Perianastomotic drainage in Ivor-Lewis esophagectomy, does habit affect utility? An 11-year single-center experience

Pasqual, Carlo Alberto De; Weindelmayer, Jacopo; Laiti, Silvia; Mendola, Roberta La; Bencivenga, Maria; Alberti, Luca; Giacopuzzi, Simone; Manzoni, Giovanni De

doi:10.1007/s13304-019-00674-9

Cited by 9 publications

(9 citation statements)

References 23 publications

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“…It represents a quite good result also compared to the current literature: the international registry established by the UGIRA and including 622 robotic‐assisted Ivor–Lewis esophagectomies reported a leakage rate of 17% when a circular stapled anastomosis, similar to ours, was performed 29 . We chose to replicate during RAMIE procedures the same end‐to‐end 25 mm circular stapled anastomosis we perform in open surgery, with the aim of reaching a comparable leak rate 30 . Interestingly, a similar anastomosis has been chosen also by the surgical team from Mainz, one of the European leading groups for robotic esophageal surgery.…”

Section: Discussionmentioning

confidence: 71%

“…we perform in open surgery, with the aim of reaching a comparable leak rate. 30 Interestingly, a similar anastomosis has been chosen also by the surgical team from Mainz, one of the European leading groups for robotic esophageal surgery. In a recent paper, these authors reported for their 28 mm end-to-side circular stapled anastomosis a leak rate of around 10% in a series of more than 200 Ivor-Lewis esophagectomies.…”

Section: Discussionmentioning

confidence: 99%

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Robotic versus open Ivor–Lewis esophagectomy: A more accurate lymph node dissection without burdening the leak rate

Weindelmayer

Pasqual

Turolo

et al. 2023

Journal of Surgical Oncology

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Background Robotic‐assisted minimally invasive esophagectomy (RAMIE) combines the beneficial effects of minimally invasive surgery on postoperative complications, especially on pulmonary ones, with the safety of the anastomosis performed in open surgery. Moreover, RAMIE could allow a more accurate lymphadenectomy. Methods We reviewed our database to identify all patients with adenocarcinoma of the esophagus treated by Ivor–Lewis esophagectomy in the period January 2014 to June 2022. Patients were divided according to the thoracic approach into RAMIE and open esophagectomy (OE) groups. We compared the groups for early surgical outcomes, 90‐day mortality as well as R0 rate, and the number of lymph nodes harvested. Results We identified 47 patients in RAMIE and 159 patients in the OE group. Baseline characteristics were comparable. Operative time was significantly longer for RAMIE procedures (p < 0.01); however, we did not observe the difference in overall (RAMIE 55.5% vs. OE 61%, p = 0.76) and severe complications rate (RAMIE 17% vs. OE 22.6%, p = 0.4). The anastomotic leak rate was 2.1% after RAMIE and 6.9% after OE (p = 0.56). We did not report the difference in 90‐day mortality (RAMIE 2.1% vs. OE 1.9%, p = 0.65). In the RAMIE group, we observed a significantly higher number of thoracic lymph nodes harvested, with a median of 10 lymph nodes in the RAMIE group versus 8 in the OE group (p < 0.01). Conclusions In our experience, RAMIE has morbimortality rates comparable to OE. Moreover, it allows a more accurate thoracic lymphadenectomy which results in a higher thoracic lymph nodes retrieval rate.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Robotic versus open Ivor–Lewis esophagectomy: A more accurate lymph node dissection without burdening the leak rate

Weindelmayer

Pasqual

Turolo

et al. 2023

Journal of Surgical Oncology

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“…Comparing the use of single versus two chest drains after oesophagectomy, retrospective studies 50–52 have suggested equivalence in terms of respiratory complications, but a reduction in pain scores with fewer drains 50 , 51 . Similarly, transhiatal drain placement may result in lower pain scores and analgesia use 52–54 , without any significant differences in respiratory or other complications.…”

Section: Resultsmentioning

confidence: 99%

Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS)/Perioperative Quality Initiative (POQI) consensus statement on intraoperative and postoperative interventions to reduce pulmonary complications after oesophagectomy

