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Chobarporn T, Qureshi A, Hunter JG, Wood SG. Minimally Invasive Transhiatal Esophagectomy Using Antegrade Inversion Technique in Esophageal Cancer: 10-Year Experience from a Tertiary Care Center. J Laparoendosc Adv Surg Tech A 2024; 34:1119-1127. [PMID: 39441536 DOI: 10.1089/lap.2024.0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024] Open
Abstract
Background: Esophageal cancer surgery aims for curative intent but carries high complication rates. Transthoracic esophagectomy is the dominant approach, however, transhiatal esophagectomy (THE) offers selective advantages in certain clinical scenarios. Minimally invasive THE (MI-THE) is an evolving technique with limited data. Methods: This retrospective study reviewed 38 patients with esophageal cancer who underwent MI-THE using "Antegrade Inversion Technique" between 2013 and 2023 at a tertiary care center. Perioperative outcomes were analyzed. Data were presented as mean with standard deviation, median with interquartile range, and percentages. Results: Most patients (86.8%) had early-stage cancer. Median operative time was 375 minutes, hospital stay was 8 days, and intensive care unit stay was 3 days. All patients achieved a negative resection margin. Pleural effusion (57.9%) was the most common complication, followed by pneumothorax (31.6%) and surgical site infection (15.8%). Anastomotic leak rate was 13.2%. There was no mortality. Conclusions: MI-THE appears safe and feasible with encouraging perioperative outcomes, particularly for early-stage disease and high-risk patients. While potentially offering advantages over open THE, further research is needed to definitively establish its role compared to traditional approaches.
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Affiliation(s)
- Thitiporn Chobarporn
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Alia Qureshi
- Division of Gastrointestinal and General Surgery, Department of Surgery, Faculty of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - John G Hunter
- Division of Gastrointestinal and General Surgery, Department of Surgery, Faculty of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Stephanie G Wood
- Division of Gastrointestinal and General Surgery, Department of Surgery, Faculty of Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Scheduled intravenous acetaminophen versus continuous intravenous fentanyl in postoperative analgesia following McKeown esophagectomy with thoracotomy and laparotomy: A pilot study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kvasha A, Khalifa M, Biswas S, Farraj M, Bramnik Z, Waksman I. Novel Transgastric Endoluminal Segmental Esophagectomy and Primary Anastomosis Technique: A Hybrid Transgastric Thoracoscopic Esophagectomy for the Treatment of High Grade Dysplasia and Early Esophageal Cancer in a Porcine Ex vivo Model. Front Surg 2021; 8:676031. [PMID: 34277694 PMCID: PMC8280354 DOI: 10.3389/fsurg.2021.676031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Multiple modalities are currently employed in the treatment of high grade dysplasia and early esophageal carcinoma. While they are the subject of ongoing investigation, surgery remains the definitive modality for oncological resection. Esophagectomy, however, is traditionally a challenging surgical procedure and carries a significant incidence of morbidity and mortality. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are considerably less invasive alternatives to esophagectomy in the diagnosis and treatment of high grade dysplasia, early esophageal squamous cell carcinoma and adenocarcinoma. However, many early esophageal cancer patients, with favorable histology, who could benefit from endoscopic resection, are referred for formal esophagectomy due to lesion characteristics such as unfavorable lesion morphology or recurrence after previous endoscopic resection. In this study we present a novel, hybrid thoracoscopic transgastric endoluminal segmental esophagectomy with primary anastomosis for the potential treatment of high grade dysplasia and early esophageal cancer in a porcine ex vivo model as a proposed bridge between endoscopic resection and the relatively high mortality and morbidity formal esophagectomy procedure. The novel technique consists of thoracoscopic esophageal mobilization in addition to transgastric endoluminal segmental esophagectomy and anastomosis utilizing a standard circular stapler. The technique was found feasible in all experimental subjects. The minimally invasive nature of this novel procedure as well as the utility of basic surgical equipment and surgical skill is an important attribute of this method and can potentially make it a treatment option for many patients who would otherwise be referred for a formal esophagectomy.
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Affiliation(s)
- Anton Kvasha
- Ziv Medical Center, Safed, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Tzfat, Israel
| | - Muhammad Khalifa
- Ziv Medical Center, Safed, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Tzfat, Israel
| | | | - Moaad Farraj
- The Azrieli Faculty of Medicine, Bar-Ilan University, Tzfat, Israel.,The Baruch Padeh Medical Center, Tiberias, Israel
| | - Zakhar Bramnik
- The Azrieli Faculty of Medicine, Bar-Ilan University, Tzfat, Israel.,The Baruch Padeh Medical Center, Tiberias, Israel
| | - Igor Waksman
- The Azrieli Faculty of Medicine, Bar-Ilan University, Tzfat, Israel.,Galilee Medical Center, Nahariya, Israel
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4
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Davoodvandi A, Shabani Varkani M, Clark CCT, Jafarnejad S. Quercetin as an anticancer agent: Focus on esophageal cancer. J Food Biochem 2020; 44:e13374. [PMID: 32686158 DOI: 10.1111/jfbc.13374] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/09/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022]
Abstract
Esophageal cancer (EC) is regarded as the sixth highest contributor to all cancer-related mortality, worldwide. In spite of advances in the treatment of EC, currently used methods remain ineffective. Quercetin, as a dietary antioxidant, is a plant flavonol from the flavonoid group of polyphenols, and can be found in numerous vegetables, fruits, and herbs. Quercetin can affect the processes of cancer-related diseases via cell proliferation inhibitory effects, potential apoptosis effects, and antioxidant properties. Of the various types of cancer, the use of quercetin has now become prominent in the treatment of EC. In this review, we discuss how quercetin may be an important supplement for the prevention, treatment, and management of EC, owing to its natural origin, and low-cost relative to synthetic cancer drugs. However, most findings cited in the current study are based on in vitro and in vivo studies, and thus, further human-based research is necessitated. PRACTICAL APPLICATIONS: In spite of advances in the treatment of esophageal cancer, currently used methods remain ineffective, therefore, an alternative or complementary therapy is required. Quercetin, as a dietary antioxidant, can affect the processes of cancer-related diseases via cell proliferation inhibitory effects, potential proapoptotic functions, and antioxidant properties. Quercetin may be an important supplement for the prevention, treatment, and management of EC, owing to its natural origin. The low cost of quercetin as supplement or dietary intake, relative to synthetic cancer drugs, is an advantage of the compound which should be considered.
