DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20150325

Minimally invasive esophageal surgery-standard of care-our experience

Snigdha Patnaik, Sujit Chyau Patnaik

Abstract


Background: Surgery is the most effective treatment for the resectable esophageal cancer of the middle & lower third and gastro-esophageal junction (GEJ) tumors. We hereby scrutinise our experience in minimally invasive esophageal surgery (MIES) to evaluate its safety and efficacy as an oncosurgical procedure.

Methods: The study included99consecutive patients. Depending on the location of the tumor, either thoracoscopic transthoracic esophagectomy (TTE) in prone position or laparoscopic transhiatal esophagectomy (THE) was planned. 2 field comprehensive nodal dissection were part of both the surgical procedures.

Results: 05 patients were excluded, 18 were inoperable and 12 had open surgery.

64 underwent MIES (THE-37, TTE-27), Male: Female-31:33. Nodal Harvest (nodes): THE-14.27, TTE-14.77. Margins (cm): THE-proximal (P) - 6.70, distal (D) -2.51, TTE: (P)-5.41, (D)-5.11.

30 days Morbidity (26): cervical leak-05, left vocal cord palsy-05, tracheostomy-03, respiratory insufficiency-03, aspiration-01, chyle leak-01, exploratory laparotomy-01, cardiac-02, stroke-01, surgical emphysema -01, abdominal wound Infection -03

30 days Mortality (1) –pulmonary embolus. Operative time (minutes): THE-234, TTE-322. Blood loss (ml/patient): THE-265, TTE-380. Hospital stays (days): THE-7.3, TTE-10.

Conclusions: 79% of properly selected & evaluated cases underwent MIES, with one Mortality and 26 events of morbidity.  6% required conversion. The procedure detected inoperability in 16% cases. The nodal yield, status of margins, operative time, blood loss and hospital stay indicates that MIES has a future to become a standard of care in the treatment of esophageal cancers.

 


Keywords


MIES, Cancer esophagus, GEJ, Nodal dissection, Margins

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References


Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence mortality and prevalence across five continents. J Clin Oncol. 2006;24:2137–50.

Cherian JV, Sivaraman R, Muthusamy AK, et al. Carcinoma of the esophagus in Tamil Nadu (South India): 16-year trends from a tertiary center. J Gastrointestin Liver Dis. 2007;16:245-9.

Butler N, Collins S, Memon B, Memon MA. Minimally invasive oesophagectomy- current status and future direction. Surg Endosc. 2011;25:2071–83.

Verhage RJJ, Hazebroek EJ, Boone J, et al. Minimally invasive surgery compared to open procedures in esophagectomy for cancer: a systematic review of the literature. Minerva Chirurgica. 2009;64:135–46.

Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;19(379):1887-92.

DeGraaf GW, Ayantunde AA, Parsons SL, et al. The role of staging laparoscopy in oesophagogastric cancers. Eur J SurgOncol. 2007;33:988-92.

Veeramachaneni NK, Zoole JB, Decker PA, et al. Lymph node analysis in esophageal resection: American College of Surgeons Oncology Group Z0060 trial. Ann Thorac Surg. 2008;86:418-21.

Law S, Arcilla C, Chu KM, et al. The significance of histologically infiltrated resection margin after esophagectomy for esophageal cancer. Am J Surg. 1998;176:286-90.

Barbour AP, Rizk NP, Gonen M, et al. Adenocarcinoma of the gastroesophageal junction: influence of esophageal resection margin and operative approach on outcome. Ann Surg. 2007;246:1-8.

Rizk NP, Bach PB, Schrag D, Bains MS, et al. The impact of complications on outcomes after resection of for esophageal and gastro esophageal junction carcinoma. J Am Coll Surg. 2010;198:42–50.

Sharma S. Management of Complications of Radical Esophagectomy Indian J Surg Oncol. 2013;4(2):105-11.

Inoue J, Ono R, Makiura D, et al. Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer. Dis Esophagus.