Minimally Invasive Versus Open Esophagectomy: Meta-Analysis of Outcomes

Sgourakis, George; Gockel, Ines; Radtke, Arnold; Musholt, Thomas J.; Timm, S.; Rink, Andreas D.; Tsiamis, Achilleas; Karaliotas, Constantine; Lang, Hauke

doi:10.1007/s10620-010-1153-1

Cited by 154 publications

(94 citation statements)

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“…These studies confirm that MIE is feasible and safe and seems to be oncologically equivalent to open technique with regard to radical resection and number of lymph nodes harvested (8,16,18), while long-term survival data of high quality is still lacking. Furthermore, some of these metaanalyses demonstrate a trend to reduced mortality (7) and morbidity (15,(17)(18)(19) for patients who underwent an MIE compared to those who when operated with conventional open esophagectomy. Moreover, after MIE implementation we have seen a reduction in blood loss and shorter hospital stay (15,17,19).…”

Section: Discussionmentioning

confidence: 60%

“…Over the last years several meta-analyses have been published comparing conventional open esophagectomy and MIE (7,8,(15)(16)(17)(18)(19)(20). These studies confirm that MIE is feasible and safe and seems to be oncologically equivalent to open technique with regard to radical resection and number of lymph nodes harvested (8,16,18), while long-term survival data of high quality is still lacking. Furthermore, some of these metaanalyses demonstrate a trend to reduced mortality (7) and morbidity (15,(17)(18)(19) for patients who underwent an MIE compared to those who when operated with conventional open esophagectomy.…”

Section: Discussionmentioning

confidence: 94%

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Implementation of minimally invasive esophagectomy in a tertiary referral center for esophageal cancer

et al. 2017

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years, high morbidity rates are still recorded (5,6). In an effort to reduce the postoperative morbidity associated with open esophagectomy various minimally invasive esophagectomy (MIE) techniques have been introduced and developed during the recent years. MIE is believed to minimize the surgical trauma and subsequently the postoperative pain resulting in a faster mobilization and recovery with reduced postoperative complication rates and shorter hospital stay compared to the open procedure. During the last 20 years several studies have been published within the field demonstrating that MIE is a safe technique with an oncological outcome at least equal to open esophagectomy with regard to complete resection rate, number of lymph nodes harvested and postoperative survival (7-9). Moreover, there is an indication of shortterm benefits after MIE especially with regards to reduced pulmonary complications and improved health related quality of life compared to the open procedure (10,11).The aim of the current study was to present our 4.5-year experience of the gradual implementation of various MIE techniques in our tertiary referral center with special focus on the evolution of adaptive changes and refinements of our practice of the procedure over this period. Methods Our unitCenter of digestive diseases (CDD) at Karolinska University Hospital, Stockholm is one of the largest and most highly specialized centers in the Nordic countries. It is a tertiary referral center in Stockholm County with a catchment area of approximately 2,500,000 inhabitants. Furthermore, CDD receives referrals for patients with newly diagnosed esophageal and cardia cancer from neighboring counties with an additional population of 650,000. This results in an annual case volume of 40-60 esophageal and resections in the most recent years.The Unit engages three consultant surgeons (MN, ML, IR), with long laparoscopic experience within benign upper gastrointestinal (UGI) surgery as well as long previous experience in open esophageal cancer surgery. Karolinska, Stockholm. From 2009, one of the current consultant surgeons, IR, spent 3 years in a fellowship in UGI cancer surgery at Bristol Royal Infirmary, Bristol, UK with special focus in MIE. During these years he became confident in both the hybrid laparoscopic assisted esophagectomy (HLAE) technique including laparoscopic gastric mobilization and abdominal lymph node dissection followed by thoracotomy and intrathoracic anastomosis as well as with the minimal invasive McKeown (MIMK) technique, i.e., thoracolaparoscopy followed by cervical anastomosis by performing more than 70 cases. In the meantime, two other consultant surgeons (MN & ML) had the chance to visit another center with extensive In May 2012 and as a first test of transition to MIE, the first HLAE was performed safely with all consultants present. This was followed shortly by an additional procedure with satisfactory results and without any technical problems to be encountered. HLAE was chosen as the most feasible MIE in the beginning...