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Affiliation(s)
- Amirhossein Davoodvandi
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran.,Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Cain C T Clark
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Sadegh Jafarnejad
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
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Transition from open to minimally invasive en bloc esophagectomy can be achieved without compromising surgical quality. Surg Endosc 2020; 35:3067-3076. [PMID: 32556773 DOI: 10.1007/s00464-020-07696-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND En bloc esophagectomy results in higher lymph node (LN) retrieval than standard esophagectomy. Minimally invasive esophagectomy (MIE) has gained traction due to improved short-term outcomes, but many large series report LN yields well below the international benchmark of 23. We sought to determine if an established approach to open en bloc resection can be safely transferred to MIE using LN yield as a quality benchmark. METHODS An open approach to en bloc esophagectomy (OE) was established over 5 years (~ 300 cases) before en bloc MIE was introduced in 2010. Patients undergoing curative-intent en bloc Ivor-Lewis and McKeown esophagectomy for cancer from 2010 to 2019 by a single surgeon with formal minimally invasive surgery training were identified from a prospectively collected database. Mann-Whitney U and χ2 tests and cumulative sum analysis were used for statistical analysis. "Failure" was defined as LN yield less than AJCC's 8th edition guidelines: 10 LNs for pT1 cancers, 20 for pT2 and 30 for pT3-4. RESULTS A total of 269 esophageal resections met inclusion criteria [193(72%) OE; 76(28%) MIE]. Age, sex, BMI and comorbidities were comparable between groups. Tumors were larger and more often locally advanced in OE. Median LN retrieval was sufficient by international standards in both groups [OE:34(27-46); MIE:28(22-39); p = 0.01]. "Failures" occurred in 33(17%) of OE and 12(16%) MIE cases (p = 0.63). No learning effect was observed for LN yield. R0 resection rate was comparable [OE:191(99%); MIE:73(96%); p = 0.90]. Operative time was longer for MIE [275(246-300)] than OE [240(210-270) minutes], p < 0.0001, while estimated blood loss (OE:350(250-500)mL; MIE:300(200-400)mL; p = 0.02] and length of stay [OE:8(6-13); MIE7(6-9) days; p = 0.02] were higher for OE. Morbidity and mortality were comparable between groups and LN yield did not impact survival. CONCLUSIONS Under appropriate conditions, an established approach to open en bloc esophagectomy can be safely transferred to MIE without compromising surgical quality.
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Li ZY, Li HF, Zhang YY, Zhang XL, Wang B, Liu JT. Value of long non-coding RNA Rpph1 in esophageal cancer and its effect on cancer cell sensitivity to radiotherapy. World J Gastroenterol 2020; 26:1775-1791. [PMID: 32351293 PMCID: PMC7183868 DOI: 10.3748/wjg.v26.i15.1775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/23/2020] [Accepted: 03/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageal cancer is a common digestive tract tumor that is generally treated with radiotherapy. Poor responses to radiotherapy in most patients generally result in local radiotherapy failure, so it is essential to find new radiosensitizers that can enhance the response of cancer cells to radiotherapy and improve the survival of esophageal cancer patients with radiation resistance. The long non-coding RNA (lncRNA) Rpph1 is highly expressed in human gastric cancer tissues, and represses breast cancer cell proliferation and tumorigenesis. However, the expression of lncRNA Rpph1 in esophageal cancer and its relationship with radio-sensitivity has not been studied.
AIM To explore the value of lncRNA Rpph1 in esophageal cancer and its effect on cancer cell sensitivity to radiotherapy.
METHODS Eighty-three patients with esophageal cancer admitted to Qilu Hospital of Shandong University and 90 healthy participants who received physical examinations were collected as research participants. The expression of Rpph1 was determined by qRT-PCR. siRNA-NC and siRNA-Rpph1 were transfected into esophageal cancer cell lines, and cells without transfection were designated as the blank control group. Cell survival was tested by colony formation assays, and the levels of proteins related to apoptosis and epithelial-mesenchymal transitions were determined by Western blot assays. Cell proliferation was assessed by MTT assays, cell apoptosis by flow cytometry, and cell migration by wound-healing assays. Changes in cell cycle distribution were monitored.
RESULTS Rpph1 was highly expressed in esophageal carcinoma, making it a promising marker for the diagnosis of esophageal cancer. Rpph1 could also be used to distinguish different short-term responses, T stages, N stages, and clinical stages of esophageal cancer patients. The results of 3-year overall survival favored patients with lower Rpph1 expression over patients with higher Rpph1 expression (P < 0.05). In vitro and in vivo experiments showed that silencing Rpph1 expression led to higher sensitivity of esophageal cancer cells to radiotherapy, stronger apoptosis in esophageal cancer cells induced by radiotherapy, higher expression of Bax and caspase-3, and lower expression of Bcl-2 (Bax, caspase-3, and Bcl-2 are apoptosis-related proteins). Additionally, silencing Rpph1 attenuated radiation-induced G2/M phase arrest, and significantly inhibited the expression of proteins involved in cell proliferation, migration, and epithelial-mesenchymal transition regulation in esophageal cancer cells.
CONCLUSION Rpph1 is highly expressed in esophageal cancer. Silencing Rpph1 expression can promote cell apoptosis, inhibit cell proliferation and migration, and increase radio-sensitivity.
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Affiliation(s)
- Zhen-Yang Li
- Department of Scientific Research, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
| | - Hui-Fen Li
- Department of Scientific Research, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
| | - Ying-Ying Zhang
- Department of Scientific Research, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
| | - Xue-Lan Zhang
- Department of Scientific Research, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
| | - Bing Wang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Jiang-Ting Liu
- Department of Scientific Research, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
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Triantafyllou T, Olson MT, Theodorou D, Schizas D, Singhal S. Enhanced recovery pathways vs standard care pathways in esophageal cancer surgery: systematic review and meta-analysis. Esophagus 2020; 17:100-112. [PMID: 31974853 DOI: 10.1007/s10388-020-00718-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/12/2020] [Indexed: 02/03/2023]
Abstract
Enhanced recovery after surgery (ERAS) protocols vs standard care pathways after esophagectomy for malignancy have gained wide popularity among surgeons. However, the current literature is still lacking level-I evidence to show a clear superiority of one approach. The present study is a detailed systematic review and meta-analysis of the published trials. A systematic review of literature databases was conducted for randomized controlled trials (RCTs) and non-randomized, prospective, comparative studies between January 1990 and September 2019, comparing ERAS pathway group with standard care for esophageal resection for esophageal cancer. Mean difference (MD) for continuous variables and odds ratio (OR) or risk difference (RD) for dichotomous variables with 95% confidence interval (CI) were used. Between-study heterogeneity was evaluated. Eight studies with a total of 1133 patients were included. Hospital stay [Standard mean difference (Std. MD) = - 1.92, 95% CI - 2.78, - 1.06, P < 0.0001], overall morbidity (OR 0.68, CI 0.49, 0.96, P = 0.03), pulmonary complications (OR 0.45, CI 0.31, 0.65, P < 0.0001), anastomotic leak rate (OR 0.37, CI 0.18, 0.74, P = 0.005), time to first flatus and defecation (Std. MD = -5.01, CI - 9.53, - 0.49, P = 0.03), (Std. MD = - 1.36, CI - 1.78, - 0.94, P < 0.00001) and total hospital cost (Std. MD = - 1.62, CI - 2.24, - 1.01, P < 0.00001) favored the ERAS group. Patients who undergo ERAS have a clear benefit over the standard care protocol. However, existing protocols in different centers are followed by great variability, while the evaluated parameters suffer from significant heterogeneity. A well-formulated, standardized protocol should be standard-of-care at all centers.
