Impact of the Surgical Technique on Pulmonary Morbidity After Esophagectomy

Bakhos, Charles; Fabian, Thomas; Oyasiji, Tolutope; Gautam, Shiva; Gangadharan, Sidhu P.; Kent, Michael S.; Martin, Jeremiah T.; Critchlow, Jonathan F.; DeCamp, Malcolm M.

doi:10.1016/j.athoracsur.2011.07.030

Cited by 87 publications

(53 citation statements)

References 25 publications

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“…In this study, we showed that VE compared with OE was associated with lower postoperative overall pulmonary complications, lower postoperative atelectasis and lower postoperative pneumonia in a study population of wellmatched esophageal cancer patients. Our overall incidence of pulmonary complications and pneumonia in OE was comparable with that of other previous studies (5). The number of harvested lymph nodes was not significantly different (31 vs. 33, P=0.198) between the two groups, satisfying the requirements for the Worldwide Esophageal Cancer Collaboration data (12,13).…”

Section: Discussionsupporting

confidence: 78%

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Clinical outcomes of video-assisted thoracoscopic surgery esophagectomy for esophageal cancer: a propensity score-matched analysis

et al. 2017

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Results: Matching based on propensity scores produced 42 patients in each group for the analysis.After propensity matching, there were only two operative mortalities in the OE group, and both died of postoperative pneumonia. The overall incidence of postoperative complications was 38.1% (16 of 42) and 57.1% (24 of 42) in the VE group and in the OE group, respectively (P=0.088). The incidence of pulmonary complications was lower in the VE group than in the OE group (9.5% vs. 40.5%, P=0.004). The 2-year overall survival and disease-free survival were not different between the two groups (74.4% and 69.5% in the VE group, 69.5% and 69.8% in the OE group, P=0.865 and P=0.513, respectively). Conclusions:In select patients, superior short-term surgical results and equal oncological outcomes were achieved with VE compared with OE.

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Section: Discussionsupporting

confidence: 78%

“…However, esophageal cancer surgery remains to have high postoperative morbidity and mortality. This is most likely associated with extensive and aggressive surgical procedures (2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of video-assisted thoracoscopic surgery esophagectomy for esophageal cancer: a propensity score-matched analysis

et al. 2017

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“…Insgesamt wurden eine RCT [2], vier systematische Reviews mit Metaanalysen [3,4,5,6] sowie 18 retrospektive Kohortenstudien [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24] gefunden. Entsprechend liegt somit nur eine einzige Publikation mit Evidenzlevel I vor [2].…”

Section: Ergebnisseunclassified

“…Vier Publikationen berichteten ebenfalls über weniger pulmonale Komplikationen nach minimalinvasiver Operation [10,11,14,19]. Die Mehrzahl der verfügbaren Publikationen fand keine Unterschiede zwischen minimalinvasiver und offener Chirurgie bezüglich postoperativer pulmonaler Komplikationen [7,8,9,12,15,17,18,20,21,22,23,24]. Drei von vier Metaanalysen analysierten pulmonale Komplikationen, wobei zwei Metaanalysen keinen Unterschied zwischen minimalinvasiver und offener Chirurgie fanden [3,4], während eine Metaanalyse weniger respiratorische Komplikationen nach minimalinvasiver Operation beobachtete [5].…”

Section: Ergebnisseunclassified

Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltrakts: Ösophagus - Kontra-Position

Gertler

Feith

2013

Visc Med

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Hintergrund: Die chirurgische Therapie des Ösophaguskarzinoms besteht in der Ösophagektomie mit Lymphadenektomie. Diese wird traditionell offen, in den letzten Jahren jedoch auch zunehmend minimalinvasiv durchgeführt. Methoden: Ziel dieser Übersichtsarbeit ist es, die Kontra-Position zur minimalinvasiven Chirurgie darzulegen. Hierfür führten wir eine Literaturrecherche bei PubMed durch. Es wurden eine randomisiert kontrollierte Studie, vier Metaanalysen sowie 18 retrospektive Kohortenstudien einbezogen. Ergebnisse: Insgesamt zeigt sich bei den vorliegenden Publikationen ein niedriger Evidenzlevel mit anzunehmendem Selektionsbias in den retrospektiven Kohortenstudien. Trotzdem kann davon ausgegangen werden, dass die minimalinvasive Ösophagektomie heutzutage zumindest mit vergleichbarer Morbidität und Mortalität wie die offene Ösophagektomie durchgeführt werden kann und mit weniger Schmerzen, kürzerem Krankenhausaufenthalt und höherer früh-postoperativer Lebensqualität einhergeht. Unterschiedliche Ergebnisse zeigen sich bezüglich einer möglichen Reduktion von postoperativen pulmonalen Komplikationen nach der minimalinvasiven Operation, nicht zuletzt, weil hier neben dem reinen operativen Zugangsweg auch andere Faktoren wie die Ein-Seiten-Lungenbeatmung und eine längere Lungenkompression Einfluss nehmen. Schlussfolgerungen: Der onkologische Stellenwert der minimalinvasiven Ösophagektomie ist auf der Grundlage der vorliegenden Literatur nicht ausreichend zu beurteilen, auch wenn vergleichbare R0-Resektionsraten und Lymphknotenzahlen berichtet werden. Zu wenig standardisiert sind hier die durchgeführten Operationen, während die Patientenkollektive bezüglich Tumortyp, Stadienverteilung und Nachsorge zu heterogen ausfallen.

