Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer

Mariette, C.; Markar, Sheraz R.; Dabakuyo‐Yonli, Tienhan Sandrine; Meunier, Brigitte; Pezet, Denis; Collet, Denis; D’Journo, Xavier Benoît; Brigand, Cécile; Perniceni, Thierry; Carrère, Nicolas; Mabrut, Jean‐Yves; Msika, Simon; Peschaud, Frédérique; Prudhomme, Michel; Bonnetain, Franck; Piessen, Guillaume

doi:10.1056/nejmoa1805101

Cited by 549 publications

(457 citation statements)

References 26 publications

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“…Attrition during neoadjuvant therapy was significant compared with that in clinical trials, but similar to that of previous consecutive cohort data. Although three RCTs have reported reduced pulmonary morbidity with minimally invasive approaches, all patients in the present study underwent open surgery, so the implications for minimally invasive oesophagectomy are unclear. However, the present data provide a useful framework for further research in this context.…”

Section: Discussionsupporting

confidence: 84%

“…A transhiatal approach has been suggested for patients with significant pulmonary co‐morbidity, owing to a reduced incidence of postoperative pulmonary complications and because the need for single‐lung ventilation in obviated, and the present data may inform such discussions. However, minimally invasive approaches may produce similar benefits for patients with significant baseline pulmonary co‐morbidity, while producing favourable oncological outcomes even compared with open transthoracic resection.…”

Section: Discussionmentioning

confidence: 99%

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Effect of neoadjuvant chemoradiation on preoperative pulmonary physiology, postoperative respiratory complications and quality of life in patients with oesophageal cancer

Elliott

O’Byrne

Foley

et al. 2019

British Journal of Surgery

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Background It remains controversial whether neoadjuvant chemoradiation (nCRT) for oesophageal cancer influences operative morbidity, in particular pulmonary, and quality of life. This study combined clinical outcome data with systematic evaluation of pulmonary physiology to determine the impact of nCRT on pulmonary physiology and clinical outcomes in locally advanced oesophageal cancer. Methods Consecutive patients treated between 2010 and 2016 were included. Three‐dimensional conformal radiation was standard, with a lung dose–volume histogram of V20 less than 25 per cent, and total radiation between 40 and 41·4 Gy. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) were assessed at baseline and 1 month after nCRT. Radiation‐induced lung injury (grade 2 or greater), comprehensive complications index (CCI) and pulmonary complications were monitored prospectively. Health‐related quality of life was assessed among disease‐free patients in survivorship. Results Some 228 patients were studied. Comparing pulmonary physiology values before with those after nCRT, FEV1 decreased from mean(s.d.) 96·8(17·7) to 91·5(20·4) per cent (–3·6(10·6) per cent; P < 0·001), FVC from 104·9(15·6) to 98·1(19·8) per cent (–3·2(11·9) per cent; P = 0·005) and DLCO from 97·6(20·7) to 82·2(20·4) per cent (–14·8(14·0) per cent; P < 0·001). Five patients (2·2 per cent) developed radiation‐induced lung injury precluding surgical resection. Smoking (P = 0·005) and increased age (P < 0·001) independently predicted percentage change in DLCO. Carboplatin and paclitaxel with 41·4 Gy resulted in a greater DLCO decline than cisplatin and 5‐fluorouracil with 40 Gy (P = 0·001). On multivariable analysis, post‐treatment DLCO predicted CCI (P = 0·006), respiratory failure (P = 0·020) and reduced physical function in survivorship (P = 0·047). Conclusion These data indicate that modern nCRT alters pulmonary physiology, in particular diffusion capacity, which is linked to short‐ and longer‐term clinical consequences, highlighting a potentially modifiable index of risk.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Effect of neoadjuvant chemoradiation on preoperative pulmonary physiology, postoperative respiratory complications and quality of life in patients with oesophageal cancer

Elliott

O’Byrne

Foley

et al. 2019

British Journal of Surgery

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“…A total of 24 studies with 7117 patients were involved in the analysis of all‐cause RCs. Figure a shows that the patients who underwent MIE experienced less postoperative RCs as compared to those who underwent OE (OR = 0.56; 95% CI = 0.41, 0.78; P = <0.001).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 22 studies with 6925 patients were included in the analysis of all‐cause AL, which showed low level of heterogeneity ( P = 0.08, I 2 = 32%) and no statistical difference between MIE versus OE (OR = 1.08; 95% CI = 0.92, 1.26; P = 0.35) (Figs b, S2c). Data for all‐cause CCs was reported in 13 studies with 2302 patients and showed neither heterogeneity ( P = 0.99, I 2 = 0%), nor statistically significant difference between MIE or OE (OR = 0.97; 95% CI = 0.74, 1.26; P = 0.81) (Figs a, S2d).…”

Section: Resultsmentioning

confidence: 99%

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Postoperative short‐term outcomes of minimally invasive versus open esophagectomy for patients with esophageal cancer: An updated systematic review and meta‐analysis

et al. 2020

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Background: We performed a systematic review and meta-analysis to synthesize the available evidence regarding short-term outcomes between minimally invasive esophagectomy (MIE) and open esophagectomy (OE). Methods: Studies were identified by searching databases including PubMed, EMBASE, Web of Science and Cochrane Library up to March 2019 without language restrictions. Results of these searches were filtered according to a set of eligibility criteria and analyzed in line with PRISMA guidelines. Results: There were 33 studies included with a total of 13 269 patients in our review, out of which 4948 cases were of MIE and 8321 cases were of OE. The pooled results suggested that MIE had a better outcome regarding all-cause respiratory complications (RCs) (OR = 0.56, 95% CI = 0.41-0.78, P = <0.001), inhospital duration (SMD = −0.51; 95% CI = −0.78−0.24; P = <0.001), and blood loss (SMD = −1.44; 95% CI = −1.95−0.93; P = <0.001). OE was associated with shorter duration of operation time, while no statistically significant differences were observed regarding other outcomes. Additionally, subgroup analyses were performed for a number of different postoperative events. Conclusions: Our study indicated that MIE had more favorable outcomes than OE from the perspective of short-term outcomes. Further large-scale, multicenter randomized control trials are needed to explore the long-term survival outcomes after MIE versus OE.

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Comparison of Clinical Outcomes of Robot-Assisted, Video-Assisted, and Open Esophagectomy for Esophageal Cancer

et al. 2021

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Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer

Cited by 549 publications

References 26 publications

Effect of neoadjuvant chemoradiation on preoperative pulmonary physiology, postoperative respiratory complications and quality of life in patients with oesophageal cancer

Effect of neoadjuvant chemoradiation on preoperative pulmonary physiology, postoperative respiratory complications and quality of life in patients with oesophageal cancer

Postoperative short‐term outcomes of minimally invasive versus open esophagectomy for patients with esophageal cancer: An updated systematic review and meta‐analysis

Comparison of Clinical Outcomes of Robot-Assisted, Video-Assisted, and Open Esophagectomy for Esophageal Cancer

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