Initial experience with uniportal video-assisted thoracic surgery esophagectomy

Nachira, Dania; Meacci, Elisa; Mastromarino, Maria Giovanna; Pogliani, Laura; Zanfrini, Edoardo; Iaffaldano, Amedeo; Petracca-Ciavarella, Leonardo; Chiappetta, Marco; Congedo, Maria Teresa; Vita, Maria Letizia; Porziella, Venanzio; Margaritora, Stefano

doi:10.21037/jtd.2018.04.17

Cited by 5 publications

(6 citation statements)

References 32 publications

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“…After our preliminary series of 12 procedures (all McKeown) reported in 2018 (9), other authors confirmed the feasibility and efficacy of Uniportal-VATS approach for esophagectomy (3,10).…”

Section: Discussionmentioning

confidence: 63%

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Uniportal-VATS vs. open McKeown esophagectomy: Surgical and long-term oncological outcomes

Nachira

Congedo²,

Calabrese³

et al. 2023

Front. Surg.

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BackgroundTill now there are very few reports about surgical results of Uniportal-VATS esophagectomy and no one about long-term outcomes. This study is the first comparing surgical and oncological outcomes of Uniportal-VATS with open McKeown esophagectomy, with the largest reported series and longest oncological follow-up.MethodsThe prospectively collected clinical, surgical and oncological data of 75 patients, undergone McKeown esophagectomy at our Thoracic Surgery Department, from January 2012 to August 2022, were retrospectively analyzed. Nineteen patients underwent esophagectomy by thoracotomy and reconstruction according to McKeown technique while 56 by Uniportal-VATS approach. Gastric tubulization was performed totally laparoscopic or through a mini-laparatomic access and cervical anastomosis was made according to Orringer's technique.ResultsThe mean operative thoracic time was similar in both accesses (102.34 ± 15.21 min in Uniportal-VATS vs. 115.56 ± 23.12 min in open, p: 0.646), with a comparable number of mediastinal nodes retrieved (Uniportal-VATS:13.40 ± 8.12 vs. open:15.00 ± 6.86, p: 0.275). No case needed conversion from VATS to open. The learning curve in Uniportal-VATS was completed after 34 cases, while the Mastery was reached after 40. Both approaches were comparable in terms of minor post-operative complications (like pneumonia, lung atelectasis, anemization, atrial fibrillation, anastomotic-leak, left vocal cord palsy, chylothorax), while the number of re-operation for major complications (bleeding or mediastinitis) was higher in open group (21.0% vs. 3.6%, p: 0.04). Both techniques were also effective in terms of surgical radicality and local recurrence but VATS approach allowed a significantly lower chest tube length (11.89 ± 9.55 vs. 25.82 ± 24.37 days, p: 0.003) and post-operative stay (15.63 ± 11.69 vs. 25.53 ± 23.33, p: 0.018). The 30-day mortality for complications related to surgery was higher in open group (p: 0.002). The 2-, 5- and 8-year survival of the whole series was 72%, 50% and 33%, respectively. Combined 2- and 5-year OS in Uniportal-VATS group was 76% and 47% vs. 62% and 62% in open group, respectively (Log-rank, p: 0.286; Breslow-Wilcoxon: p: 0.036). No difference in DFS was recorded between the two approaches (5 year-DFS in Uniportal-VATS: 86% vs. 72%, p: 0.298). At multivariate analysis, only pathological stage independently affected OS (p: 0.02), not the surgical approach (p: 0.276).ConclusionsUniportal-VATS seems to be a safe, feasible and effective technique for performing McKeown esophagectomy, with equivalent surgical and long-term oncological results to standard thoracotomy, but with a faster and unharmed recovery, and a quite short learning curve.

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“…After our preliminary series of 12 procedures (all McKeown) reported in 2018 (9), other authors confirmed the feasibility and efficacy of Uniportal-VATS approach for esophagectomy (3,10).…”

Section: Discussionmentioning

confidence: 63%

“…The main steps of each time (Uniportal-VATS thoracic approach, abdominal and cervical approaches) were already described in a previous paper (9) on the technique by our group.…”

Section: Surgical Techniquementioning

confidence: 99%

Uniportal-VATS vs. open McKeown esophagectomy: Surgical and long-term oncological outcomes

Nachira

Congedo²,

Calabrese³

et al. 2023

Front. Surg.

