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

Batırel, Hasan Fevzi

doi:10.3389/fsurg.2022.844796

Cited by 3 publications

(4 citation statements)

References 17 publications

(20 reference statements)

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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: 59%

“…Batirel (3), in his preliminary series on 18 Uniportal-VATS esophagectomy (16 Ivor-Lewis and 2 McKeown), reported a mean number 23 ± 8 lymph nodes, with a mean VATS time of 82 ± 22 min. Three patients developed a leak (2 in the thorax and Furthermore, while all the previous papers dealt with only short-term outcomes, we also compared long-term oncological outcomes, with a median FUP period of 42 months.…”

Section: Discussionmentioning

confidence: 99%

“…In this scenario and in the field of MIE, the role of Uniportal-Video assisted Thoracic Surgery (VATS) esophagectomy is even more debated and right now very limited reports (mainly cases series with short-term results or surgical technique papers) are available to can address this point (3,4).…”

Section: Introductionmentioning

confidence: 99%

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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: 59%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Nachira

Congedo²,

Calabrese³

et al. 2023

Front. Surg.

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“…Furthermore, the Uniportal-access gives the surgeons the possibility to have a good exposure (of lesions either of anterior that posterior mediastinum), to introduce several instruments at the same time (as ring forceps for grasping the lesions, dissectors and energy-devices), with the same hand-eye coordination as in open surgery (18). Uniportal-VATS requires good skills in thoracoscopy and dexterity but, in the hands of expert surgeons, it is a safe and feasible approach (19), as it seems to be also for chest wall lesions, allowing fast recovery to patient, low post-operative pain and good cosmetic results (20).…”

Section: Discussionmentioning

confidence: 99%

Uniportal-video-assisted thoracoscopic surgery (VATS) resection of multiple left thoracic neurofibromas: a case report

Napolitano¹,

Nachira²,

Vita³

et al. 2023

Shanghai Chest

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Background: Mediastinal and chest wall tumors include a huge variety of tumors, often related to syndromes. Neurofibromatosis is a heterogenic group of diseases; patient affected by neurofibromatosis type 1 (NF1) can develop several manifestations, including thoracic masses, and their symptoms can variate related to dimension. Surgical treatment may be challenging and often performed by invasive approaches.Thoracoscopic approach in this this kind of tumors is always challenging, due to lesions size and possible chest wall infiltration. Only few cases are described in literature, approached by highly invasive surgery (thoracotomy, sternotomy) and only one by minimally invasive surgery [triportal video-assisted thoracoscopic surgery (VATS)].Case Description: We report the first case of uniportal-VATS resection of multiple left thoracic neurofibromas in a 40-year-old patient, affected by NF1, with good surgical outcomes and with a fast and safe post-operative recovery. Indeed, chest tube was removed on the second post-operative day, with normal chest X-ray at discharge. Conclusions: Uniportal-VATS approach seems to be a safe, and feasible procedure for surgical treatment of mediastinal and chest wall pathologies, including neurofibromas. It requires good skills in thoracoscopy but, in the hands of expert surgeons, it is a safe and valuable approach. Experienced surgeons with good skills in minimally invasive surgery are required.

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Uniportal video-assisted thoracic surgery Ivor-Lewis oesophagectomy with circular stapling anastomosis

Nachira,

Biondi,

D’Ugo

et al. 2024

Journal of Minimal Access Surgery

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Amongst all minimally invasive oesophagectomies, uniportal video-assisted thoracic surgery (VATS) Ivor-Lewis remains the most challenging procedure due to the skills required for performing the intrathoracic anastomosis. We present an easy and safe circular stapling latero-terminal anastomosis for performing uniportal VATS Ivor-Lewis. The patient had an uneventful post-operative recovery and was disease-free 9 months after surgery.

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

Cited by 3 publications

References 17 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-video-assisted thoracoscopic surgery (VATS) resection of multiple left thoracic neurofibromas: a case report

Uniportal video-assisted thoracic surgery Ivor-Lewis oesophagectomy with circular stapling anastomosis

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