Outcomes, quality of life, and survival after esophagectomy for squamous cell carcinoma: A propensity score–matched comparison of operative approaches

Wang, Hao; Shen, Yaxing; Feng, Mingxiang; Zhang, Yi; Jiang, Wei; Xu, Songtao; Tan, Lijie; Wang, Qun

doi:10.1016/j.jtcvs.2014.12.063

Cited by 81 publications

(86 citation statements)

References 22 publications

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“…In our series, the average number of harvested lymph nodes was 19.2, which is similar to previous meta‐analyses, and is even higher compared to the best OE series conducted . Therefore, we believe that long term survival of MIE will be better than OE, or at least equal, as reported by Wang et al …”

Section: Discussionsupporting

confidence: 89%

Minimally invasive esophagectomy in the lateral‐prone position: Experience of 124 cases in a single center

Yan

Liu

et al. 2017

Thoracic Cancer

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BackgroundMinimally invasive esophagectomy was first introduced as a new technique for esophageal cancer treatment 20 years ago. Performing this procedure in the lateral‐prone position is the most appropriate method. Since May 2013, our center has performed 124 esophageal cancer operations using this procedure. Herein, we share our experience.MethodsWe retrospectively reviewed 124 consecutive patients who had received minimally invasive esophagectomy in the lateral‐prone position from May 2013 to June 2017. The procedure, operative variables, postoperative complications, and oncology outcomes were assessed.ResultsThe surgery was successful in all 124 patients; three cases converted to an abdominal opening procedure during surgery. The mean total lymph node harvest was 19.2: 12.9 in the thoracic cavity and 6.0 in the abdominal cavity. The average total operation duration was 376 minutes and blood loss was 156 mL. No mortality occurred within 30 postoperative days. Forty‐three cases of postoperative morbidity occurred in 38 patients (30.6%), including 11 anastomotic leakages (8.9%), 1 chyle leak (0.8%), 12 lateral recurrent nerve palsies (9.7%), 11 pulmonary complications (8.9%), and 8 other complications (6.5%). A learning curve indicated that blood loss, operation duration, and the number of lymph nodes harvested would improve with time.ConclusionsSurgical and oncological outcomes following minimally invasive esophagectomy for esophageal cancer were acceptable. There are some advantages to this technique compared to previous reports of opening procedures.

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Section: Discussionsupporting

confidence: 89%

Minimally invasive esophagectomy in the lateral‐prone position: Experience of 124 cases in a single center

Yan

Liu

et al. 2017

Thoracic Cancer

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“…As is known to all, minimally invasive esophagectomy (MIE) had great advantages in improving short-term outcomes without compromised long-term survival (7)(8)(9). Recently, it is also demonstrated MIE is an acceptable surgical therapy for advanced-stage esophageal malignancies after nCRT (10-13).…”

Section: [Neoadjuvant Chemotherapy (Nct) Plus Mie] (Cm) and [Nct Plusmentioning

confidence: 99%

Neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy: is it a superior approach for locally advanced resectable esophageal squamous cell carcinoma?