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“…Reports on uniportal VATS in esophageal cancer are limited. A 12-patient series by Nachira et al (14) reported an average duration of 105 ± 21 min in the chest part and 10.4 ± 3.9 lymph nodes. Wang et al (15) reported 44 esophageal mobilizations with a uniportal VATS technique.…”

Section: Discussionmentioning

confidence: 99%

“…The average duration was 163 ± 16 min and the lymph node yield was 24. In both of these series, anastomosis was performed in the neck (14,15). In our experience, if the proximal margin of cancer was located distal to the carina, our intention was to perform a high intrathoracic anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Uniportal VATS Approach in Esophageal Cancer – How to Do It Update

Batırel

2022

Front. Surg.

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The adoption of minimally invasive esophagectomy has been used for over a decade, and the chest part is evolving into a uniportal video-assisted thoracoscopic surgery (VATS) approach. Uniportal esophageal mobilization and anastomosis have many peculiar aspects, which include placement of the incision, alignment of instruments, and anastomosis. The incision is placed over the sixth intercostal space posterior axillary line. The esophagus is usually encircled at the level of the inferior pulmonary vein. The use of curved suction helps in the retraction of the esophagus and the exposure of the left main bronchus deep in the mediastinum. For intrathoracic anastomosis in Ivor Lewis esophagectomy, a completely side-to-side linear-stapled anastomosis is preferred. This anastomotic technique results in a long stapler line. The correct alignment of tissues and adequate anastomotic circumference are of utmost importance to prevent leaks or strictures. Perioperative and oncologic results in several series with uniportal VATS, esophageal mobilization, and anastomosis are comparable with open or other types of minimally invasive esophagectomy. Uniportal VATS for esophagectomy is feasible and fast with good results.

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“…Uniportal video-assisted thoracoscopic surgery (VATS) technique is widely applied nowadays and is at least comparable in pain and morbidity to multiportal VATS for lung resection [ 3 , 4 ]. There are limited data on the comparison of uniportal and multiportal VATS esophagectomy, but it would not be surprising to achieve similar results [ 5–9 ].…”

Section: Introductionmentioning

confidence: 99%

Uniportal video-assisted thoracoscopic surgery esophagectomy outcomes in 40 consecutive patients

Aslan

Tiryaki

Pashayev

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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Objectives Minimally invasive oesophagectomy has improved over time becoming faster and less invasive. We have changed our technical approach from multiportal to uniportal VATS (video-assisted thoracoscopic surgery) oesophagectomy over the years. In this study we analyzed our results with uniportal VATS oesophagectomy technique. Methods This study was a retrospective analysis of 40 consecutive patients with the intent to perform uniportal VATS oesophagectomy for oesophageal cancer between July 2017 and August 2021. Demographic criteria, comorbidities, neoadjuvant therapy, intraoperative data, complications, length of stay, pathological data, 30 and 90-day mortality and 2-year survival data were recorded. Results Forty patients (21 female) were operated (Median age 62.9 [53.5–70.25]). Eighteen patients (45%) received neoadjuvant chemoradiation. The chest part of all cases was started with uniportal VATS and thirty-one (77.5%) was completed uniportally (34 Ivor Lewis, 6 McKeown). The median thoracic operation time in minimally invasive Ivor Lewis oesophagectomy was 90 min (77.5–100). The median time for uniportal side to side anastomosis was 12 min (11–16). Five (12.5%) patients had leak, four were intrathoracic. Twenty-eight (70%) patients had squamous cell carcinoma, eleven adenocarcinoma and one squamous cell carcinoma with sarcomatoid differentiation. Thirty-seven (92.5%) patients had R0 resection. The mean number of lymph nodes dissected was 24 ± 9.5. 30-and 90-day mortality was 2.5% (n = 1). The mean follow-up was 44 ± 2.8 months. 2-year survival was 80%. Conclusions Uniportal VATS oesophagectomy is a safe, fast and feasible alternative to other minimally invasive and open approaches. Comparable results to contemporary series are observed in perioperative and oncologic outcomes.

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Initial experience with uniportal video-assisted thoracic surgery esophagectomy

Cited by 5 publications

References 32 publications

Uniportal-VATS vs. open McKeown esophagectomy: Surgical and long-term oncological outcomes

Uniportal-VATS vs. open McKeown esophagectomy: Surgical and long-term oncological outcomes

Uniportal VATS Approach in Esophageal Cancer – How to Do It Update

Uniportal video-assisted thoracoscopic surgery esophagectomy outcomes in 40 consecutive patients

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