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Affiliation(s)
- Tania Triantafyllou
- 1st Propaedeutic Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Michael T Olson
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Dimitrios Theodorou
- 1st Propaedeutic Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital of Athens, Athens, Greece
| | - Saurabh Singhal
- Department of GI Surgery and Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India.
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8
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Outcomes of self-expandable metal stent placement for malignant oesophageal strictures. Clin Radiol 2019; 75:156.e21-156.e27. [PMID: 31703807 DOI: 10.1016/j.crad.2019.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/03/2019] [Indexed: 01/21/2023]
Abstract
AIM To analyse the outcomes of oesophageal stenting for malignant strictures and to study the correlation between the follow-up time and major complications. MATERIALS AND METHODS Patients with oesophageal malignancy who underwent stent placement between 2011 and 2016 for dysphagia were included. The data included age, sex, dysphagia, length and location of stenosis, date of stent placement, complications, follow-up time, and survival. RESULTS Two hundred and ninety-eight patients were included in the study. Minor complications occurred in 113 patients (37.9%) including chest pain (17.1%), foreign body sensation (25.5%), hiccups (1.68%), and reflux symptoms (27.5%). Major adverse events occurred in 93 (31.1%) patients including pneumonia (25.5%), migration (3%), perforation (0.67%), bleeding (1.68%), and restenosis (22.5%). oesophago-airway fistula occurred in 45 (15.1%) patients. The incidence of recurrent dysphagia, pneumonia, and oesophago-airway fistula increased over 3 months and decreased after another 3 months. The incidence of major complications as a percentage of survivors remained high after 3 months (>40%). Spearman analysis revealed a significant positive correlation between the incidence and the follow-up time over this period (rs=0.907, p<0.01). CONCLUSION The major complications of oesophageal stenting increased with time over 3 months and remained high for another 3 months. Therefore, stenting should be considered for palliation in patients with short expected survival (usually <3 months).
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9
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Comparative outcomes of minimally invasive and robotic-assisted esophagectomy. Surg Endosc 2019; 34:814-820. [PMID: 31183790 DOI: 10.1007/s00464-019-06834-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/15/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Minimally invasive esophagectomy (MIE) has demonstrated superior outcomes compared to open approaches. The myriad of techniques has precluded the recommendation of a standard approach. The addition of robotics to esophageal resection has potential benefits. We sought to examine the outcomes with MIE to include robotics. METHODS Utilizing a prospective esophagectomy database, we identified patients who underwent (MIE) Ivor Lewis via thoracoscopic/laparoscopic (TL), transhiatal (TH), or robotic-assisted Ivor Lewis (RAIL). Patient demographics, tumor characteristics, and complications were analyzed via ANOVA, χ2, and Fisher exact where appropriate. RESULTS We identified 302 patients who underwent MIE: TL 95 (31.5%), TH 63 (20.8%), and RAIL 144 (47.7%) with a mean age of 65 ± 9.6. The length of operation was longer in the RAIL: TL (299 ± 87), TH (231 ± 65), RAIL (409 ± 104 min), p < 0.001. However, the EBL was lower in the patients undergoing transthoracic approaches (RAIL + TL): TL (189 ± 188 ml), TH (242 ± 380 ml), RAIL (155 ± 107 ml), p = 0.03. Conversion to open was also lower in these patients: TL 7 (7.4%), TH 8 (12.7%), RAIL 0, p < 0.001. The R0 resection rate and lymph node (LN) harvest also favored the RAIL cohort: TL 86 (93.5%), TH 60 (96.8%), and RAIL 144 (100%), p = 0.01; LN: TL 14 ± 7, TH 9 ± 6, and RAIL 20 ± 9, p < 0.001. The overall morbidity was lower in MIE patients that underwent a transthoracic approach vs. transhiatal: TL 29 (30.5%), TH 39 (61.9%), RAIL 34 (23.6%), p < 0.001. CONCLUSIONS Patients undergoing MIE via thoracoscopic/laparoscopic and robotic transthoracic approaches demonstrated lower EBL, morbidity, and conversion to open compared to the transhiatal approach. Additionally the oncologic outcomes measured by R0 resections and LN harvest also favored the patients who underwent a transthoracic approach.
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10
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Grimminger PP, Fuchs HF. [Minimally invasive and robotic-assisted surgical management of upper gastrointestinal cancer]. Chirurg 2019; 88:1017-1023. [PMID: 29026937 DOI: 10.1007/s00104-017-0522-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Total minimally invasive upper gastrointestinal resections are currently mainly performed in centers. The advantages include reduction of operative trauma, magnified enlargement of the operation field and the resulting improvement in operative precision. Robotic-assisted minimally invasive esophagectomy (RAMIE) and laparoscopic/thoracoscopic minimally invasive esophagectomy (MIE) are currently the most commonly performed strategies for esophageal cancer. Laparoscopic (MIG) and robotic-assisted gastrectomy (RAG) are the equivalent procedures for gastric cancer. Due to the relatively low number of reported cases, no definitive statement regarding superiority of these procedures compared to standard open or hybrid procedures can be made; however, there is mounting evidence from high-volume centers in which these procedures are routinely performed that there might be an advantage regarding perioperative morbidity. All of the four procedures described are provided at our high-volume centers in a standardized manner and we are convinced of the benefits of these minimally invasive techniques with respect to morbidity compared to open and hybrid techniques. The additional costs of this technology have to be off-set against a possible reduction of morbidity, reduced cost for personnel and new operative options, such as real-time fluoroscopy.
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Affiliation(s)
- P P Grimminger
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Johannes Gutenberg Universität Mainz, Mainz, Deutschland
| | - H F Fuchs
- Klinik und Poliklinik für Allgemein‑, Viszeral- und Tumorchirurgie, Universität zu Köln, Kerpener Str. 62, Köln, Deutschland.
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Liu G, Peng L, Liu B, Wang K, Han Y. Analysis of risk factors for pulmonary infection in patients with minimally invasive esophagectomy. Oncol Lett 2019; 17:3283-3288. [PMID: 30867761 PMCID: PMC6396272 DOI: 10.3892/ol.2019.9987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/24/2019] [Indexed: 12/29/2022] Open
Abstract
Clinical manifestations of patients with pulmonary infection after minimally invasive esophagectomy were analyzed. A total of 500 patients undergoing minimally invasive esophagectomy in Sichuan Cancer Hospital and Institute from January 2015 to December 2016 were consecutively selected, among which 124 patients with pulmonary infection after surgery were taken as the infection group, and the remaining 376 patients were taken as the control group. The clinical data of all patients were collected. The pulmonary infection rate after minimally invasive esophagectomy was calculated, and clinical factors with difference were analyzed using the multivariate logistic regression analysis. There were significant differences in age, long-term smoking history, presence or absence of concurrent basic diseases and vital capacity (P<0.01). The application time of antibiotics and antacids and hospitalization duration in the infection group were obviously longer than those in the control group (P<0.01). Age, long-term smoking history, vital capacity, application time of antibiotics and antacids, hospitalization duration and concurrent diabetes mellitus/coronary heart disease/diseases of respiratory system increase the risk of postoperative pulmonary infection in patients with esophageal cancer, and age, long-term smoking history, diabetes mellitus, diseases of respiratory system and hospitalization duration are independent risk factors for pulmonary infection in patients after minimally invasive esophagectomy.
