Clinical outcomes of video-assisted thoracoscopic surgery esophagectomy for esophageal cancer: a propensity score-matched analysis

Moon, Deok‐Bog; Lee, Jong Mog; Jeon, Jae Hyun; Yang, Hee Chul; Kim, Moon Soo

doi:10.21037/jtd.2017.08.71

Cited by 24 publications

(14 citation statements)

References 18 publications

(25 reference statements)

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“…Moon et al observed a longer operating time when performing thoracoscopical esophagectomy compared to a classical approach, but significantly less respiratory complications (9.5% vs. 40.5%, P=0.004) (ref. 22 ). Growing experience with minimally invasive esophagectomy has been associated with a decrease in postoperative respiratory complications [23][24][25] .…”

Section: Discussionmentioning

confidence: 99%

Complications of the surgical treatment of esophageal cancer and microbiological analysis of the respiratory tract

Vrba¹,

Neoral²,

Vomáčková³

et al. 2020

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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The aim of this study was to reduce the severe respiratory complications of esophageal cancer surgery often leading to death. Methods. Two groups of patients operated on for esophageal cancer were evaluated in this retrospective analysis. The first group was operated between 2006-2011, prior to the implementation of preoperative microbiological examination while the second group had surgery between 2012-2017 after implementation of this examination. Results. In total, 260 patients, 220 males and 40 females underwent esophagectomy. Between 2006-2011, 113 (87.6%) males and 16 (12.4%) females and between 2012-2017, esophagectomy was performed in 107 (81.7%) males and 24 (18.3%) females. In the first cohort, 10 patients died due to respiratory complications. The 30-day mortality was 6.9% and 90-day was 9.3%. In the second cohort, 4 patients died from respiratory complications. The 30-day mortality was 1.5% and 90-day mortality was 3.1%. With regard to the incidence of respiratory complications (P=0.014), these occurred more frequently in patients with sputum collection, however, severe respiratory complications were more often observed in patients without sputum collection. Significantly fewer patients died (P=0.036) in the group with sputum collection. The incidence of respiratory complications was very significantly higher in the patients who died (P<0.0001). Conclusion. The incidence of severe respiratory complications (causing death) may be reduced by identifying clinically silent respiratory tract infections.

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Section: Discussionmentioning

confidence: 99%

Complications of the surgical treatment of esophageal cancer and microbiological analysis of the respiratory tract

Vrba¹,

Neoral²,

Vomáčková³

et al. 2020

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…(42,43). The overall pulmonary complications are described to be as high as 40.5% for OE compared to 9.5% for MIE (p=0.004) in some studies (44). Especially pneumonia has a signi cant negative impact on survival (p = 0.035) with a multivariate HR of 1.456 (([CI]: [1.020; 2.079]) p= 0.039).…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Versus open AbdominoThoracic Esophagectomy for esophageal carcinoma (MIVATE) - study protocol for a randomized controlled trial DRKS00016773

Nickel

Probst

Studier-Fischer

et al. 2020

Preprint

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Background:The only curative treatment for most esophageal cancers is radical esophagectomy. Minimally invasive esophagectomy (MIE) aims to reduce postoperative morbidity, but is not yet widely established. Linear stapled anastomosis is a promising technique for MIE because it is quite feasible even without robotic assistance. Aim of the present study is to compare total MIE with linear stapled anastomosis to open esophagectomy (OE) with circular stapled anastomosis with special regard to postoperative morbidity in an expertise-based randomized controlled trial (RCT).Methods/design:This superiority RCT compares MIE with linear stapled anastomosis (intervention) to OE with circular stapled anastomosis (control) for Ivor-Lewis esophagectomy. It was initiated in February 2019 and recruitment is expected to last for 3 years. For inclusion, patients must be 18 years of age or more with a resectable primary malignancy in the distal esophagus. Participants with tumor localizations above the azygos vein, metastasis or infiltration into adjacent tissue will be excluded. In an expertise-based approach the allocated treatment will only be carried out by the single most experienced surgeon of the surgical center for each respective technique. The sample size was calculated with 20 participants per group for the primary endpoint postoperative morbidity according to comprehensive complication index (CCI) within 30 postoperative days. Secondary endpoints include anastomotic insufficiency, pulmonary complications, other intra- and postoperative outcome parameters such as estimated blood loss, operative time, length of stay, short-term oncologic endpoints, adherence to a standardized fast-track protocol, postoperative pain, and postoperative recovery (QoR-15). Quality of life (SF-36, CAT EORTC QLQ-C30, CAT EORTC QLQ-OES18) and oncological outcomes are evaluated with 60 months follow-up.Discussion:MIVATE is the first RCT to compare OE with circular stapled anastomosis to total MIE with linear stapled anastomosis exclusively for intrathoracic anastomosis. The expertise-based approach limits bias due to heterogeneity of surgical expertise. The use of a dedicated fast-track protocol in both OE and MIE will shed light on the role of the access strategy alone in this setting. The findings of this study will serve to define which approach has the best perioperative outcome for patients requiring esophagectomy.Trial registration: German Clinical Trials Register DRKS00016773. Registered on February 18th, 2019.