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“…24,25,34,[45][46][47][48][49][50][51][52] O fit for surgery pretende-se que passe cada vez mais por cálculos de probabilidade e menos pela impressão clínica. Os principais órgãos alvo de complicações foram o pulmão e o coração.…”

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Cancro do Esófago: Estratégia de Abordagem Cirúrgica

et al. 2014

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Acta Med Port 2014 Sep-Oct;27(5):593-600 RESUMOIntrodução: A ressecção transmediastínica e a ressecção transtorácica têm mortalidade hospitalar (1,4% -14%) e sobrevivência (± 25% aos cinco anos) semelhantes. A terapêutica neo-adjuvante é opção em estádios avançados. A intenção deste trabalho é apresentar uma série consecutiva de 52 doentes -opção operatória baseada na localização anatómica: tumores infra-carinais e cervicais submetidos a ressecção transmediastínica e restantes ressecções transtorácicas. Discussão: Não tendo sido demonstrada vantagem oncológica para a ressecção transtorácica ou a ressecção transmediastínica, basear a opção operatória na localização do tumor permitiu-nos com segurança e eficácia, planear e executar as ressecções esofági-cas desta série. Conclusão: As curvas de sobrevida foram sobreponíveis para ressecção transtorácica e ressecção transmediastínica e bastante favoráveis numa população com 52 % de estádios pIII/IV. A quimio-radioterapia contribuiu para aumentar a ressecabilidade. Palavras-chave: Esofagectomia; Laparoscopia; Neoplasias Esofágicas/cirurgia; Toracotomia. ABSTRACT Introduction:Oesophagectomy for cancer is associated to a significant morbidity and mortality. The superiority of transthoracic vs transhiatal is still a matter of controversy. The aim of this paper is to discuss the results of a series of patients submitted to either a transthoracic or a transhiatal according to the anatomic location regarding the carina. Material and Methods: Retrospective analysis of 52 consecutive patients, with oesophageal carcinoma, 7 female and 45 males, median age 64 years. Location: cervical -1; above carina -22; below or at carina level -19; cardia type I -10. 19 adenocarcinoma, 32 squamous cells, 1 lymphoma. Twenty patients (40%) -neo-adjuvant therapy. Thoracoabdominal approach -3, cervico-thoracoabdominal -20, transhiatal -27, exploratory thoracotomy -2. Gastric pull-up 49 (cervical anastomosis -46; thoracic -3); cervical oesofagocoloplasty -1. Results: Pathologic staging: complete remission -8; Ib -3; IIa -9; IIb -4; IIa -11; IIIb -2; IIIc -10; IV -1; non-stageable -3. Major complications: 37%. Resectability: 96% (50/52). Mortality: 4th week -6%; in-hospital -14%. Median survival 18 months . Survival Curves (Kaplan-Meier): 2 years -47%; 5 years -19% (transthoracic vs transhiatal p > 0.05). Discussion: Selection of surgical approach based on the anatomic location of the tumour regarding the carina was safe, the resectability was high and similar when a transthoracic or a transhiatal was planed and carry-on. Conclusions: In this series of oesophageal cancer patients, in advanced pathologic condition (52% p Stages III/IV) the overall survival was similar for transthoracic and transhiatal. Neo-adjuvant treatments definitively contributed to enhance resectability.

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Impact of the Surgical Technique on Pulmonary Morbidity After Esophagectomy

Cited by 87 publications

References 25 publications

Clinical outcomes of video-assisted thoracoscopic surgery esophagectomy for esophageal cancer: a propensity score-matched analysis

Clinical outcomes of video-assisted thoracoscopic surgery esophagectomy for esophageal cancer: a propensity score-matched analysis

Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltrakts: Ösophagus - Kontra-Position

Cancro do Esófago: Estratégia de Abordagem Cirúrgica

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