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Affiliation(s)
- Guangyuan Liu
- Ward 1, Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Chengdu, Sichuan 610041, P.R. China
| | - Lin Peng
- Ward 1, Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Chengdu, Sichuan 610041, P.R. China
| | - Bin Liu
- Clinical Research Standardized Treatment Ward, Department of Medical Oncology, Sichuan Cancer Hospital and Institute, Chengdu, Sichuan 610041, P.R. China
| | - Kangning Wang
- Ward 1, Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Chengdu, Sichuan 610041, P.R. China
| | - Yongtao Han
- Ward 1, Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Chengdu, Sichuan 610041, P.R. China
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12
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Evaluation of the metabolic response to open and minimally invasive resection of the oesophagus due to oesophageal cancer. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 15:151-156. [PMID: 30310392 PMCID: PMC6180019 DOI: 10.5114/kitp.2018.78438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022]
Abstract
Aim The aim of this study was to compare the metabolic response in the early postoperative period after radical resection of stage I and II oesophageal cancer applying a minimally invasive procedure and an open procedure involving classical laparotomy and thoracotomy. Material and methods Serum concentrations of interleukin 6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP), tumour necrosis factor-α (TNF-α), and total serum protein (TP) and leukocyte count (WBC) in blood collected on the day of surgery prior to the procedure (day 0) and on days 1, 2 and 7 after the surgery were measured in two groups of patients undergoing oesophageal resection due to cancer: applying a minimally invasive procedure involving laparoscopy and videothoracoscopy (group A) and applying a classical procedure involving full opening of the chest and abdominal cavity (group B). The study involved a total of 24 patients divided into two groups of 12 patients each. Results Tumour necrosis factor-α concentration was lower in group A compared to group B on day 0, PCT concentration was lower in group A compared to group B on day 2 after surgery, and on the remaining days TNF-α and PCT concentrations were not statistically different between groups. Conclusions Lower concentration of PCT on post-surgery day 2 in the group of patients undergoing minimally invasive oesophageal resection seems to be associated with a smaller perioperative injury. Lower TNF-α concentration in serum collected on day 0 in the group of patients undergoing minimally invasive resection is associated with a lower stage of oesophageal cancer in this group.
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Abstract
We have come a long way from the onset of surgery for esophageal cancer. Surgical resection is pivotal for the long-term survival in patients with locally advanced esophageal cancer. Moreover, advancements in post-operative care and surgical techniques have contributed to reductions in morbidity. More recently minimally invasive esophagectomy has been increasingly used in patients undergoing esophageal cancer resection. Potential advantages of MIE include: the decreased pulmonary complications, lower post-operative wound infection, decreased post-operative pain, and decreased length of hospitalization. The application of robotics to esophageal surgery is becoming more widespread. Robotic esophageal surgery has potential advantages over the known limitations of laparoscopic and thoracoscopic approaches to esophagectomy while adhering to the benefits of the minimally invasive approach. This paper is a review of the evolution from open esophagectomy to the most recent robotic approach.
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Affiliation(s)
- Caitlin Takahashi
- Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Ravi Shridhar
- Department of Radiation Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA
| | - Jamie Huston
- Department of Gastrointestinal Oncology, Sarasota Memorial Healthcare System, Sarasota, FL, USA
| | - Kenneth Meredith
- Department of Gastrointestinal Oncology, Sarasota Memorial Healthcare System, Sarasota, FL, USA.,Department of Gastrointestinal Oncology, Florida State University College of Medicine, Tallahassee, FL, USA
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14
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Kuwai T, Yamaguchi T, Imagawa H, Miura R, Sumida Y, Takasago T, Miyasako Y, Nishimura T, Iio S, Yamaguchi A, Kouno H, Kohno H, Ishaq S. Endoscopic submucosal dissection for early esophageal neoplasms using the stag beetle knife. World J Gastroenterol 2018; 24:1632-1640. [PMID: 29686470 PMCID: PMC5910546 DOI: 10.3748/wjg.v24.i15.1632] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/16/2018] [Accepted: 03/30/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine short- and long-term outcomes of endoscopic submucosal dissection (ESD) using the stag beetle (SB) knife, a scissor-shaped device.
METHODS Seventy consecutive patients with 96 early esophageal neoplasms, who underwent ESD using a SB knife at Kure Medical Center and Chugoku Cancer Center, Japan, between April 2010 and August 2016, were retrospectively evaluated. Clinicopathological characteristics of lesions and procedural adverse events were assessed. Therapeutic success was evaluated on the basis of en bloc, histologically complete, and curative or non-curative resection rates. Overall and tumor-specific survival, local or distant recurrence, and 3- and 5-year cumulative overall metachronous cancer rates were also assessed.
RESULTS Eligible patients had dysplasia/intraepithelial neoplasia (22%) or early cancers (squamous cell carcinoma, 78%). The median procedural time was 60 min and on average, the lesions measured 24 mm in diameter, yielding 33-mm tissue defects. The en bloc resection rate was 100%, with 95% and 81% of dissections deemed histologically complete and curative, respectively. All procedures were completed without accidental incisions/perforations or delayed bleeding. During follow-up (mean, 35 ± 23 mo), no local recurrences or metastases were observed. The 3- and 5-year survival rates were 83% and 70%, respectively, with corresponding rates of 85% and 75% for curative resections and 74% and 49% for non-curative resections. The 3- and 5-year cumulative rates of metachronous cancer in the patients with curative resections were 14% and 26%, respectively.
CONCLUSION ESD procedures using the SB knife are feasible, safe, and effective for treating early esophageal neoplasms, yielding favorable short- and long-term outcomes.
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Affiliation(s)
- Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Toshiki Yamaguchi
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Hiroki Imagawa
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Ryoichi Miura
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Yuki Sumida
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Takeshi Takasago
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Yuki Miyasako
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Tomoyuki Nishimura
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Sumio Iio
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Atsushi Yamaguchi
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Hirotaka Kouno
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Hiroshi Kohno
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Sauid Ishaq
- Department of Gastroenterology, DGH, SGU, WI, Birmingham City University, Birmingham B4 7BD, United Kingdom
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Nora I, Shridhar R, Meredith K. Robotic-assisted Ivor Lewis esophagectomy: technique and early outcomes. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:93-100. [PMID: 30697567 PMCID: PMC6193432 DOI: 10.2147/rsrr.s99537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Esophagectomy is pivotal for the long-term survival in patients with early stage and advanced esophageal cancer, and improved perioperative care and advanced surgical techniques have contributed to reduced postoperative morbidity. However, despite these advances, esophagectomy continues to be associated with significant morbidity and mortality. Minimally invasive esophageal surgery (MIE) has been increasingly used in patients undergoing surgery for esophageal cancer. Potential advantages of MIE include the decreased postoperative pain; lower postoperative wound infection, decreased pulmonary complications, and decreased length of hospitalization. Robotic esophageal surgery has the ability to overcome some of the limitations of laparoscopic and thoracoscopic approaches to esophagectomy while maintaining the benefits of the minimally invasive approach. In this article, we will review the clinical efficacy and outcomes associated with robotic-assisted Ivor Lewis esophagectomy (RAIL).
