Decreasing morbidity and mortality in 100 consecutive minimally invasive esophagectomies

Ben-David, Kfır; Sarosi, George A.; Cendán, Juan; Howard, Drew; Rossidis, Georgios; Hochwald, Steven N.

doi:10.1007/s00464-011-1846-3

Cited by 81 publications

(55 citation statements)

References 37 publications

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“…The average LOS for MIE was reported to be 19 days (standard deviation =8 days). In contrast, others including our group have reported a median LOS of 7-8 days (14,15). The authors reported that the rates of major and minor complications were 6.7% and 32.5%, respectively, which is consistent with our own experience (14).…”

supporting

confidence: 55%

Contemporary issues in endoscopic resection for esophageal squamous cell cancer

Gabriel

Hochwald

2017

Ann. Transl. Med.

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supporting

confidence: 55%

Contemporary issues in endoscopic resection for esophageal squamous cell cancer

Gabriel

Hochwald

2017

Ann. Transl. Med.

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“…Furthermore, patients suffering from esophageal cancer are often elderly with significant comorbidities, which increases the postoperative risks after such a procedure (4). Although, the postoperative mortality after esophagectomy has significantly decreased in high-volume centers over the Original Article Implementation of minimally invasive esophagectomy in a tertiary referral center for esophageal cancer years, high morbidity rates are still recorded (5,6). In an effort to reduce the postoperative morbidity associated with open esophagectomy various minimally invasive esophagectomy (MIE) techniques have been introduced and developed during the recent years.…”

Section: Introductionmentioning

confidence: 99%

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Implementation of minimally invasive esophagectomy in a tertiary referral center for esophageal cancer

et al. 2017

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years, high morbidity rates are still recorded (5,6). In an effort to reduce the postoperative morbidity associated with open esophagectomy various minimally invasive esophagectomy (MIE) techniques have been introduced and developed during the recent years. MIE is believed to minimize the surgical trauma and subsequently the postoperative pain resulting in a faster mobilization and recovery with reduced postoperative complication rates and shorter hospital stay compared to the open procedure. During the last 20 years several studies have been published within the field demonstrating that MIE is a safe technique with an oncological outcome at least equal to open esophagectomy with regard to complete resection rate, number of lymph nodes harvested and postoperative survival (7-9). Moreover, there is an indication of shortterm benefits after MIE especially with regards to reduced pulmonary complications and improved health related quality of life compared to the open procedure (10,11).The aim of the current study was to present our 4.5-year experience of the gradual implementation of various MIE techniques in our tertiary referral center with special focus on the evolution of adaptive changes and refinements of our practice of the procedure over this period. Methods Our unitCenter of digestive diseases (CDD) at Karolinska University Hospital, Stockholm is one of the largest and most highly specialized centers in the Nordic countries. It is a tertiary referral center in Stockholm County with a catchment area of approximately 2,500,000 inhabitants. Furthermore, CDD receives referrals for patients with newly diagnosed esophageal and cardia cancer from neighboring counties with an additional population of 650,000. This results in an annual case volume of 40-60 esophageal and resections in the most recent years.The Unit engages three consultant surgeons (MN, ML, IR), with long laparoscopic experience within benign upper gastrointestinal (UGI) surgery as well as long previous experience in open esophageal cancer surgery. Karolinska, Stockholm. From 2009, one of the current consultant surgeons, IR, spent 3 years in a fellowship in UGI cancer surgery at Bristol Royal Infirmary, Bristol, UK with special focus in MIE. During these years he became confident in both the hybrid laparoscopic assisted esophagectomy (HLAE) technique including laparoscopic gastric mobilization and abdominal lymph node dissection followed by thoracotomy and intrathoracic anastomosis as well as with the minimal invasive McKeown (MIMK) technique, i.e., thoracolaparoscopy followed by cervical anastomosis by performing more than 70 cases. In the meantime, two other consultant surgeons (MN & ML) had the chance to visit another center with extensive In May 2012 and as a first test of transition to MIE, the first HLAE was performed safely with all consultants present. This was followed shortly by an additional procedure with satisfactory results and without any technical problems to be encountered. HLAE was chosen as the most feasible MIE in the beginning...

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“…Esophagectomy and esophageal reconstruction is a complex invasive procedure with high morbidity (40%) and mortality (5-10%) rates (1,2). According to previous studies, the presence of comorbidities such as old age, hypertension, diabetes, smoking status, congestive heart failure, coronary artery disease, poor preoperative pulmonary function, and high preoperative serum creatinine level worsens the clinical outcomes including anastomotic leakage, pulmonary complications, and overall survival (2-7).…”

Section: Introductionmentioning

confidence: 99%

A non-randomized retrospective observational study on the subcutaneous esophageal reconstruction after esophagectomy: is it feasible in high-risk patients?

Chung

Lee

et al. 2017

J. Thorac. Dis.

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Background: Esophageal reconstruction after esophagectomy is a complex procedure with high morbidity and mortality. Anastomotic leakage is more severe and frequent in patients with preoperative comorbidities and may present with septic conditions. Considering the possibility of an easier management of such cases, we evaluated the safety and feasibility of subcutaneous esophageal reconstruction in patients with high operative risks. Results: The mean postoperative hospital stay was longer in the subcutaneous group than the overall group. Anastomotic leakage occurred more frequently in the subcutaneous group [10 (47.6%) vs. 7 (13%), P=0.004]. Three major leakages resulted in chronic cutaneous fistula, but were successfully treated by lower neck reconstruction using radial forearm fasciocutaneous free flap (RFFF). There was no in-hospital mortality in the subcutaneous group.Conclusions: Subcutaneous esophageal reconstruction in high-risk patients showed a higher rate of anastomotic leakage. However, easier correction without fatal septic conditions could be obtained by primary repair or flap reconstruction resulting in lower perioperative mortality. Therefore, esophageal reconstruction through the subcutaneous route is not recommended as a routine primary option. However, in highly selected patients with unfavorable preoperative comorbidities or intraoperative findings, especially those with poor blood supply to the graft, graft hematoma or edema, or gross tumor invasion to surrounding tissues, esophageal reconstruction through the subcutaneous route may carefully be considered as an alternative to the conventional surgical techniques.

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Decreasing morbidity and mortality in 100 consecutive minimally invasive esophagectomies

Abstract: Our results support the continued safe use of esophagectomy for selected esophageal diseases, including malignancy. Morbidity, especially wound infection, anastomotic leak, and length of stay is decreasing with the incorporation of minimally invasive techniques.

Cited by 81 publications

References 37 publications

Contemporary issues in endoscopic resection for esophageal squamous cell cancer

Contemporary issues in endoscopic resection for esophageal squamous cell cancer

Implementation of minimally invasive esophagectomy in a tertiary referral center for esophageal cancer

A non-randomized retrospective observational study on the subcutaneous esophageal reconstruction after esophagectomy: is it feasible in high-risk patients?

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