Krashna Patel1, Alan Askari2, Omar Abbassi3, Naga Venkatesh Jayanthi3, Oliver Claydon4, James Laycock4, Aravindh Ramalingam4, Bhaskar Kumar4, Joshua Wong2, Mohamed Aly2, Periyathambi Jambulingam2. 1. Essex Upper GI, Regional Centre for Oesophagogastric Surgery, Broomfield Hospital, Court Road, Broomfield, Chelmsford, CM1 7ET, UK. krashna@doctors.org.uk. 2. Upper GI Cancer Centre, Watford General Hospital, Vicarage Road, Watford, UK. 3. Essex Upper GI, Regional Centre for Oesophagogastric Surgery, Broomfield Hospital, Court Road, Broomfield, Chelmsford, CM1 7ET, UK. 4. The Department of Upper Gastrointestinal (UGI) Surgery, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, UK.
Abstract
BACKGROUND: Limited robust evidence exists comparing outcomes following completely minimally invasive oesophagectomy (CMIO) to hybrid oesophagectomy (HO) in the treatment of resectable oesophageal and gastro-oesophageal junctional (GOJ) cancer. This multi-centre study aims to assess postoperative morbidity between HO and CMIO according to the full Esophagectomy Complications Consensus Group (ECCG) complication platform. METHODS: All consecutive patients undergoing an Ivor-Lewis HO or Ivor-Lewis CMIO for cancer between 2016 and 2018 in three UK tertiary centres were included. The primary study outcome was 30-day overall complications, evaluated by the ECCG complication subgroups. Secondary outcomes included survival outcomes and perioperative parameters between the two approaches. RESULTS: Of the 382 patients included, 228 (59.7%) patients had HOs and 154 (40.3%) patients had CMIOs with no inter-group baseline differences. Patients undergoing CMIO experienced less 30-day postoperative complications compared to those under undergoing HO (43.5% vs 57.0%, p = 0.010). ECCG defined pulmonary and infective complications were less frequent in the CMIO group. Anastomotic leak rates and oncological outcomes were similar between the two groups. Independent predictors of 30-day postoperative complications include surgical approach with HO and high ASA grade on multivariable analysis. CONCLUSIONS: Ivor-Lewis CMIO demonstrates superior short-term surgical outcomes when compared to Ivor-Lewis HO with no compromise in oncological feasibility. Anastomotic leak rates were equivalent between both groups. A robust randomised controlled trial is required to validate the findings of this study.
BACKGROUND: Limited robust evidence exists comparing outcomes following completely minimally invasive oesophagectomy (CMIO) to hybrid oesophagectomy (HO) in the treatment of resectable oesophageal and gastro-oesophageal junctional (GOJ) cancer. This multi-centre study aims to assess postoperative morbidity between HO and CMIO according to the full Esophagectomy Complications Consensus Group (ECCG) complication platform. METHODS: All consecutive patients undergoing an Ivor-Lewis HO or Ivor-Lewis CMIO for cancer between 2016 and 2018 in three UK tertiary centres were included. The primary study outcome was 30-day overall complications, evaluated by the ECCG complication subgroups. Secondary outcomes included survival outcomes and perioperative parameters between the two approaches. RESULTS: Of the 382 patients included, 228 (59.7%) patients had HOs and 154 (40.3%) patients had CMIOs with no inter-group baseline differences. Patients undergoing CMIO experienced less 30-day postoperative complications compared to those under undergoing HO (43.5% vs 57.0%, p = 0.010). ECCG defined pulmonary and infective complications were less frequent in the CMIO group. Anastomotic leak rates and oncological outcomes were similar between the two groups. Independent predictors of 30-day postoperative complications include surgical approach with HO and high ASA grade on multivariable analysis. CONCLUSIONS: Ivor-Lewis CMIO demonstrates superior short-term surgical outcomes when compared to Ivor-Lewis HO with no compromise in oncological feasibility. Anastomotic leak rates were equivalent between both groups. A robust randomised controlled trial is required to validate the findings of this study.
Authors: Conor F Murphy; Talulla Dunne; Jessie A Elliott; Sivesh K Kamarajah; James Leighton; Richard P T Evans; James Bundred; Sinead King; Narayanasamy Ravi; Claire L Donohoe; S Michael Griffin; Ewen A Griffiths; Alexander W Phillips; John V Reynolds Journal: Ann Surg Date: 2021-12-01 Impact factor: 12.969
Authors: Marianne C Kalff; Eivind Gottlieb-Vedi; Rob H A Verhoeven; Hanneke W M van Laarhoven; Jesper Lagergren; Suzanne S Gisbertz; Sheraz R Markar; Mark I van Berge Henegouwen Journal: Ann Surg Date: 2021-08-04 Impact factor: 12.969
Authors: Rachel C Brierley; Daisy Gaunt; Chris Metcalfe; Jane M Blazeby; Natalie S Blencowe; Marcus Jepson; Richard G Berrisford; Kerry N L Avery; William Hollingworth; Caoimhe T Rice; Aida Moure-Fernandez; Newton Wong; Joanna Nicklin; Anni Skilton; Alex Boddy; James P Byrne; Tim Underwood; Ravi Vohra; James A Catton; Kish Pursnani; Rachel Melhado; Bilal Alkhaffaf; Richard Krysztopik; Peter Lamb; Lucy Culliford; Chris Rogers; Benjamin Howes; Katy Chalmers; Sian Cousins; Jackie Elliott; Jenny Donovan; Rachael Heys; Robin A Wickens; Paul Wilkerson; Andrew Hollowood; Christopher Streets; Dan Titcomb; Martyn Lee Humphreys; Tim Wheatley; Grant Sanders; Arun Ariyarathenam; Jamie Kelly; Fergus Noble; Graeme Couper; Richard J E Skipworth; Chris Deans; Sukhbir Ubhi; Robert Williams; David Bowrey; David Exon; Paul Turner; Vinutha Daya Shetty; Ram Chaparala; Khurshid Akhtar; Naheed Farooq; Simon L Parsons; Neil T Welch; Rebecca J Houlihan; Joanne Smith; Rachel Schranz; Nicola Rea; Jill Cooke; Alexandra Williams; Carolyn Hindmarsh; Sally Maitland; Lucy Howie; Christopher Paul Barham Journal: BMJ Open Date: 2019-11-19 Impact factor: 2.692
Authors: M M K Veenstra; B M Smithers; E Visser; D Edholm; S Brosda; J M Thomas; D C Gotley; I G Thomson; B P L Wijnhoven; A P Barbour Journal: BJS Open Date: 2021-01-08