Esophagectomy—prevention of complications-tips and tricks for the preoperative, intraoperative and postoperative stage

Romario, Uberto Fumagalli; Pascale, Stefano De

doi:10.1007/s13304-022-01332-3

Cited by 5 publications

(4 citation statements)

References 102 publications

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“…Physical therapy and rehabilitation are integral for restoring function and quality of life post-esophagectomy. Finally, rehabilitation programs focusing on respiratory exercises and mobility aid in avoiding muscle wasting, thus regaining strength and independence [46]. We categorized postoperative complications according to the Clavien-Dindo classification, defining SPCs as those with a grade ≥3.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Impact of Severe Postoperative Complications after Esophagectomy for Cancer: Individual Patient Data Meta-Analysis

Bona,

Manara,

Bonitta

et al. 2024

Cancers

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Background. Severe postoperative complications (SPCs) may occur after curative esophagectomy for cancer and are associated with prolonged hospital stay, augmented costs, and increased in-hospital mortality. However, the effect of SPCs on survival after esophagectomy is uncertain. Aim. To assess the impact of severe postoperative complications (SPCs) on long-term survival following curative esophagectomy for cancer, we conducted a systematic search of PubMed, MEDLINE, Scopus, and Web of Science databases up to December 2023. The included studies examined the relationship between SPCs and survival outcomes, defining SPCs as Clavien–Dindo grade > 3. The primary outcome measure was long-term overall survival (OS). We used restricted mean survival time difference (RMSTD) and 95% confidence intervals (CIs) to calculate pooled effect sizes. Additionally, we applied the GRADE methodology to evaluate the certainty of the evidence. Results. Ten studies (2181 patients) were included. SPCs were reported in 651 (29.8%) patients. The RMSTD overall survival analysis shows that at 60-month follow-up, patients experiencing SPCs lived for 8.6 months (95% Cis −12.5, −4.7; p < 0.001) less, on average, compared with no-SPC patients. No differences were found for 60-month follow-up disease-free survival (−4.6 months, 95% CIs −11.9, 1.9; p = 0.17) and cancer-specific survival (−6.8 months, 95% CIs −11.9, 1.7; p = 0.21). The GRADE certainty of this evidence ranged from low to very low. Conclusions. This study suggests a statistically significant detrimental effect of SPCs on OS in patients undergoing curative esophagectomy for cancer. Also, a clinical trend toward reduced CSS and DFS was perceived.

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Section: Discussionmentioning

confidence: 99%

Long-Term Impact of Severe Postoperative Complications after Esophagectomy for Cancer: Individual Patient Data Meta-Analysis

Bona,

Manara,

Bonitta

et al. 2024

Cancers

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“…A previous report indicated that a substantial portion (56.7%) of patients experience multiple complications ( 21 ). To minimize postoperative morbidity, it is crucial to identify patients at risk for complications early and perform individualized postoperative arrangements ( 22 ). However, there is a scarcity of studies that have investigated the implementation and impact of individual stratification in guiding postoperative triage and care.…”

Section: Discussionmentioning

confidence: 99%

An esophagectomy surgical Apgar score-based nomogram—a risk-based postoperative triage system: a phase II randomised trial

Chen,

Xi,

Lin

et al. 2024

J Thorac Dis

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Background The esophagectomy surgical Apgar score (eSAS) has been found to be a predictor of postoperative complications in esophagectomy. In our previous study, we built a graphic nomogram based on eSAS and demonstrated that it can effectively predict the risk of major morbidity after esophagectomy. In this study, we aimed to assess the benefits of using an eSAS-based nomogram model as a postoperative risk-based triage system for patients undergoing esophagectomy. Methods We enrolled 119 patients diagnosed with esophageal carcinoma and randomly assigned them to a nomogram group (NG) or control group (CG) from January 2019 to December 2020. Patients in the NG were assigned to a low-risk group and high-risk group based on the nomogram. Patients in the high-risk group were admitted to the intensive care unit (ICU) after esophagectomy. Risk estimation in the CG patients was based on the surgeon’s clinical experience. Thirty-day major complications, postoperative hospital stay, hospital costs, and quality of life (QOL) during the follow-up were compared between the two groups. Results Baseline clinicopathological characteristics were comparable between the NG (n=58) and CG (n=61). All patients underwent esophagectomy. Postoperative complications were significantly higher in the CG (30, 49.2%) than in the NG (14, 24.1%) (P=0.008), with pneumonia being the most common (CG: 23, 37.7%; NG: 12, 20.7%; P=0.042). There was no significant difference in anastomotic leakage (NG: 1, 1.7%; CG: 6, 9.8%; P=0.12). Postoperative median hospital stay was shorter in the NG (14 days) than in the CG (16 days) (P=0.041). Hospital costs (NG: ¥60,045.1; CG: ¥63,961.5; P=0.21) and postoperative QOL did not differ significantly between groups. Conclusions An eSAS-based nomogram as a triage system can reduce the overall occurrence of postoperative complications and shorten postoperative hospital stay without increasing hospital costs. Trial Registration Chinese Clinical Trial Registry ChiCTR1900021636.

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“…The conservative approach attempted, in this case, has never been described in the literature to our knowledge. The underpinning rationale was to resolve the patient's symptoms with partial resection of the benign tumor, avoiding an esophagectomy, which carries a risk of any postoperative adverse event of 63.9 % [ 10 ], anastomotic leak of 11.4 % [ 11 ], and death of 3.3 % [ 10 ]. This conservative approach is more tolerable although it is probably associated with a higher relapsing rate.…”

Section: Discussionmentioning

confidence: 99%

A case report of esophageal leiomyoma in Alport's syndrome treated with robotic-assisted distal myotomy: A surgical technique to avoid esophagectomy

Takeda

Júnior

Sallum

2023

International Journal of Surgery Case Reports

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Esophagectomy—prevention of complications-tips and tricks for the preoperative, intraoperative and postoperative stage

Cited by 5 publications

References 102 publications

Long-Term Impact of Severe Postoperative Complications after Esophagectomy for Cancer: Individual Patient Data Meta-Analysis

Long-Term Impact of Severe Postoperative Complications after Esophagectomy for Cancer: Individual Patient Data Meta-Analysis

An esophagectomy surgical Apgar score-based nomogram—a risk-based postoperative triage system: a phase II randomised trial

A case report of esophageal leiomyoma in Alport's syndrome treated with robotic-assisted distal myotomy: A surgical technique to avoid esophagectomy

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