Effectiveness of intervention with a perioperative multidisciplinary support team for radical esophagectomy

Akiyama, Yuji; Iwaya, Takeshi; Endo, Fumitaka; Shioi, Yoshihiro; Kumagai, Miho; Takahara, Taro; Otsuka, Koki; Nitta, Hiroyuki; Koeda, Keisuke; Morita, Masaru; Kimura, Yusuke; Suzuki, Kenji; Sasaki, Akira

doi:10.1007/s00520-017-3801-x

Cited by 20 publications

(16 citation statements)

References 22 publications

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“…The reconstruction conduit was a gastric tube pulled through the posterior mediastinum or the retrosternal route with cervical esophagogastrostomy by hand‐sewn anastomosis . The perioperative management of radical esophagectomy has previously been described . Postoperative complications were defined based on the classification of the Esophagectomy Complications Consensus Group .…”

Section: Methodsmentioning

confidence: 99%

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Safety of thoracoscopic esophagectomy after induction chemotherapy for locally advanced unresectable esophageal squamous cell carcinoma

Akiyama

Iwaya

Endo

et al. 2019

Asian J Endoscop Surgery

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Introduction Recent studies have reported that induction chemotherapy with docetaxel plus cisplatin and 5‐fluorouracil (DCF) is an effective treatment for unresectable, locally advanced esophageal cancer. The aim of this study was to investigate the safety and feasibility of thoracoscopic esophagectomy (TE) after DCF for initially unresectable esophageal squamous cell carcinoma (ESCC). Methods Twenty‐three patients with initially unresectable T4 thoracic ESCC underwent TE after induction DCF. Results The neighboring organs with tumors were the tracheobronchus in nine patients, thoracic aorta in 13, and pericardium and diaphragm in three each (concurrent overlapping invasion occurred in five patients). The mean total operation time was 556.3 ± 107.2 minutes, and the mean time of the thoracic procedure was 258.9 ± 83.9 minutes. The mean total blood loss was 166.2 ± 117.8 mL, and the loss during the thoracic procedure was 33.5 ± 24.6 mL. All patients achieved complete R0 resection under TE. No conversions to open thoracotomy were performed. The postoperative morbidity rate was 34.8%. The postoperative hospital stay was 24.3 (range, 13‐38) days. Five patients had recurrence: four had distant metastasis (lung, two; liver, three; and one with overlap), and one had mediastinal lymph node recurrence. No local recurrence was noted at the site of the primary T4 tumor. Conclusions TE was safely performed in 23 patients after DCF therapy for locally advanced unresectable ESCC. Induction DCF, followed by TE, could be an alternative treatment for unresectable T4 ESCC.

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Section: Methodsmentioning

confidence: 99%

“…19 The perioperative management of radical esophagectomy has previously been described. 20 Postoperative complications were defined based on the classification of the Esophagectomy Complications Consensus Group. 21 The severity of complication was defined following the Clavien-Dindo classification.…”

Section: Treatment Assessmentsmentioning

confidence: 99%

Safety of thoracoscopic esophagectomy after induction chemotherapy for locally advanced unresectable esophageal squamous cell carcinoma

Akiyama

Iwaya

Endo

et al. 2019

Asian J Endoscop Surgery

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“…In the left thoracoabdominal approach using the thoracolaparotomy procedure, a lower esophagectomy and total gastrectomy with a lower mediastinal and abdominal lymphadenectomy and Roux–en–Y jejunal reconstruction were performed. The perioperative management during radical esophagectomy has been described previously [ 28 ]. Postoperative complications were defined based on the classification of the Esophagectomy Complications Consensus Group [ 29 ].…”

Section: Methodsmentioning

confidence: 99%

Outcomes of esophagectomy after chemotherapy with biweekly docetaxel plus cisplatin and fluorouracil for advanced esophageal cancer: a retrospective cohort analysis

