPERIENCE AND OUTCOMES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 109-110
Author(s):  
Temisanren Akitikori ◽  
Bruno Lorenzi ◽  
Kanatheepan Shanmuganathan ◽  
Oluwasunmisola Soile ◽  
Aadil Hussain ◽  
...  
Keyword(s):  
Lymph Node ◽  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
High Volume ◽  
Pulmonary Complications ◽  
Cardiac Complications ◽  
Initial Experience ◽  
Chyle Leak ◽  
Anastomotic Strictures ◽  
Minimally Invasive Oesophagectomy

Abstract Background Totally minimally invasive oesophagectomy although challenging to perform has garnered popularity in the surgical treatment of oesophageal cancer. Advanced laparoscopic surgical skills are needed with the construction of the intra-thoracic anastomosis in the case of a 2-stage procedure being the rate-limiting step. We aim to report our initial experience and short-term outcomes of totally minimally invasive 3-stage and 2-stage oesophagectomies for cancer. Methods From January 2016 when the minimally invasive oesophagectomy programme was implemented in our Unit, to December 2017, 65 consecutive cases underwent either a 2-stage or a 3-stage oesophagectomy for cancer. In all cases a radical 2-field lymph node dissection was performed. All were performed in a prone position and in the 3-stage oesophagectomies, superior mediastinal lympadenectomy was additionally performed. In the 2-stage cases an end-to-side esophago-gastric anastomosis was constructed in two layers with barbed knotless suture (V-LocTM). Results Male: female was 4:1 with a mean age of 66.44 years (IQR, 43–82). n = 53 were 2-stage and 12 were 3-stage oesophagectomies. Thirty five (53.8%) had neoadjuvant chemotherapy and 30(46.2%) went straight to surgery. There were no open conversions. No feeding jejunostomies were placed routinely. Complete resection (R0) rate was 61.54% (40/65) with a mean lymph node harvest of 28 (IQR, 11–68). Five (7.6%) anastomotic leaks were diagnosed (4 in 2-stage and 1 in 3-stage oesophagectomies), with 1(1.5%) of them (in the 2-stage group) being subclinical requiring no intervention. Furthermore, 1(1.5%) chyle leak and 1(1.5%) gastric staple line leak were also observed. Pulmonary complications were reported in 13.8% of cases and cardiac complications arose in 1.5%. Seven (10.8%) anastomotic strictures were also noted that were treated with endoscopic balloon dilatation. Mean hospital stay was 13 days and 30-day mortality rate was 4.62%. Conclusion Implementation of a minimally invasive oesophagectomy program in our high-volume tertiary centre is yielding good initial results. Vast previous experience in the field is of paramount importance. Hand-sewn intrathoracic anastomosis during 2-stage procedures is feasible and with repetitively good outcomes. Disclosure All authors have declared no conflicts of interest.

O181 SERUM C-REACTIVE PROTEIN CAN BE AN EARLY PREDICTOR OF LENGHT OF HOSPITAL STAY AFTER MINIMALLY INVASIVE OESOPHAGECTOMY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Gabriele Corsi ◽  
Krashna Patel ◽  
Omar Abbassi ◽  
Zobia Gudkalli ◽  
David O’Hara ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Acute Phase Protein ◽  
C Reactive Protein ◽  
Operative Morbidity ◽  
Reactive Protein ◽  
Operative Recovery ◽  
Minimally Invasive Oesophagectomy ◽  
Overall Mortality

Abstract Aim Oesophagectomy is associated with a significant number of potential complications affecting the lenght of the post-operative recovery. Serum C-reactive protein (CRP) is an acute phase protein which has been linked to early detection of post-operative complications, including but not limited to anastomotic leak. The aim of this retrospective study was to investigate the value of CRP elevation in the early post-operative days as a predictor of lenght of Hospital stay after minimally invasive oesophagectomy for cancer. Background and Methods The study group included 88 patients undergoing minimally invasive oesophagectomy for cancer from September 2017 to April 2019. CRP values on post-operative day 1,3,5 and 7 were retrieved and correlated to overall lenght of stay. Post-operative morbidity and mortality were also recorded. Results The approach was fully minimally invasive in 65 patients (74%) and hybrid in the remaining 23 (26%). The median length of stay was 11 days (IQR, 6-105 days) with overall mortality of 3.4% (n=3). Gastro-intestinal complications occurred in 15 patients (17%). The overall surgical or endoscopic re-intervention rate was 13.6% (n=12). The median CRP value was 54.8, 167, 143 and 134 mg/L, respectively on day 1,3,5 and 7. There was a positive correlation between CRP and length of stay on day 1, 3 and 7. A cut-off value of 167 mg/L on day 3 appeared to be a significant predictor of increased lenght of stay (12.8 vs 23.3 days, p=0.008). Conclusion CRP levels above 167mg/L on post-operative day 3 were associated with a prolonged lenght of hospital stay in our group of patients. Elevated CRP in the early post-operative period could represent a useful tool to predict lenght of stay after minimally invasive oesophagectomy.