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“…The primary analysis will test the following hypotheses: (42,43). The overall pulmonary complications are described to be as high as 40.5% for OE compared to 9.5% for MIE (p = 0.004) in some studies (44). Especially pneumonia has a signi cant negative impact on survival (p = 0.035) with a multivariate HR of 1.456 (([CI]: [1.020; 2.079]) p= 0.039).…”

Section: Data Managementmentioning

confidence: 99%

Minimally Invasive Versus open AbdominoThoracic Esophagectomy (MIVATE) - study protocol for a randomized controlled trial DRKS00016773

Nickel¹,

Probst²,

Studier-Fischer³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The only curative treatment for most esophageal cancers is radical esophagectomy. Minimally invasive esophagectomy (MIE) aims to reduce postoperative morbidity, but is not yet widely established. Linear stapled anastomosis is a promising technique for MIE because it is quite feasible even without robotic assistance. Aim of the present study is to compare total MIE with linear stapled anastomosis to open esophagectomy (OE) with circular stapled anastomosis with special regard to postoperative morbidity in an expertise-based randomized controlled trial (RCT). Methods/design: This superiority RCT compares MIE with linear stapled anastomosis (intervention) to OE with circular stapled anastomosis (control) for Ivor-Lewis esophagectomy. It was initiated in February 2019 and recruitment is expected to last for 3 years. For inclusion, patients must be 18 years of age or more with a resectable primary malignancy in the distal esophagus. Participants with tumor localizations above the azygos vein, metastasis or infiltration into adjacent tissue will be excluded. In an expertise-based approach the allocated treatment will only be carried out by the single most experienced surgeon of the surgical center for each respective technique. The sample size was calculated with 20 participants per group for the primary endpoint postoperative morbidity according to comprehensive complication index (CCI) within 30 postoperative days. Secondary endpoints include anastomotic insufficiency, pulmonary complications, other intra- and postoperative outcome parameters such as estimated blood loss, operative time, length of stay, short-term oncologic endpoints, adherence to a standardized fast-track protocol, postoperative pain, and postoperative recovery (QoR-15). Quality of life (SF-36, CAT EORTC QLQ-C30, CAT EORTC QLQ-OES18) and oncological outcomes are evaluated with 60 months follow-up. Discussion: MIVATE is the first RCT to compare OE with circular stapled anastomosis to total MIE with linear stapled anastomosis exclusively for intrathoracic anastomosis. The expertise-based approach limits bias due to heterogeneity of surgical expertise. The use of a dedicated fast-track protocol in both OE and MIE will shed light on the role of the access strategy alone in this setting. The findings of this study will serve to define which approach has the best perioperative outcome for patients requiring esophagectomy. Trial registration: German Clinical Trials Register DRKS00016773. Registered on February 18th, 2019.

show abstract

Clinical outcomes of video-assisted thoracoscopic surgery esophagectomy for esophageal cancer: a propensity score-matched analysis

Cited by 24 publications

References 18 publications

Complications of the surgical treatment of esophageal cancer and microbiological analysis of the respiratory tract

Complications of the surgical treatment of esophageal cancer and microbiological analysis of the respiratory tract

Minimally Invasive Versus open AbdominoThoracic Esophagectomy for esophageal carcinoma (MIVATE) - study protocol for a randomized controlled trial DRKS00016773

Minimally Invasive Versus open AbdominoThoracic Esophagectomy (MIVATE) - study protocol for a randomized controlled trial DRKS00016773

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