Endoscopic microsurgical dissection of the esophagus

Kipfmüller, K.; Naruhn, M.; Melzer, Andreas; Kessler, S; Bueß, G.

doi:10.1007/bf00590902

Cited by 23 publications

(9 citation statements)

References 11 publications

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“…Minimally invasive oesophagectomy (MIO), first described in 1990s [ 14 – 16 ], has superiority in reducing the risk of postoperative morbidity without compromising oncological outcomes through avoiding thoracotomy and laparotomy [ 4 , 17 – 20 ]. Theoretically, MIO has an advantage over OE in reduction the risk of IHM to a larger extent.…”

Section: Introductionmentioning

confidence: 99%

Superiority of Minimally Invasive Oesophagectomy in Reducing In-Hospital Mortality of Patients with Resectable Oesophageal Cancer: A Meta-Analysis

et al. 2015

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BackgroundCompared with open oesophagectomy (OE), minimally invasive oesophagectomy (MIO) proves to have benefits in reducing the risk of pulmonary complications for patients with resectable oesophageal cancer. However, it is unknown whether MIO has superiority in reducing the occurrence of in-hospital mortality (IHM).ObjectiveThe objective of this meta-analysis was to explore the effect of MIO vs. OE on the occurrence of in-hospital mortality (IHM).Data SourcesSources such as Medline (through December 31, 2014), Embase (through December 31, 2014), Wiley Online Library (through December 31, 2014), and the Cochrane Library (through December 31, 2014) were searched.Study SelectionData of randomized and non-randomized clinical trials related to MIO versus OE were included.InterventionsEligible studies were those that reported patients who underwent MIO procedure. The control group included patients undergoing conventional OE.Study Appraisal and Synthesis MethodsFixed or random -effects models were used to calculate summary odds ratios (ORs) or relative risks (RRs) for quantification of associations. Heterogeneity among studies was evaluated by using Cochran’s Q and I2 statistics.ResultsA total of 48 studies involving 14,311 cases of resectable oesophageal cancer were included in the meta-analysis. Compared to patients undergoing OE, patients undergoing MIO had statistically reduced occurrence of IHM (OR=0.69, 95%CI =0.55 -0.86). Patients undergoing MIO also had significantly reduced incidence of pulmonary complications (PCs) (RR=0.73, 95%CI = 0.63-0.86), pulmonary embolism (PE) (OR=0.71, 95%CI= 0.51-0.99) and arrhythmia (OR=0.79, 95%CI = 0.68-0.92). Non-significant reductions were observed among the included studies in the occurrence of anastomotic leak (AL) (OR=0.93, 95%CI =0.78-1.11), or Gastric Tip Necrosis (GTN) (OR=0.89, 95%CI =0.54-1.49).LimitationMost of the included studies were non-randomized case-control studies, with a diversity of study designs, demographics of participants and surgical intervention.ConclusionsMinimally invasive oesophagectomy (MIO) has superiority over open oesophagectomy (OE) in terms of the occurrence of in-hospital mortality (IHM) and should be the first-choice surgical procedure in esophageal surgery.

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Section: Introductionmentioning

confidence: 99%

Superiority of Minimally Invasive Oesophagectomy in Reducing In-Hospital Mortality of Patients with Resectable Oesophageal Cancer: A Meta-Analysis

et al. 2015

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“…[15]. Three different approaches can be used: either an abdominothoracic approach allowing a large mediastinectomy and a lymph node dissection [10-12], a blunt dissection as described by Orringer 113-141, or an endoscopic transcervical dissection as reported by Buess et a/.…”

Section: Discussionmentioning

confidence: 99%

Case report: Subtotal oesophagectomy by thoracoscopy and laparoscopy

Dallemagne

Weerts

Jehaes

et al. 1992

Minimally Invasive Therapy

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“…Endoscopic microsurgical dissection (by mediastinoscope) of the oesophagus was described in 1989 by Kipfmuller et al using a specially designed mediastinoscope [45]. The mediastinoscope has a tip that works as tissue dilator and is adapted to run along the shape of the oesophagus to facilitate dissection.…”

Section: Endoscopic Microsurgical Dissectionmentioning

confidence: 99%

Minimally invasive oesophageal resection for distal oesophageal cancer: A review of the literature

Scheepers

Mulder

Peet

et al. 2006

Scandinavian Journal of Gastroenterology

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Oesophagus resection is adequate treatment for some benign oesophageal diseases, especially caustic and peptic stenosis and end-stage motility dysfunction. However, the most frequent indications for oesophageal resection are the high-grade dysplasia of Barrett oesophagus and non-metastasized oesophageal cancer. Different procedures have been developed for performing oesophageal resection given the 5-year survival rate of only 18% among patients operated on. A disadvantage of the conventional approach is the high morbidity rate, especially with pulmonary complications. Minimally invasive oesophageal resections, which were first performed in 1991, may reduce this important morbidity and preserve the oncologic outcome. The first reports of morbidity and respiratory complications with this approach were disappointing and it seemed likely that the procedure would have to be abandoned. However, in the past 5 years, Japanese groups and the group of Luketich in Pittsburgh have given these techniques an important impetus. The outcomes of the new series are different from those in the beginning period, and are leading to an enormous expansion worldwide. Important factors behind the change are standardization of the operative technique, the experience of many surgeons with more advanced laparoscopic procedures, important improvements in instruments for dissection and division of tissues, a better technique in use of anaesthesia, and a better selection of patients for operation. Two minimally invasive techniques are being perfected: the three-stage operation by right thoracoscopy and laparoscopy, and the transhiatal laparoscopic approach. The former may be applied successfully for any tumour in the oesophagus, whereas the latter seems ideal for distal oesophageal and oesophagogastric junction tumours. This review article discusses all these aspects, giving special attention to indications and operative technique.

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Endoscopic microsurgical dissection of the esophagus

Cited by 23 publications

References 11 publications

Superiority of Minimally Invasive Oesophagectomy in Reducing In-Hospital Mortality of Patients with Resectable Oesophageal Cancer: A Meta-Analysis

Superiority of Minimally Invasive Oesophagectomy in Reducing In-Hospital Mortality of Patients with Resectable Oesophageal Cancer: A Meta-Analysis

Case report: Subtotal oesophagectomy by thoracoscopy and laparoscopy

Minimally invasive oesophageal resection for distal oesophageal cancer: A review of the literature

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