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Affiliation(s)
- Ian Nora
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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16
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Yibulayin W, Abulizi S, Lv H, Sun W. Minimally invasive oesophagectomy versus open esophagectomy for resectable esophageal cancer: a meta-analysis. World J Surg Oncol 2016; 14:304. [PMID: 27927246 PMCID: PMC5143462 DOI: 10.1186/s12957-016-1062-7] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/23/2016] [Indexed: 12/11/2022] Open
Abstract
Background Open esophagectomy (OE) is associated with significant morbidity and mortality. Minimally invasive oesophagectomy (MIO) reduces complications in resectable esophageal cancer. The aim of this study is to explore the superiority of MIO in reducing complications and in-hospital mortality than OE. Methods MEDLINE, Embase, Science Citation Index, Wanfang, and Wiley Online Library were thoroughly searched. Odds ratio (OR)/weighted mean difference (WMD) with a 95% confidence interval (CI) was used to assess the strength of association. Results Fifty-seven studies containing 15,790 cases of resectable esophageal cancer were included. MIO had less intraoperative blood loss, short hospital stay, and high operative time (P < 0.05) than OE. MIO also had reduced incidence of total complications; (OR = 0.700, 95% CI = 0.626 ~ 0.781, PV < 0.05), pulmonary complications (OR = 0.527, 95% CI = 0431 ~ 0.645, PV < 0.05), cardiovascular complications (OR = 0.770, 95% CI = 0.681 ~ 0.872, PV < 0.05), and surgical technology related (STR) complications (OR = 0.639, 95% CI = 0.522 ~ 0.781, PV < 0.05), as well as lower in-hospital mortality (OR = 0.668, 95% CI = 0.539 ~ 0.827, PV < 0.05). However, the number of harvested lymph nodes, intensive care unit (ICU) stay, gastrointestinal complications, anastomotic leak (AL), and recurrent laryngeal nerve palsy (RLNP) had no significant difference. Conclusions MIO is superior to OE in terms of perioperative complications and in-hospital mortality.
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Affiliation(s)
- Waresijiang Yibulayin
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Sikandaer Abulizi
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Hongbo Lv
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Wei Sun
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China.
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17
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Hirahara N, Matsubara T, Kawahara D, Mizota Y, Ishibashi S, Tajima Y. Prognostic value of hematological parameters in patients undergoing esophagectomy for esophageal squamous cell carcinoma. Int J Clin Oncol 2016; 21:909-919. [PMID: 27154178 PMCID: PMC5055579 DOI: 10.1007/s10147-016-0986-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/25/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND It is now widely recognized that outcomes in cancer patients are not determined by their tumor characteristics alone. In this study, we retrospectively analyzed the clinical data of esophageal cancer patients to evaluate the impact of red blood cell distribution width (RDW), platelet distribution width (PDW), and mean platelet volume (MPV) on cancer-specific survival (CSS). STUDY DESIGN We retrospectively reviewed a database of 144 consecutive patients who underwent curative esophagectomy for esophageal squamous cell carcinoma at our institute between 2006 and 2014. RESULT In multivariate analysis, pathological stage (pStage) (p = 0.0002) and a high RDW (p = 0.0300) were found to be independently associated with poor survival. Patients with a high RDW had a significantly poorer prognosis in terms of CSS than those with a low RDW (p = 0.004). Among non-elderly patients, multivariate analysis demonstrated that pStage (p = 0.0120), and a high RDW (p = 0.0092) were independent risk factors for a worse prognosis. In addition, non-elderly patients with a high RDW had a significantly poorer prognosis in terms of CSS than those with a low RDW (p = 0.0003). On the other hand, univariate analysis demonstrated that pStage (p = 0.0008) was the only significant risk factor for a poor prognosis in elderly patients. CONCLUSIONS We confirmed that a high RDW was significantly associated with the CSS of esophageal cancer patients after curative esophagectomy. Furthermore, in non-elderly patients, a high RDW was a significant and independent predictor of poor survival.
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Affiliation(s)
- Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
| | - Takeshi Matsubara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Daisuke Kawahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Yoko Mizota
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Shuichi Ishibashi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
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18
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Hirahara N, Matsubara T, Mizota Y, Ishibashi S, Tajima Y. Prognostic value of preoperative inflammatory response biomarkers in patients with esophageal cancer who undergo a curative thoracoscopic esophagectomy. BMC Surg 2016; 16:66. [PMID: 27650456 PMCID: PMC5028997 DOI: 10.1186/s12893-016-0179-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 09/07/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Several inflammatory response biomarkers, including lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) have been reported to predict survival in various cancers. The aim of this study is to evaluate the clinical value of these biomarkers in patients undergoing curative resection for esophageal cancer. METHODS The LMR, NLR and PLR were calculated in 147 consecutive patients who underwent esophagectomy between January 2006 and February 2015. We examined the prognostic significance of the LMR, NLR, and PLR in both elderly and non-elderly patients. We evaluated the cancer-specific survival (CSS), with the cause of death determined from the case notes or computerized records. RESULTS Univariate analyses demonstrated that TNM pStage (p < 0.0001), tumor size (p = 0.0014), operation time (p = 0.0209), low LMR (p = 0.0008), and high PLR (p = 0.0232) were significant risk factors for poor prognosis. Meanwhile, TNM pStage (p < 0.0001) and low LMR (p = 0.0129) were found to be independently associated with poor prognosis via multivariate analysis. In non-elderly patients, univariate analyses demonstrated that TNM pStage (p < 0.0001), tumor size (p = 0.0001), operation time (p = 0.0374), LMR (p < 0.0001), and PLR (p = 0.0189) were significantly associated with a poorer prognosis. Multivariate analysis demonstrated that TNM pStage (p = 0.001) and LMR (p = 0.0007) were independent risk factors for a poorer prognosis. In elderly patients, univariate analysis demonstrated that that TNM pStage (p = 0.0023) was the only significant risk factor for a poor prognosis. CONCLUSIONS LMR was associated with cancer-specific survival (CSS) of esophageal cancer patients after curative esophagectomy. In particular, a low LMR was a significant and independent predictor of poor survival in non-elderly patients. The LMR was convenient, cost effective, and readily available, and could thus act as markers of survival in esophageal cancer.
