Totally minimally invasive Ivor-Lewis esophagectomy (TMIIL) is associated to lower rate of post-operative complication, decreases length of hospital stay and improves quality of life compared to open approach. Nevertheless, adaptation of TMIIL still proceeds at slow pace, mainly due to the difficulty to perform the intra-thoracic anastomosis and heterogeneity of surgical techniques. We present our experience with TMIIL utilizing a stapled side-to-side anastomosis. We retrospectively evaluated 36 patients who underwent a planned TMIIL from January 2017 to September 2020. Esophagogastric anastomoses were performed using a 3-cm linear-stapled side-to-side technique. General features, operative techniques, pathology data and short-term outcomes were analyzed. The median operative time was 365 min (ranging from 240 to 480 min) with a median blood loss of 100 ml (50–1000 ml). The median overall length of stay was 13 (7–64) days and in-hospital mortality rate was 2.8%. Two patients (5.6%) had an anastomotic leak, without need for operative intervention and another patient developed an anastomotic stricture, resolved with a single endoscopic dilation. Chylothorax occurred in three patients; two of these required a surgical intervention. Pulmonary complications occurred in six patients (16.7%). Based on Comprehensive Complications Index (CCI), median values of complications were 27.9 (ranging from 20.9 to 100). The results of our study suggest that TMIIL with a 3-cm linear-stapled anastomosis seems to be safe and effective, with low rates of post-operative anastomotic leak and stricture.
Enhanced recovery after surgery (ERAS) programs have been developed by combining several evidence-based techniques for perioperative care, with the intention of reducing the stress response and organ dysfunction, thus allowing improved clinical results. ERAS programs have been widely adopted for colorectal surgery; however, their adoption for upper gastrointestinal surgery has been challenging even though good results have been reported in the literature. Our intent was to investigate the adoption of ERAS programs for resective gastric surgery in Italy. A survey was conducted among 20 departments of surgery belonging to the Italian Group for Research on Gastric Cancer (GC). Analysis of our survey showed that several evidence-based practices and many items of the ERAS guidelines for gastric surgery are not implemented in real practice in Italian centers dedicated to GC. This situation may be related to the hesitation of surgeons to introduce radical changes to the traditional postoperative management after gastrectomy. A multidisciplinary approach to the perioperative care of these patients is not routinely applied in many Italian centers. A strict collaboration of all clinicians involved in the perioperative care of patients undergoing gastrectomy for GC is key for the future implementation of ERAS in gastric surgery in our departments.
Background and Objective: Minimally invasive approach for small gastric gastrointestinal stromal tumors (GISTs) (<5 cm) is widely accepted according to National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO) guidelines published in 2010. During last 15 years, many different techniques were proposed with the intent to reduce invasiveness ensuring adequate oncological radicality. In this chapter, we describe the laparoscopic, robotic and laparoscopic-endoscopic cooperative techniques for the treatment of this type of neoplasms. Our technique is also described.
Methods:We have conducted a literature review from 01.01.2008 to 06.31.2021 on PubMed database for studies regarding laparoscopic, robotic and endoscopic techniques for treatment of gastric GISTs. The medical search headings (MeSH) "gastric GIST", "laparoscopic GIST", "robotic GIST", "minimally invasive surgery", "laparoscopic and endoscopic cooperative surgery procedures" and combinations of these were used. The lists of articles identified were examined to find relevant studies cited in this article. These studies compared sometimes different approaches (laparoscopic, robotic, laparoscopic and endoscopic cooperative surgery procedures), dividing the GISTs according to their gastric site and different types of resection. We analysed review, systematic review, and meta-analyses, restricting to English-language publications.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.