Early Oral Feeding Following McKeown Minimally Invasive Esophagectomy

Sun, Hai; Li, Yin; Liu, Xian Ben; Zhang, Rui Xiang; Wang, Zong Fei; Lerut, Toni; Liu, Chia Chuan; Fiorelli, Alfonso; Chao, Yin‐Kai; Molena, Daniela; Cerfolio, Robert J.; Ozawa, Soji; Chang, Andrew C.

doi:10.1097/sla.0000000000002304

Cited by 114 publications

(54 citation statements)

References 20 publications

(22 reference statements)

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“…Of note, the perioperative mortality rate in other studies from East Asia was also no higher than 2%. 18 - 20 In this study, the OS (67.2% for 3-year OS) in group CRT is in line with the prognosis (68.3%) of the squamous cell carcinoma subgroup receiving NCRT in the ChemoRadiotherapy for Esophageal Cancer Followed by Surgery Study (CROSS). 11 Taken together, these results suggest that the difference in OS should not be ascribed to the poor outcomes in group S, but can be attributed to effective NCRT, followed by surgery.…”

Section: Discussionsupporting

confidence: 68%

Neoadjuvant Chemoradiotherapy Followed by Surgery Versus Surgery Alone for Locally Advanced Squamous Cell Carcinoma of the Esophagus (NEOCRTEC5010): A Phase III Multicenter, Randomized, Open-Label Clinical Trial

Yang¹,

Liu²,

Chen³

et al. 2018

JCO

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635

673

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PurposeThe efficacy of neoadjuvant chemoradiotherapy (NCRT) plus surgery for locally advanced esophageal squamous cell carcinoma (ESCC) remains controversial. In this trial, we compared the survival and safety of NCRT plus surgery with surgery alone in patients with locally advanced ESCC.Patients and MethodsFrom June 2007 to December 2014, 451 patients with potentially resectable thoracic ESCC, clinically staged as T1-4N1M0/T4N0M0, were randomly allocated to NCRT plus surgery (group CRT; n = 224) and surgery alone (group S; n = 227). In group CRT, patients received vinorelbine 25 mg/m2 intravenously (IV) on days 1 and 8 and cisplatin 75 mg/m2 IV day 1, or 25 mg/m2 IV on days 1 to 4 every 3 weeks for two cycles, with a total concurrent radiation dose of 40.0 Gy administered in 20 fractions of 2.0 Gy on 5 days per week. In both groups, patients underwent McKeown or Ivor Lewis esophagectomy. The primary end point was overall survival.ResultsThe pathologic complete response rate was 43.2% in group CRT. Compared with group S, group CRT had a higher R0 resection rate (98.4% v 91.2%; P = .002), a better median overall survival (100.1 months v 66.5 months; hazard ratio, 0.71; 95% CI, 0.53 to 0.96; P = .025), and a prolonged disease-free survival (100.1 months v 41.7 months; hazard ratio, 0.58; 95% CI, 0.43 to 0.78; P < .001). Leukopenia (48.9%) and neutropenia (45.7%) were the most common grade 3 or 4 adverse events during chemoradiotherapy. Incidences of postoperative complications were similar between groups, with the exception of arrhythmia (group CRT: 13% v group S: 4.0%; P = .001). Peritreatment mortality was 2.2% in group CRT versus 0.4% in group S (P = .212).ConclusionThis trial shows that NCRT plus surgery improves survival over surgery alone among patients with locally advanced ESCC, with acceptable and manageable adverse events.

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Section: Discussionsupporting

confidence: 68%

Neoadjuvant Chemoradiotherapy Followed by Surgery Versus Surgery Alone for Locally Advanced Squamous Cell Carcinoma of the Esophagus (NEOCRTEC5010): A Phase III Multicenter, Randomized, Open-Label Clinical Trial

Yang¹,

Liu²,

Chen³

et al. 2018

JCO

Self Cite

635

673

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“…Investigating early oral feeding instead of feeding by tube, Zhang et al obtained good results with no increased rate of anastomotic leakage (43). Also Sun et al compared early oral feeding (1 postoperative day, POD) versus late oral feeding (7 POD) and obtained satisfactory results with no increased morbidity but higher quality of life (44).…”