Singh

Gossage

Markar

et al. 2022

British Journal of Surgery

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Background Pulmonary complications are the most common morbidity after oesophagectomy, contributing to mortality and prolonged postoperative recovery, and have a negative impact on health-related quality of life. A variety of single or bundled interventions in the perioperative setting have been developed to reduce the incidence of pulmonary complications. Significant variation in practice exists across the UK. The aim of this modified Delphi consensus was to deliver clear evidence-based consensus recommendations regarding intraoperative and postoperative care that may reduce pulmonary complications after oesophagectomy. Methods With input from a multidisciplinary group of 23 experts in the perioperative management of patients undergoing surgery for oesophageal cancer, a modified Delphi method was employed. Following an initial systematic review of relevant literature, a range of anaesthetic, surgical, and postoperative care interventions were identified. These were then discussed during a two-part virtual conference. Recommendation statements were drafted, refined, and agreed by all attendees. The level of evidence supporting each statement was considered. Results Consensus was reached on 12 statements on topics including operative approach, pyloric drainage strategies, intraoperative fluid and ventilation strategies, perioperative analgesia, postoperative feeding plans, and physiotherapy interventions. Seven additional questions concerning the perioperative management of patients undergoing oesophagectomy were highlighted to guide future research. Conclusion Clear consensus recommendations regarding intraoperative and postoperative interventions that may reduce pulmonary complications after oesophagectomy are presented.

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“…Determination of amylase in the pleural fluid may be useful in assessing the integrity of an esophageal anastomosis, and successive evaluation of amylase on the 5 th to the 7 th postoperative day may be a method of detecting anastomotic leaks (33). Some authors claim that the anastomotic drain has a limited sensibility in leaks diagnosis and cannot replace the clinical signs and symptoms (34).…”

Section: Intraoperative Placement Of the Perianastomotic Drainage Tubementioning

confidence: 99%

“…Patients with extensive devitalization of the esophagus, with large anastomotic fistulas or an unviable gastric tube, are not suitable for endoscopic stenting. If perianastomotic and pleural drainage is inadequate or it was removed before the leakage becomes visible, additional drainage tubes may be required under thoracoscopic or CT guidance (34).…”

Section: Intraoperative Placement Of the Perianastomotic Drainage Tubementioning

confidence: 99%

Postoperative Esophageal Leaks in Malignant Pathology - Optimal Management: A Systematic Review

Bîrlă¹,

Hoara²,

Dinu³

et al. 2019

chr

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Introducere: Fistulele esofagiene postoperatorii reprezintã una dintre importantele cauze de mortalitate şi morbiditate postoperatorie. Scopul acestui studiu a fost de a revizui cunoştinţele actuale cu privire la metodele actuale de diagnostic şi management al fistulelor esofagiene postoperatorii Metodă: O căutare sistematică a literaturii a fost efectuată în baza de date PubMed/Medline folosind termenii "fistule esofagiene postoperatorii" şi "complicaţii postesofagectomie" pentru a identifica articole relevante pentru diagnosticul actual şi tratamentul profilactic şi curativ al fistulelor anastomotice postesofagectomie. Rezultate: Mai multe lucrări au arătat că incidenţa fistulelor variază şi este dependentă de mai mulţi factori: localizarea anastomozei, tipul de sutură utilizat, condiţia biologică a pacientului. Datorită gravităţii fistulei anastomotice mediastinale se acordă actual o mare importanţă metodelor de prevenire a apariţiei sale prin testarea intraoperatorie sau îmbunătăţirea vascularizaţiei tubului gastric. Cele mai recente articole prezintă metodele endoscopice de tratament al acestei complicaţii prin utilizarea stenturilor esofagiene acoperite şi a terapiei endoluminale cu vacuum. Concluzii: La pacienţii cu fistule esofagiene postoperatorii mediastinale, diagnosticul şi managementul reprezintă o adevărată provocare pentru echipa chirurg-endoscopist-terapeut. Diagnosticarea precoce şi instituirea unei terapii optime care să se adreseze defectului parietal şi statusului biologic a pacientului sunt condiţii obligatorii pentru rezolvarea acestei complicaţii postoperatorii.

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Perianastomotic drainage in Ivor-Lewis esophagectomy, does habit affect utility? An 11-year single-center experience

Cited by 9 publications

References 23 publications

Robotic versus open Ivor–Lewis esophagectomy: A more accurate lymph node dissection without burdening the leak rate

Robotic versus open Ivor–Lewis esophagectomy: A more accurate lymph node dissection without burdening the leak rate

Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS)/Perioperative Quality Initiative (POQI) consensus statement on intraoperative and postoperative interventions to reduce pulmonary complications after oesophagectomy

Postoperative Esophageal Leaks in Malignant Pathology - Optimal Management: A Systematic Review

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