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 94%

Implementation of minimally invasive esophagectomy in a tertiary referral center for esophageal cancer

et al. 2017

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“…Somit kann davon ausgegangen werden, dass bei entsprechender Erfahrung über den minimalinvasiven Zugang eine vergleichbar umfangreiche Lymphadenektomie wie beim offenen Zugang erfolgen kann. Auch bei den Hybrid-Operationen mit nur einem minimalinvasiven Zugang wurde eine vergleichbare Radikalität erreicht [19,20]. In Bezug auf die R0-Resektions-rate sind die Daten für die minimalinvasive ebenfalls mit der offenen Ösophagektomie vergleichbar [16,21].…”

Section: Ergebnisseunclassified

“…Dies zeigt sich auch in der kontrollierten randomisierten Studie von Biere et al [16] mit einer Rate von 12% an pulmonalen Infektionen bei minimalinvasiven Eingriffen - gegenüber 34% bei offenen Operationen. Bei den Hybrid-Operationen mit einem minimalinvasiven Zugang zeigt sich eine höhere Morbidität als bei den komplett minimalinvasiv operierten Patienten, übersteigt aber nicht die der offen operierten Patienten [19,20,28]. Einen nicht zu vernachlässigenden Punkt stellt weiterhin die Operationszeit dar.…”

Section: Ergebnisseunclassified

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

Wolter¹,

Mann²,

Izbicki³

2013

Visc Med

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Hintergrund: Die offene onkologische Resektion ist derzeit der Goldstandard in der Behandlung des Plattenepithel- und Adenokarzinoms des Ösophagus. Die mit den Therapieverfahren assoziierte Morbidität und Mortalität konnte in den letzten Jahren durch die Verbesserung des chirurgischen und perioperativen Managements deutlich gesenkt werden, bleibt aber im Vergleich zu anderen Eingriffen am Gastrointestinaltrakt weiterhin hoch. Methoden: Diese Übersicht basiert auf einer strukturierten Analyse der aktuellen, in MEDLINE, PubMed, EMBASE und den Cochrane Databases gelisteten Studien. Ergebnisse: In den letzten 20 Jahren sind zunehmend Arbeiten erschienen, die seit der Erstbeschreibung der minimalinvasiven Ösophagusresektion zeigen, dass in entsprechend erfahrenen Zentren die hohe Morbidität und Mortalität, insbesondere für pulmonale Komplikationen durch minimalinvasive Ösophagusresektionen, drastisch gesenkt werden konnte - ohne Verzicht auf onkologische Radikalität und ohne Verschlechterung des onkologischen Outcomes. Die postoperative Lebensqualität war ebenfalls nicht schlechter für minimalinvasiv operierte Patienten. Allerdings sind die minimalinvasiven Techniken im Bereich der Ösophaguschirurgie mit einer signifikanten Lernkurve verbunden - ein weiteres Argument für eine Zentralisierung der Ösophaguschirurgie. Schlussfolgerungen: Die bisher erhobenen Daten zur minimalinvasiven Ösophagusresektion sind zwar sehr vielversprechend, jedoch sind weitere kontrollierte randomisierte Studien erforderlich, um die bisher erhobenen Daten zu erhärten.

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“…, publicó un metaanálisis donde incluyó 3 estudios comparativos concluyendo que no había diferencia ni en la morbilidad ni en la sobrevida a 5 años entre ambas técnicas 34 . Sin embargo, en el mismo metaanálisis se incluyeron 5 estudios donde se compara la cirugía completamente mini invasiva (torácica y abdominal) vs la vía abierta (toracotomía y laparotomía), evidenciándose que la vía mínimamente invasiva presentó en general menos complicaciones con similar mortalidad operatoria y sobrevida a 3 años.…”

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Resultados De La Cirugía Actual Para El Tratamiento Del Cáncer De Esófago

et al. 2016

Rev Chil Cir

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surgical treatment of esophageal cancer. an updateEsophageal cancer surgery is a challenge despite the advances in surgical techniques and perioperative care. It continues to have high rates of complications and mortality, even in large volume centers. This paper revises the epidemiology, staging and therapeutic options for esophageal cancer, according to its stage and location. It also encompasses the digestive tract reconstruction options, according to our own experience and reports from abroad.Key words: Esophageal cancer, surgery, digestive tract reconstruction. resumenLa cirugía del cáncer de esófago ha sido y sigue siendo un desafío pese a los avances en técnica quirúrgica y cuidados peri operatorios y a pesar de que las complicaciones postoperatorias y la morbimortalidad sigue siendo alta, aún en centros con alto volumen de procedimientos y más aún en centros no dedicados a la atención de estos pacientes. En este artículo se revisarán algunos aspectos epidemiológicos, las herramientas diagnósticas actuales, su etapificación, y las opciones terapéuticas de acuerdo al estadío, sea en etapas precoces o avanzadas, la localización y tipo de tumor, opciones de reconstrucción del tránsito digestivo en base a lo reportado en la literatura internacional, la experiencia nacional y en base a nuestros propios resultados en

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Minimally Invasive Versus Open Esophagectomy: Meta-Analysis of Outcomes

Abstract: In summary, both arms were comparable with regard to perioperative results and prognosis. Further prospective comparative or randomized-controlled trials focusing on the oncological impact of MIE are needed.

Cited by 154 publications

References 23 publications

Implementation of minimally invasive esophagectomy in a tertiary referral center for esophageal cancer

Implementation of minimally invasive esophagectomy in a tertiary referral center for esophageal cancer

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

Resultados De La Cirugía Actual Para El Tratamiento Del Cáncer De Esófago

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