Benedetto Mungo1, Anne O Lidor2, Miloslawa Stem2, Daniela Molena3. 1. Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Blalock 240, Baltimore, MD, 21287, USA. 2. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 3. Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Blalock 240, Baltimore, MD, 21287, USA. dmolena2@jhmi.edu.
Abstract
BACKGROUND: Minimally invasive esophagectomy (MIE) is gaining increasing popularity in the treatment of esophageal cancer. In fact, while surgical and oncologic outcomes are not inferior to those achieved through a traditional open approach, patients undergoing MIE benefit from shorter length of stay, lesser pain and prompter recovery. This technique is, however, highly challenging, and the development of a MIE program, even in the setting of a tertiary center, requires time and progressive honing of surgical skills. METHODS: We use a minimally invasive Ivor Lewis approach. The abdominal phase of the procedure includes complete celiac lymphadenectomy and tubularization of the stomach, which will constitute the neo-esophagus. The video-assisted thoracoscopic surgery portion of the operation takes place in left lateral decubitus and allows for optimal thoracic lymphadenectomy and anastomosis. RESULTS: From October 2011 to January 2015, we treated 52 patients with the above-described procedure. The evolution of our anastomotic technique included a first group of circular stapled anastomosis with Orvil™ and 3.5-mm EEA™ (n = 16 patients), subsequently abandoned in favor of a linear anastomosis (n = 12), before going back to the Orvil™ coupled with 4.8-mm EEA™ (n = 22) in more recent times. There were also an additional two anastomoses that did not fall under any of these categories. We experienced two postoperative deaths. The overall leak rate was 14%, but fell down to 4% in the last group. Median LOS was 9 days. Lymph node retrieval was adequate throughout the whole series. CONCLUSIONS: Developing a MIE program requires a significant learning curve before the results plateau. Only once a technique of choice is refined and mastered, the advantages granted by MIE become apparent.
BACKGROUND: Minimally invasive esophagectomy (MIE) is gaining increasing popularity in the treatment of esophageal cancer. In fact, while surgical and oncologic outcomes are not inferior to those achieved through a traditional open approach, patients undergoing MIE benefit from shorter length of stay, lesser pain and prompter recovery. This technique is, however, highly challenging, and the development of a MIE program, even in the setting of a tertiary center, requires time and progressive honing of surgical skills. METHODS: We use a minimally invasive Ivor Lewis approach. The abdominal phase of the procedure includes complete celiac lymphadenectomy and tubularization of the stomach, which will constitute the neo-esophagus. The video-assisted thoracoscopic surgery portion of the operation takes place in left lateral decubitus and allows for optimal thoracic lymphadenectomy and anastomosis. RESULTS: From October 2011 to January 2015, we treated 52 patients with the above-described procedure. The evolution of our anastomotic technique included a first group of circular stapled anastomosis with Orvil™ and 3.5-mm EEA™ (n = 16 patients), subsequently abandoned in favor of a linear anastomosis (n = 12), before going back to the Orvil™ coupled with 4.8-mm EEA™ (n = 22) in more recent times. There were also an additional two anastomoses that did not fall under any of these categories. We experienced two postoperative deaths. The overall leak rate was 14%, but fell down to 4% in the last group. Median LOS was 9 days. Lymph node retrieval was adequate throughout the whole series. CONCLUSIONS: Developing a MIE program requires a significant learning curve before the results plateau. Only once a technique of choice is refined and mastered, the advantages granted by MIE become apparent.
Authors: John D Birkmeyer; Andrea E Siewers; Emily V A Finlayson; Therese A Stukel; F Lee Lucas; Ida Batista; H Gilbert Welch; David E Wennberg Journal: N Engl J Med Date: 2002-04-11 Impact factor: 91.245
Authors: Francesco Palazzo; Ernest L Rosato; Asadulla Chaudhary; Nathaniel R Evans; Jocelyn A Sendecki; Scott Keith; Karen A Chojnacki; Charles J Yeo; Adam C Berger Journal: J Am Coll Surg Date: 2014-12-27 Impact factor: 6.113
Authors: Robert James Cerfolio; Ayesha S Bryant; Cheri L Canon; Roopa Dhawan; Mohamad A Eloubeidi Journal: J Thorac Cardiovasc Surg Date: 2009-03 Impact factor: 5.209
Authors: Ankit Dhamija; Joshua E Rosen; Anish Dhamija; Bonnie E Gould Rothberg; Anthony W Kim; Frank C Detterbeck; Daniel J Boffa Journal: Innovations (Phila) Date: 2014 Jul-Aug
Authors: Surya S A Y Biere; Mark I van Berge Henegouwen; Kirsten W Maas; Luigi Bonavina; Camiel Rosman; Josep Roig Garcia; Suzanne S Gisbertz; Jean H G Klinkenbijl; Markus W Hollmann; Elly S M de Lange; H Jaap Bonjer; Donald L van der Peet; Miguel A Cuesta Journal: Lancet Date: 2012-05-01 Impact factor: 79.321
Authors: J A H Gooszen; L Goense; S S Gisbertz; J P Ruurda; R van Hillegersberg; M I van Berge Henegouwen Journal: Br J Surg Date: 2018-02-07 Impact factor: 6.939
Authors: Uberto Fumagalli; Gian Luca Baiocchi; Andrea Celotti; Paolo Parise; Andrea Cossu; Luigi Bonavina; Daniele Bernardi; Giovanni de Manzoni; Jacopo Weindelmayer; Giuseppe Verlato; Stefano Santi; Giovanni Pallabazzer; Nazario Portolani; Maurizio Degiuli; Rossella Reddavid; Stefano de Pascale Journal: World J Gastroenterol Date: 2019-01-21 Impact factor: 5.742