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Affiliation(s)
- Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Takeshi Matsubara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Yoko Mizota
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Shuichi Ishibashi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501 Japan
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19
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Giugliano DN, Berger AC, Rosato EL, Palazzo F. Total minimally invasive esophagectomy for esophageal cancer: approaches and outcomes. Langenbecks Arch Surg 2016; 401:747-56. [PMID: 27401326 DOI: 10.1007/s00423-016-1469-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/16/2016] [Indexed: 12/23/2022]
Abstract
Since the introduction of minimally invasive esophagectomy 25 years ago, its use has been reported in several high volume centers. With only one published randomized control trial and five meta-analyses comparing its outcomes to open esophagectomy, available level I evidence is very limited. Available technical approaches include total minimally invasive transthoracic (Ivor Lewis or McKeown) or transhiatal esophagectomy; several hybrid options are available with one portion of the procedure completed via an open approach. A review of available level I evidence with focus on total minimally invasive esophagectomy is presented. The old debate regarding the superiority of a transthoracic versus transhiatal approach to esophagectomy may have been settled by minimally invasive esophagectomy as only few centers are reporting on the latter being utilized. The studies with the highest level of evidence available currently show that minimally invasive techniques via a transthoracic approach are associated with less overall morbidity, fewer pulmonary complications, and shorter hospital stays than open esophagectomy. There appears to be no detrimental effect on oncologic outcomes and possibly an added benefit derived by improved lymph node retrieval. Quality of life improvements may also translate into improved survival, but no conclusive evidence exists to support this claim. Robotic and hybrid techniques have also been implemented, but there currently is no evidence showing that these are superior to other minimally invasive techniques.
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Affiliation(s)
- Danica N Giugliano
- Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA
| | - Adam C Berger
- Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA
| | - Ernest L Rosato
- Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA
| | - Francesco Palazzo
- Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA.
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20
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Shridhar R, Abbott AM, Doepker M, Hoffe SE, Almhanna K, Meredith KL. Perioperative outcomes associated with robotic Ivor Lewis esophagectomy in patient's undergoing neoadjuvant chemoradiotherapy. J Gastrointest Oncol 2016; 7:206-12. [PMID: 27034787 DOI: 10.3978/j.issn.2078-6891.2015.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy (NCR) for the treatment of esophageal cancer has been associated with increased perioperative morbidity and mortality. Minimally invasive procedures utilizing robotic techniques have been shown to reduce perioperative complications and length of hospitalization (LOH). The purpose of this study is to compare perioperative outcomes between patients undergoing NCR and robotic-assisted Ivor Lewis esophagectomy (RAIL) versus upfront RAIL. METHODS A database of esophagectomy patients was queried to identify RAIL patients. Differences in perioperative outcomes were analyzed between NCR and non NCR patients. RESULTS Eighty-nine patients were identified who underwent RAIL Seventy-seven patients (87%) had NCR and 22 patients did not (13%). The median age was 66 (range, 44-83). The median age of the patients treated with NCR was younger {69 [44-83] vs. 64 [46-81] years respectively, P=0.05}. The patients who underwent NCR had a higher BMI then those who went straight to esophagectomy (31 vs. 27; P=0.001). There were no conversions to open laparotomy or thoracotomy in either group. There were no statistically significant differences in the mean operative times and estimated blood loss (EBL) between both groups. Complications occurred in 17 (19.1%) patients. There were no statistically significant differences in the rates of any complications between patients receiving NCR and those that did not receive NCR (P=0.11). There were no deaths in either group. The total number of days in hospital and total number of intensive care unit (ICU) days were also similar in both groups (P=0.25). There was no statistically significant difference in the mean number of lymph nodes harvested in the patients treated with NCR compared with those treated without NCR. CONCLUSIONS We have demonstrated that RAIL is a safe and feasible option for patients with esophageal cancer. The administration of NCR to RAIL did not result in an increase in perioperative morbidity and mortality. The number of lymph nodes harvested and the completeness of resection was also similar between patients who received NCR and those who did not. Longer follow-up is required in order to determine long term oncologic outcome.
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Affiliation(s)
- Ravi Shridhar
- 1 Department of Radiation Oncology, Florida Hospital Orlando, Orlando, FL, USA ; 2 Department of Surgical Oncology, 3 Department of Radiation Oncology, 4 Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA ; 5 Department of Gastrointestinal and Surgical Oncology, Sarasota Memorial Hospital, Sarasota, FL, USA
| | - Andrea M Abbott
- 1 Department of Radiation Oncology, Florida Hospital Orlando, Orlando, FL, USA ; 2 Department of Surgical Oncology, 3 Department of Radiation Oncology, 4 Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA ; 5 Department of Gastrointestinal and Surgical Oncology, Sarasota Memorial Hospital, Sarasota, FL, USA
| | - Matthew Doepker
- 1 Department of Radiation Oncology, Florida Hospital Orlando, Orlando, FL, USA ; 2 Department of Surgical Oncology, 3 Department of Radiation Oncology, 4 Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA ; 5 Department of Gastrointestinal and Surgical Oncology, Sarasota Memorial Hospital, Sarasota, FL, USA
| | - Sarah E Hoffe
- 1 Department of Radiation Oncology, Florida Hospital Orlando, Orlando, FL, USA ; 2 Department of Surgical Oncology, 3 Department of Radiation Oncology, 4 Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA ; 5 Department of Gastrointestinal and Surgical Oncology, Sarasota Memorial Hospital, Sarasota, FL, USA
| | - Khaldoun Almhanna
- 1 Department of Radiation Oncology, Florida Hospital Orlando, Orlando, FL, USA ; 2 Department of Surgical Oncology, 3 Department of Radiation Oncology, 4 Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA ; 5 Department of Gastrointestinal and Surgical Oncology, Sarasota Memorial Hospital, Sarasota, FL, USA
| | - Kenneth L Meredith
- 1 Department of Radiation Oncology, Florida Hospital Orlando, Orlando, FL, USA ; 2 Department of Surgical Oncology, 3 Department of Radiation Oncology, 4 Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA ; 5 Department of Gastrointestinal and Surgical Oncology, Sarasota Memorial Hospital, Sarasota, FL, USA
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21
