Learning Curve and Associated Prognosis of Minimally Invasive McKeown Esophagectomy

Bao, Tao; Li, Kunkun; Bi, Long; Zhao, Xiaolong; Wang, Yingjian; Guo, Wei

doi:10.1016/j.athoracsur.2022.01.045

Cited by 9 publications

(3 citation statements)

References 23 publications

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“…Nonetheless, cMIE is not without limitations. Restricted movement of instruments, decreasing dexterity, prove to be technically complex and demanding, requiring a high number of patients to complete a surgeon’s learning curve [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy for esophageal cancer: a systematic review and meta-analysis of 18,187 patients

Perry,

Barbosa,

Perry

et al. 2024

J Robotic Surg

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The role of robotic surgery in the curative-intent treatment of esophageal cancer patients is yet to be defined. To compare short-term outcomes between conventional minimally invasive (cMIE) and robot-assisted minimally invasive esophagectomy (RAMIE) in esophageal cancer patients. PubMed, Web of Science and Cochrane Library were systematically searched. The included studies compared short-term outcomes between cMIE and RAMIE. Individual risk of bias was calculated using the MINORS and RoB2 scales. There were no statistically significant differences between RAMIE and cMIE regarding conversion to open procedure, mean number of harvested lymph nodes in the mediastinum, abdomen and along the right recurrent laryngeal nerve (RLN), 30- and 90-day mortality rates, chyle leakage, RLN palsy as well as cardiac and infectious complication rates. Estimated blood loss (MD − 71.78 mL, p < 0.00001), total number of harvested lymph nodes (MD 2.18 nodes, p < 0.0001) and along the left RLN (MD 0.73 nodes, p = 0.03), pulmonary complications (RR 0.70, p = 0.001) and length of hospital stay (MD − 3.03 days, p < 0.0001) are outcomes that favored RAMIE. A significantly shorter operating time (MD 29.01 min, p = 0.004) and a lower rate of anastomotic leakage (RR 1.23, p = 0.0005) were seen in cMIE. RAMIE has indicated to be a safe and feasible alternative to cMIE, with a tendency towards superiority in blood loss, lymph node yield, pulmonary complications and length of hospital stay. There was significant heterogeneity among studies for some of the outcomes measured. Further studies are necessary to confirm these results and overcome current limitations.

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Section: Introductionmentioning

confidence: 99%

Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy for esophageal cancer: a systematic review and meta-analysis of 18,187 patients

Perry,

Barbosa,

Perry

et al. 2024

J Robotic Surg

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show abstract

“…Esophageal cancer is a common gastrointestinal malignancy, and surgery is the main treatment method for esophageal cancer. With the promotion of minimally invasive technology and concept of enhanced recovery after surgery (ERAS), minimally invasive esophagectomy (MIE) has been widely applied with many advantages, such as less trauma, quick recovery, fewer postoperative pulmonary complications, and aesthetic appearance [1][2][3][4]. In MIE, the traditional ve-port method is routinely used for gastric dissociation under laparoscopy, which can be facilitated by the assistance and exposure of the assistant.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic gastric dissociation using two-port approach in minimally invasive esophagectomy

Pan

Zhang

Li³

et al. 2022

Preprint

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Background A new approach of laparoscopic gastric dissociation in minimally invasive esophagectomy (MIE) was attempted. This study aimed to evaluate the safety and efficacy of two-port laparoscopy in McKeown procedure. Methods From August 2019 to August 2021, 206 patients with esophageal cancer underwent laparoscopic modified two-port or traditional five-port McKeown procedure in our institution. Surgical outcomes of the methods were compared. Results Of the patients, 106 (51.46%) underwent modified two-port procedure, while 100 (48.54%) underwent traditional five-port procedure. Propensity score matching produced 182 patients for comparison. The laparoscopic operative time was 48.40 ± 13.33 and 45.75 ± 10.65 min, respectively (p = 0.140). There was no significant difference in the median number of dissected celiac lymph nodes in both groups (7.69 ± 3.37 vs. 8.56 ± 6.54, p = 0.262). The number of positive celiac lymph nodes was 0.36 ± 1.01 and 0.64 ± 1.32, respectively (p = 0.116). Blood loss during laparoscopic surgery in the modified two-port group was similar to that in the traditional five-port group (16.87 ± 18.93 mL vs. 15.88 ± 17.62 mL, p = 0.716). The postoperative length of hospital stay was 10.21 ± 4.23 days and 10.22 ± 4.24 days, respectively (p = 0.986). Complication rates in both groups were not significantly different (13.2% vs. 18.7%, p = 0.563). There was no significant difference in postoperative abdominal pain VAS scores between the two groups (p > 0.05). Conclusions The modified McKeown procedure with two-port laparoscopy is a viable option for patients with esophageal cancer. Larger studies with longer follow-up duration are warranted.

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“…Esophageal cancer is a common gastrointestinal malignancy, with surgery as the primary treatment option. With the promotion of minimally invasive technology and concept of enhanced recovery after surgery (ERAS), minimally invasive esophagectomy (MIE) has become increasingly popular because of several advantages, such as reduced trauma, rapid recovery, few postoperative pulmonary complications, and improved esthetic appearance [1][2][3][4]. In MIE, the traditional five-port procedure is routinely used for laparoscopic gastric dissociation, which can be facilitated by the assistance and exposure provided by surgical assistants.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic gastric dissociation using a two-port approach in minimally invasive esophagectomy

Pan

Zhang

et al. 2022

World J Surg Onc

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Background A new approach for laparoscopic gastric dissociation in minimally invasive esophagectomy (MIE) was attempted. This study aimed to evaluate the short-term outcomes, safety, and efficacy of two-port laparoscopy using the McKeown procedure. Methods This retrospective study included 206 consecutive patients with esophageal cancer who underwent a modified two-port laparoscopic or the traditional five-port McKeown procedure at our institution from August 2019 to August 2021. Surgical outcomes of the two methods were compared. Results Of the 206 patients, 106 (51.46%) underwent the modified two-port procedure, whereas 100 (48.54%) underwent the traditional five-port procedure. Subsequently, 182 propensity score-matched patients were compared. No significant differences were observed in laparoscopic operative time, blood loss during laparoscopic surgery, number of dissected lymph nodes, and pain score on postoperative day 1 between the two groups. The rate of complication and postoperative length of hospital stay did not differ significantly between the two groups. The total hospitalization cost also did not differ significantly between the two groups (p = 0.325). No postoperative deaths occurred in either group. Conclusions Our findings demonstrate that laparoscopic gastric dissociation using the two-port approach in MIE is a safe and effective procedure, with short-term outcomes comparable to those of the traditional five-port procedure in patients with esophageal cancer. Larger studies with longer follow-up duration are warranted.

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Learning Curve and Associated Prognosis of Minimally Invasive McKeown Esophagectomy

Cited by 9 publications

References 23 publications

Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy for esophageal cancer: a systematic review and meta-analysis of 18,187 patients

Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy for esophageal cancer: a systematic review and meta-analysis of 18,187 patients

Laparoscopic gastric dissociation using two-port approach in minimally invasive esophagectomy

Laparoscopic gastric dissociation using a two-port approach in minimally invasive esophagectomy

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