Section: Postoperative Carementioning

confidence: 99%

Enhanced recovery after surgery (ERAS) programs for esophagectomy

Rubinkiewicz¹,

Witowski²,

Su³

et al. 2019

J. Thorac. Dis

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A perioperative treatment protocol, enhanced recovery after surgery (ERAS) focuses on accelerating patient recovery. Previous studies confirmed that ERAS decreases surgical trauma and the stress response, which improved outcomes including reduced length of hospital stay (LOS) and decreased postoperative morbidity. While ERAS protocols have been successfully implemented in a variety of surgical disciplines (colorectal, bariatric, orthopedic, and gynecologic surgery), its use in esophageal surgery is still limited. This paper analyzes the feasibility and value of the ERAS protocol for esophageal surgery. Reviewing the literature found that implementation of ERAS resulted in decreased costs, length of stay and pulmonary specific complication reduction, but not overall morbidity. The evidence lacks randomized control trials. Further, the ERAS Society published recommendations for esophageal resection. This opportunity for unification of the protocol would make the studies more comparable and leads to stronger conclusions. Surgery specific items also require further confirmation. Nonetheless, the successful introduction of the ERAS protocol into a wide variety of surgical disciplines provides optimism for ERAS's effectiveness in esophageal surgery.

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“…[4] Focusing on the quality of life (QOL), financial savings and fast recovery, we have previously evaluated a “no tube, no-fasting” fast-track surgery program for resectable EC. [5] The key points in this program were as follows:…”

Section: Introductionmentioning

confidence: 99%

“…[9] However, because of the high morbidity rate of esophagectomy, few studies have focused on the fast-track management of chest tubes. As one of the most important parts of the “no tube, no fasting” fast-track program, [5] the present study attempted to reduce the number of chest drainages and find the best location for the chest drainage.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of a single mediastinal drain through the abdominal wall after esophagectomy

Zheng

Liu

et al. 2018

Medicine

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This study evaluated the safety and effectiveness of a single mediastinal drainage tube in the thoracic and abdominal cavity after minimally invasive esophagectomy (MIE). This study was undertaken to determine if the procedure could be included in a fast-track surgery program for resectable esophageal carcinoma (EC).From June 17 to November 30, 2015, clinical data for 78 eligible patients who had undergone a fast-track surgery program and MIE were retrospectively analyzed. Twenty-eight patients had a chest tube and mediastinal drainage tube. Thirty-four patients had only a mediastinal drainage tube through the intercostal space. The remaining 30 patients had a single mediastinal drainage tube in the thoracic and abdominal cavity through the abdominal wall. The complication rates and pain scores for each of the groups were compared. The statistical calculations were performed using SPSS 17.0 for Windows (SPSS Inc., Chicago, IL). The quantitative data among the groups were compared using 1-way analysis of variance (ANOVA). The Chi-square, Mann–Whitney U and Fisher exact tests were used for qualitative data analysis.There were no significant differences in the anastomotic leak rates, postoperative days and total complication rates (P = .861). The lowest visual analog scale (VAS) scores of the drainage tubes were observed in the group with a single mediastinal drain through the abdominal wall (P <.001).The results of this study suggested that a single mediastinal drainage tube in the thoracic and abdominal cavity after MIE may be safe and efficient. This clinical practice is a part of our fast-track surgery program.

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Early Oral Feeding Following McKeown Minimally Invasive Esophagectomy

Abstract: In patients after McKeown minimally invasive esophagectomy is noninferior to the standard of care with regard to postoperative CRG complications. In addition, patients in the EOF group had a quicker recovery of bowel function and improved short-term QOL.

Cited by 114 publications

References 20 publications

Neoadjuvant Chemoradiotherapy Followed by Surgery Versus Surgery Alone for Locally Advanced Squamous Cell Carcinoma of the Esophagus (NEOCRTEC5010): A Phase III Multicenter, Randomized, Open-Label Clinical Trial

Neoadjuvant Chemoradiotherapy Followed by Surgery Versus Surgery Alone for Locally Advanced Squamous Cell Carcinoma of the Esophagus (NEOCRTEC5010): A Phase III Multicenter, Randomized, Open-Label Clinical Trial

Enhanced recovery after surgery (ERAS) programs for esophagectomy

Feasibility of a single mediastinal drain through the abdominal wall after esophagectomy

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