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Gurusamy KS, Pallari E, Midya S, Mughal M. Laparoscopic versus open transhiatal oesophagectomy for oesophageal cancer. Cochrane Database Syst Rev 2016; 3:CD011390. [PMID: 27030301 PMCID: PMC7086382 DOI: 10.1002/14651858.cd011390.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Surgery is the preferred treatment for resectable oesophageal cancers, and can be performed in different ways. Transhiatal oesophagectomy (oesophagectomy without thoracotomy, with a cervical anastomosis) is one way to resect oesophageal cancers. It can be performed laparoscopically or by open method. With other organs, laparoscopic surgery has been shown to reduce complications and length of hospital stay compared to open surgery. However, concerns remain about the safety of laparoscopic transhiatal oesophagectomy in terms of post-operative complications and oncological clearance compared with open transhiatal oesophagectomy. OBJECTIVES To assess the benefits and harms of laparoscopic versus open oesophagectomy for people with oesophageal cancer undergoing transhiatal oesophagectomy. SEARCH METHODS We electronically searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and trials registers until August 2015. We also searched the references of included trials to identify further trials. SELECTION CRITERIA We considered randomised controlled trials and non-randomised studies comparing laparoscopic with open transhiatal oesophagectomy in patients with resectable oesophageal cancer, regardless of language, blinding, or publication status for the review. DATA COLLECTION AND ANALYSIS Three review authors independently identified trials, assessed risk of bias and extracted data. We calculated the risk ratio (RR) or hazard ratio (HR) with 95% confidence intervals (CI), using both fixed-effect and random-effects models, with RevMan 5, based on intention-to-treat analyses. MAIN RESULTS We found no randomised controlled trials on this topic. We included six non-randomised studies (five retrospective) that compared laparoscopic versus open transhiatal oesophagectomy (334 patients: laparoscopic = 154 patients; open = 180 patients); five studies (326 patients: laparoscopic = 151 patients; open = 175 patients) provided information for one or more outcomes. Most studies included a mixture of adenocarcinoma and squamous cell carcinoma and different stages of oesophageal cancer, without metastases. All the studies were at unclear or high risk of bias; the overall quality of evidence was very low for all the outcomes.The differences between laparoscopic and open transhiatal oesophagectomy were imprecise for short-term mortality (laparoscopic = 0/151 (adjusted proportion based on meta-analysis estimate: 0.5%) versus open = 2/175 (1.1%); RR 0.44; 95% CI 0.05 to 4.09; participants = 326; studies = 5; I² = 0%); long-term mortality (HR 0.97; 95% CI 0.81 to 1.16; participants = 193; studies = 2; I² = 0%); anastomotic stenosis (laparoscopic = 4/36 (11.1%) versus open = 3/37 (8.1%); RR 1.37; 95% CI 0.33 to 5.70; participants = 73; studies = 1); short-term recurrence (laparoscopic = 1/16 (6.3%) versus open = 0/4 (0%); RR 0.88; 95% CI 0.04 to 18.47; participants = 20; studies = 1); long-term recurrence (HR 1.00; 95% CI 0.84 to 1.18; participants = 173; studies = 2); proportion of people who required blood transfusion (laparoscopic = 0/36 (0%) versus open = 6/37 (16.2%); RR 0.08; 95% CI 0.00 to 1.35; participants = 73; studies = 1); proportion of people with positive resection margins (laparoscopic = 15/102 (15.8%) versus open = 27/111 (24.3%); RR 0.65; 95% CI 0.37 to 1.12; participants = 213; studies = 3; I² = 0%); and the number of lymph nodes harvested during surgery (median difference between the groups varied from 12 less to 3 more lymph nodes in the laparoscopic compared to the open group; participants = 326; studies = 5).The proportion of patients with serious adverse events was lower in the laparoscopic group (10/99, (10.3%) compared to the open group = 24/114 (21.1%); RR 0.49; 95% CI 0.24 to 0.99; participants = 213; studies = 3; I² = 0%); as it was for adverse events in the laparoscopic group = 37/99 (39.9%) versus the open group = 71/114 (62.3%); RR 0.64; 95% CI 0.48 to 0.86; participants = 213; studies = 3; I² = 0%); and the median lengths of hospital stay were significantly less in the laparoscopic group than the open group (three days less in all three studies that reported this outcome; number of participants = 266). There was lack of clarity as to whether the median difference in the quantity of blood transfused was statistically significant favouring laparoscopic oesophagectomy in the only study that reported this information. None of the studies reported post-operative dysphagia, health-related quality of life, time-to-return to normal activity (return to pre-operative mobility without caregiver support), or time-to-return to work. AUTHORS' CONCLUSIONS There are currently no randomised controlled trials comparing laparoscopic with open transhiatal oesophagectomy for patients with oesophageal cancers. In observational studies, laparoscopic transhiatal oesophagectomy is associated with fewer overall complications and shorter hospital stays than open transhiatal oesophagectomy. However, this association is unlikely to be causal. There is currently no information to determine a causal association in the differences between the two surgical approaches. Randomised controlled trials comparing laparoscopic transhiatal oesophagectomy with other methods of oesophagectomy are required to determine the optimal method of oesophagectomy.
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Affiliation(s)
- Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | - Elena Pallari
- University College LondonDepartment of General Surgery4th Floor, Rockefeller Building21 University StreetLondonUKWC1E 6DE
- King's College London School of MedicineDivision of Cancer Studies, Cancer Epidemiology GroupGuy's Hospital, Great Maze PondResearch OncologyLondonUKSE1 6RT
| | - Sumit Midya
- Royal Berkshire HospitalDepartment of General SurgeryReadingUKRG1 5AN
- University College LondonDivision of Surgery and Interventional ScienceLondonUK
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Abstract
BACKGROUND Oesophageal cancer is the sixth most common cause of cancer-related mortality in the world. Currently surgery is the recommended treatment modality when possible. However, it is unclear whether non-surgical treatment options is equivalent to oesophagectomy in terms of survival. OBJECTIVES To assess the benefits and harms of non-surgical treatment versus oesophagectomy for people with oesophageal cancer. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Science Citation Index, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) up to 4th March 2016. We also screened reference lists of included studies. SELECTION CRITERIA Two review authors independently screened all titles and abstracts of articles obtained from the literature searches and selected references for further assessment. For these selected references, we based trial inclusion on assessment of the full-text articles. DATA COLLECTION AND ANALYSIS Two review authors independently extracted study data. We calculated the risk ratio (RR) with 95% confidence interval (CI) for binary outcomes, the mean difference (MD) or the standardised mean difference (SMD) with 95% CI for continuous outcomes, and the hazard ratio (HR) for time-to-event outcomes. We performed meta-analyses where it was meaningful. MAIN RESULTS Eight trials, which included 1132 participants in total, met the inclusion criteria of this Cochrane review. These trials were at high risk of bias trials. One trial (which included five participants) did not contribute any data to this Cochrane review, and we excluded 13 participants in the remaining trials after randomisation; this left a total of 1114 participants, 510 randomised to non-surgical treatment and 604 to surgical treatment for analysis. The non-surgical treatment was definitive chemoradiotherapy in five trials and definitive radiotherapy in three trials. All participants were suitable for major surgery. Most of the data were from trials that compared chemoradiotherapy with surgery. There was no difference in long-term mortality between chemoradiotherapy and surgery (HR 0.88, 95% CI 0.76 to 1.03; 602 participants; four studies; low quality evidence). The long-term mortality was higher in radiotherapy than surgery (HR 1.39, 95% CI 1.18 to 1.64; 512 participants; three studies; very low quality evidence). There was no difference in long-term recurrence between non-surgical treatment and surgery (HR 0.96, 95% CI 0.80 to 1.16; 349 participants; two studies; low quality evidence). The difference between non-surgical and surgical treatments was imprecise for short-term mortality (RR 0.39, 95% CI 0.11 to 1.35; 689 participants; five studies; very low quality evidence), the proportion of participants with serious adverse in three months (RR 0.61, 95% CI 0.25 to 1.47; 80 participants; one study; very low quality evidence), and