scholarly journals Routine intraoperative jejunostomy placement and minimally invasive oesophagectomy: an unnecessary step?†

2019 ◽  
Vol 56 (4) ◽  
pp. 746-753 ◽  
Author(s):  
Tiuri E Kroese ◽  
Leonidas Tapias ◽  
Jacqueline K Olive ◽  
Lena E Trager ◽  
Christopher R Morse
Keyword(s):  
Weight Loss ◽  
Minimally Invasive ◽  
Relative Weight ◽  
Patient Characteristics ◽  
Perioperative Outcomes ◽  
P Value ◽  
Oral Nutrition ◽  
Significant Difference ◽  
Minimally Invasive Oesophagectomy ◽  
The Impact

Abstract OBJECTIVES: Adequate nutrition is challenging after oesophagectomy. A jejunostomy is commonly placed during oesophagectomy for nutritional support. However, some patients develop jejunostomy-related complications and the benefit over oral nutrition alone is unclear. This study aims to assess jejunostomy-related complications and the impact of intraoperative jejunostomy placement on weight loss and perioperative outcomes in patients with oesophageal cancer treated with minimally invasive Ivor Lewis oesophagectomy (MIE). METHODS: From a prospectively maintained database, patients were identified who underwent MIE with gastric reconstruction. Between 2007 and 2016, a jejunostomy was routinely placed during MIE. After 2016, a jejunostomy was not utilized. Postoperative feeding was performed according to a standardized protocol and similar for both groups. The primary outcomes were jejunostomy-related complications, relative weight loss at 3 and 6 months postoperative and perioperative outcomes, including anastomotic leak, pneumonia and length of stay, respectively. RESULTS: A total of 188 patients were included, of whom 135 patients (72%) received a jejunostomy. Ten patients (7.4%) developed jejunostomy-related complications, of whom 30% developed more than 1 complication. There was no significant difference in weight loss between groups at 3 months (P = 0.73) and 6 months postoperatively (P = 0.68) and in perioperative outcomes (P-value >0.999, P = 0.591 and P = 0.513, respectively). CONCLUSIONS: The use of a routine intraoperative jejunostomy appears to be an unnecessary step in patients undergoing MIE. Intraoperative jejunostomy placement is associated with complications without improving weight loss or perioperative outcomes. Its use should be tailored to individual patient characteristics. Early oral nutrition allows patients to maintain an adequate nutritional status.

scholarly journals Minimally invasive oesophagectomy for cancer in patients with HIV/AIDS: considerations and future directions

2020 ◽  
Vol 102 (9) ◽  
pp. e1-e3
Author(s):  
S Davakis ◽  
A Syllaios ◽  
A Meropouli ◽  
E Kyros ◽  
I Vagios ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Techniques ◽  
Key Factors ◽  
Future Directions ◽  
Oncological Outcomes ◽  
Oesophageal Neoplasms ◽  
Minimally Invasive Oesophagectomy ◽  
Invasive Techniques ◽  
The Impact ◽  
Hiv Aids

The impact of HIV/AIDS on the treatment of oesophageal neoplasms remains undefined due to a lack of adequate data. We present our experience in treating patients with HIV/AIDS who have oesophageal cancer using minimally invasive techniques and discuss important key factors during perioperative management. Two men with HIV/AIDS underwent minimally invasive oesophagectomies in our department, with adequate clinical and oncological outcomes. Minimally invasive oesophagectomy can be safe and has the well-established benefits of minimally invasive techniques, offering good perioperative results and oncological outcomes in patients with HIV/AIDS. Multimodality therapy is crucial.

Surgical optimisation of the gastric conduit for minimally invasive oesophagectomy

2011 ◽  
Vol 26 (1) ◽  
pp. 271-276 ◽  
Author(s):  
Shahjehan A. Wajed ◽  
Darmarajah Veeramootoo ◽  
Angela C. Shore
Keyword(s):  
Minimally Invasive ◽  
Gastric Conduit ◽  
Minimally Invasive Oesophagectomy
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