Minimally Invasive Laparoscopic Esophagectomy vs. Transhiatal Open Esophagectomy in Achalasia: A Randomized Study

Fontan, A; Batista-Neto, João; Pontes, Ana Carolina Pastl; Nepomuceno, Marcos da Costa; Muritiba, Tadeu; Furtado, Rômulo da Silva

doi:10.1590/0102-672020180001e1382

Cited by 17 publications

(17 citation statements)

References 21 publications

(35 reference statements)

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“…The prognosis of this aggressive neoplasm depends mainly on the local invasion extension, hematogenous metastasis, and lymphatic spread 20 . Surgical resection is the primary treatment for localized esophageal carcinoma, and a properly lymphadenectomy is crucial for long-term survival 12 .…”

Section: Introductionmentioning

confidence: 99%

Transhiatal Esophagectomy Is Not Associated With Poor Quality Lymphadenectomy

Takeda

Tustumi

Nigro

et al. 2019

ABCD, arq. bras. cir. dig.

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Background:Esophageal cancer neoadjuvant therapy followed by surgery increases the likelihood of treatment success. Aim:To evaluate variables that can influence the number of retrieved lymph nodes, the number of retrieved metastatic lymph nodes and lymphnodal recurrence in esophagectomy after neoadjuvant chemoradiotherapy. Methods:Patients of a single institute were evaluated after completion of trimodal therapy. Univariate and multivariate analyses were performed to evaluate variables that can influence in the number of retrieved lymph nodes and retrieved metastatic lymph nodes. Results:One hundred and forty-nine patients were included. Thoracoscopy access was considered an independent factor for the number of lymph nodes retrieved, but was neither related to the number of positive lymph nodes retrieved nor to lymphnodal recurrence. Pathological complete response on the primary tumor and male were independent variables associated with the number of positive lymph node retrieved. Pathological complete response on the primary tumor site did not statistically influence the likelihood of a lower number of lymph nodes retrieved. Conclusion:Patients submitted to esophagectomy after neoadjuvant chemoradiotherapy, thoracoscopic access is more accurate for pathological staging, even in a complete pathological response. With a proper patient selection, transhiatal surgery may preserve the quality of lymphadenectomy of the positive lymph nodes.

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Section: Introductionmentioning

confidence: 99%

Transhiatal Esophagectomy Is Not Associated With Poor Quality Lymphadenectomy

Takeda

Tustumi

Nigro

et al. 2019

ABCD, arq. bras. cir. dig.

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“…In short-term survival, inconsistency was found in previous studies [ 11 , 20 – 22 ]. MIE was found associated with lower in-hospital mortality in a Japanese Inpatient Database (1.2% vs. 1.7%, P = 0.048) [ 20 ] and from a meta-analysis (OR = 0.668, 95% CI 0.539–0.827, P < 0.05) [ 11 ].…”

Section: Discussionmentioning

confidence: 83%

“…Another gap in the literature is the lack of consistent short-term mortality rate data after MIE. Several studies concluded that MIE had favorable outcomes of in-hospital mortality [ 11 , 20 ] while other studies suggested a non-significant result [ 21 , 22 ]. It is important to investigate the POAF risk and short-term mortality after MIE.…”

Section: Introductionmentioning

confidence: 99%

The role of surgery type in postoperative atrial fibrillation and in-hospital mortality in esophageal cancer patients with preserved left ventricular ejection fraction

et al. 2020

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Background Postoperative atrial fibrillation (POAF) is one of the most common complications of esophagectomy, which may extend the inpatient hospital stay. Minimally invasive esophagectomy (MIE) has been increasingly used in clinical practice; however, its POAF risk and short-term mortality remain unclear. This study aimed to examine the POAF risk and in-hospital mortality rate between patients receiving MIE and open esophagectomy (OE). Methods Esophageal cancer patients who underwent MIE or OE from a retrospective cohort study were evaluated. A multivariate logistic regression model was built to assess the associations between esophagectomy (MIE vs. OE) and various outcomes (POAF, in-hospital mortality). Covariates included age, sex, body mass index, neoadjuvant therapy, tumor stage, surgery incision type, comorbidities, cardia conditions, peri-operative medication, and complications. Results Of the 484 patients with esophageal cancer, 63 received MIE. A total of 53 patients developed POAF. Compared to patients receiving OE, MIE patients had 81% reduced odds of POAF (adjusted odds ratio [aOR] 0.185, 95% CI 0.039–0.887, P = 0.035). No statistically significant association was found for in-hospital mortality (aOR 0.709, 95% CI 0.114–4.409, P = 0.712). Conclusions MIE is associated with a lower risk of POAF, compared to traditional surgery. No significant short-term survival benefit was found for MIE.

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“…Much has been written concerning the transition from open to laparoscopic transhiatal esophagectomy (THE) with cervical anastomosis. 1–7 Among the benefits of the minimally invasive approach are shorter hospital length of stay, decreased postoperative complications, and lower intraoperative blood loss, while achieving similar oncologic outcomes. 8,9…”

Section: Introductionmentioning

confidence: 99%

Oncologic Resection in Laparoscopic Versus Robotic Transhiatal Esophagectomy

Washington

Watkins

Jay

et al. 2019

JSLS

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Background and Objectives: As the use of robotic surgery continues to increase, little is known about robotic oncologic outcomes compared with traditional methods in esophagectomy. The aim of this study was to examine the perioperative oncologic outcomes of patients undergoing laparoscopic versus robot-assisted transhiatal esophagectomy (THE). Methods: Thirty-six consecutive patients who underwent laparoscopic and robot-assisted THE for malignant disease over a 3-year period were identified in a retrospective database. Eighteen patients underwent robotic-assisted THE with cervical anastomosis, and 18 patients underwent laparoscopic THE. All procedures were performed by a single foregut and thoracic surgeon. Results: Patient demographics were similar between the 2 groups with no significant differences. Lymph node yields for both laparoscopic and robot-assisted THE were similar at 13.9 and 14.3, respectively ( P = .90). Ninety-four percent of each group underwent R0 margins, but only 1 patient from each modality had microscopic positive margins. All of the robot-assisted patients underwent neoadjuvant chemoradiation, whereas 83.3% underwent neoadjuvant therapy in the laparoscopy group ( P = .23). Clinical and pathologic stagings were similar in each group. There was 1 death after laparoscopic surgery in a cirrhotic patient and no mortalities among the robot-assisted THE patients ( P = .99). One patient from each group experienced an anastomotic leak, but neither patient required further intervention. Conclusions: Laparoscopic and robot-assisted THEs yield similar perioperative oncologic results including lymph node yield and margin status. In the transition from laparoscopic surgery, robotic surgery should be considered oncologically noninferior compared with laparoscopy.

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Minimally Invasive Laparoscopic Esophagectomy vs. Transhiatal Open Esophagectomy in Achalasia: A Randomized Study

Cited by 17 publications

References 21 publications

Transhiatal Esophagectomy Is Not Associated With Poor Quality Lymphadenectomy

Transhiatal Esophagectomy Is Not Associated With Poor Quality Lymphadenectomy

The role of surgery type in postoperative atrial fibrillation and in-hospital mortality in esophageal cancer patients with preserved left ventricular ejection fraction

Oncologic Resection in Laparoscopic Versus Robotic Transhiatal Esophagectomy

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