et al. 2018

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BackgroundDocetaxel, cisplatin, and 5-fluorouracil (DCF) therapy can cause severe adverse events, including neutropenia and febrile neutropenia. The feasibility of DCF therapy is a concern, particularly for elderly patients, patients with moderate organ disorders, and patients suffering from malnutrition caused by dysphagia or insufficient oral intake. We introduced a biweekly DCF therapy (bDCF) for the purpose of reducing severe adverse events for these fragile patients. This study investigated the feasibility and outcome of an esophagectomy after bDCF therapy for patients with advanced esophageal squamous cell carcinoma.MethodsFifty-nine patients with esophageal carcinoma underwent an esophagectomy after DCF or bDCF therapy as primary chemotherapy. DCF was administered to 37 patients in the DCF group, whereas bDCF was administered to 22 patients in the bDCF group.ResultsPatients in the bDCF group were significantly older than those in the DCF group (p = 0.016). Heart and pulmonary comorbidities were significantly more common in the bDCF than in the DCF group (p < 0.001 and p = 0.039, respectively). Grade 3 or 4 neutropenia was less frequent in the bDCF than in the DCF group (40.9 vs. 81.1%, p = 0.002). Anorexia was more frequent in the DCF group than in the bDCF group (18.9 vs. 0%, p = 0.030). The clinical response rate of the bDCF group was significantly higher than that of the DCF group (86.4 vs. 62.2%, p = 0.047). There was no significant between-group difference in the postoperative morbidity rate (bDCF 45.5% vs. DCF 32.4%) or in the histological therapeutic effect.ConclusionThe results demonstrate that primary bDCF therapy for high-risk patients with advanced esophageal cancer is feasible and safe in both chemotherapeutic and perioperative periods without a reduction in the efficacy of DCF therapy.

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“…The perioperative management of radical esophagectomy has been described previously (21). In brief, patients received rehabilitation before surgery and started an early mobilization with ambulation, respiratory training, and training for chewing and swallowing on postoperative day (POD) 1.…”

Section: Patientsmentioning

confidence: 99%

Evaluation of the need for routine feeding jejunostomy for enteral nutrition after esophagectomy

Akiyama¹,

Iwaya²,

Endo³

et al. 2018

J. Thorac. Dis

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Background: Previous studies have shown that enteral nutrition (EN) helps reduce severe postoperative complications after esophagectomy. However, the incidence of jejunostomy-related complications is approximately 30%. We evaluated the operative outcomes in patients who did not receive EN via feeding jejunostomy after esophagectomy. Methods: We retrospectively reviewed 76 consecutive patients with esophageal cancer who received radical esophagectomy. Operative outcomes were compared between 33 patients who received postoperative EN via feeding jejunostomy (group A; from May 2014 to September 2015) and 43 patients who did not receive EN via feeding jejunostomy (group B; from September 2015 to December 2017). Results: The American Society of Anesthesiologists performance status score of the patients in group B was significantly higher than that of patients in group A (P=0.002). The postoperative morbidity rate was comparable between the two groups (group A, 30.3% vs. group B, 44.2%, P=0.217). No significant betweengroup differences were observed in the incidence of infectious complications, postoperative hospital stay, readmission within 30 days after discharge, or pneumonia after discharge within 6 months. The incidence of bowel obstruction was significantly higher in group A than in group B (group A, 9.1% vs. group B, 0%, P=0.044). Two patients in group B required nutritional support via total parenteral nutrition due to bilateral vocal cord palsy or pneumonia. Conclusions: Jejunostomy-related bowel obstruction in the patients with feeding jejunostomy was significantly higher than that in the patients without jejunostomy. There was no increase in postoperative complications (including pneumonia) in the patients who did not receive EN via feeding jejunostomy. Our results suggest that routine feeding jejunostomy may not be necessary for all patients undergoing esophagectomy.

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Effectiveness of intervention with a perioperative multidisciplinary support team for radical esophagectomy

Abstract: The intervention by a perioperative multidisciplinary support team for radical esophagectomy was effective in preventing the progression and prolongation of pneumonia as well as earlier ambulation, oral feeding, and shortening of postoperative hospitalization.

Cited by 20 publications

References 22 publications

Safety of thoracoscopic esophagectomy after induction chemotherapy for locally advanced unresectable esophageal squamous cell carcinoma

Safety of thoracoscopic esophagectomy after induction chemotherapy for locally advanced unresectable esophageal squamous cell carcinoma

Outcomes of esophagectomy after chemotherapy with biweekly docetaxel plus cisplatin and fluorouracil for advanced esophageal cancer: a retrospective cohort analysis

Evaluation of the need for routine feeding jejunostomy for enteral nutrition after esophagectomy

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