Does Minimally Invasive Esophagectomy (MIE) Provide for Comparable Oncologic Outcomes to Open Techniques? A Systematic Review

Dantoc, Marc M.; Cox, Michael R.; Eslick, Guy D.

doi:10.1007/s11605-011-1792-3

Cited by 120 publications

(82 citation statements)

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“…Over the last years several meta-analyses have been published comparing conventional open esophagectomy and MIE (7,8,(15)(16)(17)(18)(19)(20). These studies confirm that MIE is feasible and safe and seems to be oncologically equivalent to open technique with regard to radical resection and number of lymph nodes harvested (8,16,18), while long-term survival data of high quality is still lacking. Furthermore, some of these metaanalyses demonstrate a trend to reduced mortality (7) and morbidity (15,(17)(18)(19) for patients who underwent an MIE compared to those who when operated with conventional open esophagectomy.…”

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confidence: 94%

“…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)(8)(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).…”

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

et al. 2017

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“…En cuanto a nuevas técnicas quirúrgicas, el abordaje mini-invasivo ha sido ampliamente desarrollado por numerosos autores, con muy buenos resultados, similares a la esofaguectomía estándar 27,[32][33][34][35] . Los resultados publicados sugieren que: a.…”

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Resultados de la esofaguectomía en 53 pacientes con adenocarcinoma del esófago y Barrett extenso

et al. 2013

Rev Chil Cir

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Results of esophagectomy among patients with esophageal cancer and Barrett esophagusBackground: The incidence of esophageal carcinoma has increased notoriously worldwide. Aim: To assess clinical features, immediate surgical results and long term survival of patients with esophageal carcinoma and Barrett esophagus. Material and Methods: Retrospective review of medical records of all patients operated for esophageal carcinoma, between 1996 y 2011. Results: The records of 53 patients aged 58 ± 9 years (45 males) were analyzed. The number of operated patients increased from 7 in the period 1968-1983 to 31 in the period 2004-2011. Peritoneal metastases were found in two patients, precluding a resection. Video assisted trans-hiatal approach was the most commonly used technique followed by minimally invasive thoracoscopic and laparoscopic surgery. Transit reconstruction was performed ascending the stomach to the neck in 90% of patients. The average length of Barrett esophagus was 7.4 cm and the mean number of excised lymph nodes was 19. Ten patients had an incipient cancer and their five years survival was 80%. The survival of those with tumors involving the muscular layer and those with transmural cancer was 25 and 5%, respectively. Conclusions: There is an increase in the incidence of esophageal cancer in the last 10 years. The survival after surgery is highly dependent on the invasiveness of the tumor.

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“…Sin embargo, los resultados obtenidos en cuanto a porcentaje de pacientes con resección R0 y la recolección de linfonodos han demostrado ser iguales o mejores que la cirugía por abordaje clásico, lo que obviamente tiene directa incidencia en la sobrevida de los pacientes. Recientemente hay excelentes reportes dando cuenta de los resultados en cuanto a sobrevida y la tendencia es aceptar que la cirugía mini-invasiva no compromete los resultados oncológicos [65][66][67][68][69] . Desde el advenimiento de la cirugía mínimamen-te invasiva, la adecuada resección oncológica en comparación a la cirugía abierta ha sido cuestionada en relación a los márgenes de resección, la completa linfadenectomía, la correcta etapificación postoperatoria y la sobrevida a largo plazo 37,39 .…”

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“…Sin embargo, en opinión casi unánime hay estudios pendientes en cuanto a resultados alejados con nuevas modalidades de terapia oncológica combinada para tener resultados definitivos [66][67][68][69][70] .…”

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Resultados De La Cirugía Actual Para El Tratamiento Del Cáncer De Esófago

et al. 2016

Rev Chil Cir

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surgical treatment of esophageal cancer. an updateEsophageal cancer surgery is a challenge despite the advances in surgical techniques and perioperative care. It continues to have high rates of complications and mortality, even in large volume centers. This paper revises the epidemiology, staging and therapeutic options for esophageal cancer, according to its stage and location. It also encompasses the digestive tract reconstruction options, according to our own experience and reports from abroad.Key words: Esophageal cancer, surgery, digestive tract reconstruction. resumenLa cirugía del cáncer de esófago ha sido y sigue siendo un desafío pese a los avances en técnica quirúrgica y cuidados peri operatorios y a pesar de que las complicaciones postoperatorias y la morbimortalidad sigue siendo alta, aún en centros con alto volumen de procedimientos y más aún en centros no dedicados a la atención de estos pacientes. En este artículo se revisarán algunos aspectos epidemiológicos, las herramientas diagnósticas actuales, su etapificación, y las opciones terapéuticas de acuerdo al estadío, sea en etapas precoces o avanzadas, la localización y tipo de tumor, opciones de reconstrucción del tránsito digestivo en base a lo reportado en la literatura internacional, la experiencia nacional y en base a nuestros propios resultados en

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Does Minimally Invasive Esophagectomy (MIE) Provide for Comparable Oncologic Outcomes to Open Techniques? A Systematic Review

Abstract: The evidence of this study suggests that MIE is equivalent to standard open esophagectomy in achieving similar oncological outcomes. Further randomised controlled trials are required to provide for a higher level of evidence.

Cited by 120 publications

References 36 publications

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

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

Resultados de la esofaguectomía en 53 pacientes con adenocarcinoma del esófago y Barrett extenso

Resultados De La Cirugía Actual Para El Tratamiento Del Cáncer De Esófago

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