et al. 2018

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Background: Few studies reported the outcomes of minimally invasive esophagectomy (MIE) in treating patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoradiotherapy (nCRT).The aim of the study was to investigate the feasibility and efficacy of nCRT plus MIE (RM) strategy in treating locally advanced resectable ESCC.Methods: This retrospective study included 175 patients with ESCC undergoing surgical resection after neoadjuvant therapy in our institution from 2010 to 2016. Patients were stratified into three groups: RM, [neoadjuvant chemotherapy (nCT) plus MIE] (CM) and [nCT plus open esophagectomy (OE)] (CO).Results: Seventy-six (43.4%), 42 (24%) and 57 (32.6%) patients received RM, CM and CO approach, There were no differences in 30-and 90-day mortality among all groups. RM approach was more likely to achieve pathological complete regression (27.6% vs. 4.8%, 1.8%, P=0.001, P=0.001) and fewer lymph node metastasis (25.0% vs. 57.1%, 61.4%, P=0.001, P=0.001) than CM or CO approach. Survival analysis revealed a potential trend towards improved overall survival in RM approach compared with CM or CO approach (P=0.098, P=0.166).Conclusions: RM approach was a safe and efficient strategy in treating locally advanced resectable ESCC. Thereafter, nCT, a safe approach (3)(4)(5)(6) showing improved survival compared with surgery alone, is being applied as the standard approach for ESCC in the east.As is known to all, minimally invasive esophagectomy (MIE) had great advantages in improving short-term outcomes without compromised long-term survival (7)(8)(9). Recently, it is also demonstrated MIE is an acceptable surgical therapy for advanced-stage esophageal malignancies after nCRT (10-13). Nevertheless, the studies available included majorities of patients with adenocarcinoma located in the distal esophagus, which might be more favourable for MIE. As for locally advanced bulky ESCC, it is dangerous to resect as is mainly located in upper or middle-third of esophagus and closely adjacent to the tracheobronchial tree. The safety of MIE after neoadjuvant therapy in treating such patients has never been evaluated in a relative large sample size. Moreover, as patients with ESCC suffered from high incidence of postoperative mortality after nCRT, it is worthwhile to investigate whether MIE could lower the risk of mortality after neoadjuvant therapy, whether nCRT plus MIE (RM) approach could be rendered as a safe and efficient approach for locally advanced ESCC.This retrospective study was performed to compare outcomes in patients with locally advanced resectable ESCC undergoing RM, nCT plus MIE (CM) or [nCT plus open esophagectomy (OE)] (CO) approach and aims to illustrate the value of RM approach in treatment of locally advanced resectable ESCC. Methods PatientsBetween January 2010 to December 2016, patients completing neoadjuvant therapy followed by esophagectomy (n=194) were selected and their medical records were reviewed. The inclusion criteria were (I) thoracic ESCC; (II) McKeown or (III) Ivor-Lewi...

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“…Due to its accessibility through national databases, early readmission is increasingly recognized for its clinical and financial significance (10, 11). Readmission rate following esophagectomy is reportedly between 5% and 20% (12–14). Although readmission has been linked to early postoperative mortality in colorectal, hepatobiliary, and pulmonary surgery, its impact on early mortality following esophagectomy is underexplored (11, 15, 16).…”

Section: Introductionmentioning

confidence: 99%

Readmission predicts 90-day mortality after esophagectomy: Analysis of Surveillance, Epidemiology, and End Results Registry linked to Medicare outcomes

McMurry

Stukenborg

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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Objectives Postoperative readmission is an increasingly scrutinized quality metric that impacts patient satisfaction and cost. Even more important is its implication for short-term prognosis. The purpose of this study is to characterize post-esophagectomy readmissions and determine their relationship with subsequent 90-day mortality. Methods Data were extracted for esophagectomy patients from the linked SEER-Medicare registry (2000–2009) which provides longitudinal information about Medicare beneficiaries with cancer. We assessed demographics, comorbidities, 30-day readmission, and 90-day mortality. Readmitting facility and diagnoses were identified. A hierarchical multivariable regression model clustered at the hospital level assessed the relationship between readmission within 30 days of discharge and 90-day mortality. Results We identified 1543 patients discharged alive after esophagectomy. Among patients discharged alive, readmission rate was 20.7% (319/1543), and 33.5% (107/319) of readmissions were to facilities that did not perform the index operation. Mortality rate at 90 days among patients discharged alive was 6.4% (98/1543). Readmission was associated with a four-fold increase in mortality (16.3% vs 3.8%, p < 0.001). Using multivariable regression, readmission was the strongest predictor of mortality (OR 6.64, p < 0.001), with a stronger association than age, Charlson score, or and index length of stay. Readmission diagnoses with the highest mortality rates were those associated with pulmonary, gastrointestinal, or cardiovascular diagnoses. Conclusions Patients readmitted within 30 days of discharge following esophagectomy are at exceptionally high risk for early mortality. Early recognition of life-threatening readmission diagnoses is essential in order to provide optimal care.

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Outcomes, quality of life, and survival after esophagectomy for squamous cell carcinoma: A propensity score–matched comparison of operative approaches

Abstract: In our experience, MIE is a safe and effective procedure for the treatment of esophageal squamous cell carcinoma. It may offer better perioperative outcomes, better postoperative QOL, and equal oncologic survival, compared with OE.

Cited by 81 publications

References 22 publications

Minimally invasive esophagectomy in the lateral‐prone position: Experience of 124 cases in a single center

Minimally invasive esophagectomy in the lateral‐prone position: Experience of 124 cases in a single center

Neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy: is it a superior approach for locally advanced resectable esophageal squamous cell carcinoma?

Readmission predicts 90-day mortality after esophagectomy: Analysis of Surveillance, Epidemiology, and End Results Registry linked to Medicare outcomes

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