Zero Leaks With Minimally Invasive Esophagectomy: a Team-Based Approach

Khithani, Amit; Jay, Jonathan; Galanopoulos, Christos; Curtis, David E.; A, Vo; Dr, Jeyarajah

doi:10.4293/108680809x12589998404326

Cited by 7 publications

(25 citation statements)

References 15 publications

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“…The 30‐day mortality was zero in our series. Both morbidity and mortality in our initial experience with minimally invasive Ivor Lewis esophagectomy compares positively with previously published series that have reported morbidity and mortality ranging from 14 to 77% and 0 to 6.8%, respectively 4–12,14–17 . The above data support that the initial experience or transition period in carrying out a minimally invasive Ivor Lewis esophagectomy can be done with minimal morbidity and mortality.…”

Section: Discussionsupporting

confidence: 83%

A preliminary experience with minimally invasive Ivor Lewis esophagectomy

Tapias

Morse

2011

Diseases of the Esophagus

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With several small series examining minimally invasive Ivor Lewis esophagectomies, we look to contribute to a growing experience. In reporting our initial results, safety, initial oncologic completeness, and preliminary outcomes with a minimally invasive Ivor Lewis esophagectomy were demonstrated. From 2007 to 2010, 40 minimally invasive Ivor Lewis esophagectomies were carried out. The approach was a laparoscopic mobilization of the stomach and a thoracoscopic esophageal mobilization and creation of a high intrathoracic anastomosis. Indications included esophageal cancer in 39 patients and esophageal gastrointestinal stromal tumor in one patient. Median age was 62 (range 39-77) with 31 (78%) male patients. Non-emergent conversion was required in two (5%) patients. Twenty-five (63%) patients underwent neoadjuvant therapy. Mean operative time was 364 minutes (range 285-455), and mean blood loss was 205 cc (range 100-400). All patients underwent an R0 resection including the removal of all Barrett's esophagus, and mean number of nodes harvested was 21 (range 11-41). Median intensive care unit stay was 1 day (range 1-3), and hospital stay was 7 days (range 6-19). There were no anastomotic leaks and no 30-day mortality. Postoperative complications included eight (21%) patients with atrial fibrillation and two (5%) chylothorax, one requiring ligation. At a mean follow-up of 16.5 months (range 1-39 months), five (13%) patients have had a distant recurrence; there have been no local recurrences. Minimally invasive Ivor Lewis esophagectomy, although technically challenging, can be carried out with reasonable operative times, a short length of stay, and minimal complication. Final oncologic validity is pending longer follow-up and a larger series.

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Section: Discussionsupporting

confidence: 83%

A preliminary experience with minimally invasive Ivor Lewis esophagectomy

Tapias

Morse

2011

Diseases of the Esophagus

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“…As of current, follow‐up data show that no patients have required endoscopic intervention procedures. These data support that the initial experience of carrying out a minimally invasive gastric ischemic devascularization procedure can be done with favorably comparable rates of conduit morbidity and mortality 21–23 …”

Section: Discussionsupporting

confidence: 58%

“…To our knowledge, a significant limitation to our study is that no true analogous data exists to compare LIC procedures followed by delayed esophageal resection via thoracotomy (without a tubularized gastric conduit) for esophageal replacement in terms of morbidity and mortality. Although not congruent procedures, previously published series of single‐stage minimally invasive esophagectomy that have reported morbidity and mortality range from 14 to 77% and 0 to 6.8%, respectively 17,21–33 . Again, it should be distinguished that the primary purpose of this study was to evaluate our data in line with assessing feasibility, safety, and initial oncologic completeness.…”

Section: Discussionmentioning

confidence: 94%

“…These data support that the initial experience of carrying out a minimally invasive gastric ischemic devascularization procedure can be done with favorably comparable rates of conduit morbidity and mortality. [21][22][23] In spite of the fact that there is no general consensus regarding specific definitions of surgical complications, it is well understood that esophagectomy procedures classically hold higher rates of morbidity and mortality. Expanded classification of our data revealed that 25% of patients experienced no complications, and 28% of patients experienced an expanse of complications that required endoscopic, interventional, or reoperation procedures without general anesthesia to operative management with general anesthesia and also included the most severe complications (multisystem organ failure and death).…”

Section: (33%)mentioning

confidence: 99%

“…Although not congruent procedures, previously published series of singlestage minimally invasive esophagectomy that have reported morbidity and mortality range from 14 to 77% and 0 to 6.8%, respectively. 17,[21][22][23][24][25][26][27][28][29][30][31][32][33] Again, it should be distinguished that the primary purpose of this study was to evaluate our data in line with assessing feasibility, safety, and initial oncologic completeness. We maintain that our initial experience supports that carrying out an LIC procedure in a two-stage procedure with esophagectomy can be done with acceptable morbidity and mortality.…”

Section: (33%)mentioning

confidence: 99%

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Laparoscopic ischemic conditioning of the stomach prior to esophagectomy

Yetasook

Leung

Howington

et al. 2012

Diseases of the Esophagus

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Several complications after esophagectomy with gastric pull-up are associated with ischemia within the gastric conduit. The aim of this study is to assess the feasibility of laparoscopic ischemic preconditioning of the stomach prior to thoracotomy, esophagectomy, and gastric pull-up with an intrathoracic anastomosis. A retrospective review of 24 consecutive patients between October 2008 and July 2011 with esophageal adenocarcinoma (stage I-III) undergoing laparoscopic gastric ischemic conditioning prior to esophagectomy was conducted. Conditioning included laparoscopic ligation of the left and short gastric arteries, celiac node dissection, and jejunostomy tube placement. Formal resection and reconstruction was then performed 4-10 days later. Of the 24 patients, 88% received neoadjuvant chemotherapy/radiation therapy. Twenty-three of the 24 patients underwent successful laparoscopic ischemic conditioning and subsequent esophagectomy. Total mean number of lymph nodes harvested was 21.8 (±8.0), and a mean of 5.3 (±2.4) celiac lymph nodes identified. There were no conversions to an open procedure. Length of stay was 3.8 (±4.8) days with a median length of stay of 2 (1-24) days. Three patients experienced anastomotic leak, six patients experience delayed gastric emptying, and two patients developed anastomotic stricture. There were no surgical site infections. R0 resection was achieved in all patients who underwent laparoscopic ischemic conditioning followed by esophagectomy. Laparoscopic ischemic conditioning of the gastric conduit has been shown to be feasible and safe.

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