proportion of people with local recurrence at maximal follow-up (RR 0.89, 95% CI 0.70 to 1.12; 449 participants; three studies; very low quality evidence). The health-related quality of life was higher in non-surgical treatment between four weeks and three months after treatment (Spitzer Quality of Life Index; MD 0.93, 95% CI 0.24 to 1.62; 165 participants; one study; very low quality evidence). The difference between non-surgical and surgical treatments was imprecise for medium-term health-related quality of life (three months to two years after treatment) (Spitzer Quality of Life Index; MD -0.95, 95% CI -2.10 to 0.20; 62 participants; one study; very low quality of evidence). The proportion of people with dysphagia at the last follow-up visit prior to death was higher with definitive chemoradiotherapy compared to surgical treatment (RR 1.48, 95% CI 1.01 to 2.19; 139 participants; one study; very low quality evidence). AUTHORS' CONCLUSIONS Based on low quality evidence, chemoradiotherapy appears to be at least equivalent to surgery in terms of short-term and long-term survival in people with oesophageal cancer (squamous cell carcinoma type) who are fit for surgery and are responsive to induction chemoradiotherapy. However, there is uncertainty in the comparison of definitive chemoradiotherapy versus surgery for oesophageal cancer (adenocarcinoma type) and we cannot rule out significant benefits or harms of definitive chemoradiotherapy versus surgery. Based on very low quality evidence, the proportion of people with dysphagia at the last follow-up visit prior to death was higher with definitive chemoradiotherapy compared to surgery. Based on very low quality evidence, radiotherapy results in less long-term survival than surgery in people with oesophageal cancer who are fit for surgery. However, there is a risk of bias and random errors in these results, although the risk of bias in the studies included in this systematic review is likely to be lower than in non-randomised studies.Further trials at low risk of bias are necessary. Such trials need to compare endoscopic treatment with surgical treatment in early stage oesophageal cancer (carcinoma in situ and Stage Ia), and definitive chemoradiotherapy with surgical treatments in other stages of oesophageal cancer, and should measure and report patient-oriented outcomes. Early identification of responders to chemoradiotherapy and better second-line treatment for non-responders will also increase the need and acceptability of trials that compare definitive chemoradiotherapy with surgery.
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Affiliation(s)
- Lawrence MJ Best
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRowland Hill StreetLondonUKNW32PF
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Abstract
CONTEXT Esophageal cancer continues to be one of the most lethal of all gastrointestinal malignancies. Its prognostic parameters are based on the gross and histopathologic examination of resected specimens by pathologists. OBJECTIVE To describe the implications of appropriate handling and examination of endomucosal resection and esophagectomy specimens from patients with esophageal carcinoma while considering the implications of the surgical techniques used to obtain such specimens. Parameters include histopathologic findings necessary for accurate staging, differences in the assessment of margins, residual malignancy, and criteria to evaluate for tumor regression after chemoradiation therapy as well as the role of immunohistochemistry and the judicious use of frozen sections. DATA SOURCES Sources were a review of the literature and the authors' experience handling these types of specimens. CONCLUSIONS Examining surgical specimens of the esophagus is critical in the management of patients with esophageal carcinoma, and it requires careful consideration of the diagnostic pitfalls, staging-related parameters, and results of molecular tests.
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Affiliation(s)
| | - Mariana Berho
- From the Department of Pathology, Cleveland Clinic Florida, Weston
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Zhou C, Ma G, Li X, Li J, Yan Y, Liu P, He J, Ren Y. Is minimally invasive esophagectomy effective for preventing anastomotic leakages after esophagectomy for cancer? A systematic review and meta-analysis. World J Surg Oncol 2015; 13:269. [PMID: 26338060 PMCID: PMC4560054 DOI: 10.1186/s12957-015-0661-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/27/2015] [Indexed: 02/07/2023] Open
Abstract
Background Compared with open esophagectomy (OE), minimally invasive esophagectomy (MIE) proves to have clear benefits in reducing the risk of pulmonary complications for patients with resectable esophageal cancer. The objectives of our study were to explore the superiority of MIE in reducing the occurrence of anastomotic leakages (ALs) when compared to OE. Methods A systematic review and meta-analysis was performed to assess the superiority of MIE on the occurrence of ALs over OE, by searching many sources (through December, 2014) such as Medline, Embase, Wiley Online Library, and Cochrane Library. Fixed-effects model was used to calculate summary odds ratios (ORs) to quantify associations between OE and MIE groups. Cochran’s Q and I2 statistics were used to evaluate heterogeneity among studies. Results Among a total of 43 studies involving 5537 patients included in the meta-analysis, 2527 (45.6 %) cases underwent MIE and 3010 (54.4 %) cases underwent OE. Compared to patients undergoing OE, patients undergoing MIE did not have statistical significance in reduced occurrence of ALs (OR = 0.97, 95 % CI = 0.80–1.17). Insignificant reduced occurrence of ALs was not associated with anastomotic location (OR = 0.90, 95 % CI = 0.71–1.13) or anastomotic procedure (OR = 1.02, 95 % CI = 0.79–1.30). Conclusions More proofs are needed to clarify the strengths or weaknesses of MIE in preventing anastomotic leakages after esophagectomy for cancer. A largely randomized, controlled trial should be undertaken to resolve this contentious issue urgently.
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Affiliation(s)
- Can Zhou
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China.
| | - Gang Ma
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China.
| | - Xiao Li
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China
| | - Juan Li
- Department of Translational Medicine Center, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Yu Yan
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China
| | - Peijun Liu
- Department of Translational Medicine Center, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Jianjun He
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China.
| | - Yu Ren
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China.
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Superiority of Minimally Invasive Oesophagectomy in Reducing In-Hospital Mortality of Patients with Resectable Oesophageal Cancer: A Meta-Analysis. PLoS One 2015. [PMID: 26196135 PMCID: PMC4509855 DOI: 10.1371/journal.pone.0132889] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Compared with open oesophagectomy (OE), minimally invasive oesophagectomy (MIO) proves to have benefits in reducing the risk of pulmonary complications for patients with resectable oesophageal cancer. However, it is unknown whether MIO has superiority in reducing the occurrence of in-hospital mortality (IHM). Objective The objective of this meta-analysis was to explore the effect of MIO vs. OE on the occurrence of in-hospital mortality (IHM). Data Sources Sources such as Medline (through December 31, 2014), Embase (through December 31, 2014), Wiley Online Library (through December 31, 2014), and the Cochrane Library (through December 31, 2014) were searched. Study Selection Data of randomized and non-randomized clinical trials related to MIO versus OE were included. Interventions Eligible studies were those that reported patients who underwent MIO procedure. The control group included patients undergoing conventional OE. Study Appraisal and Synthesis Methods Fixed or random -effects models were used to calculate summary odds ratios (ORs) or relative risks (RRs) for quantification of associations. Heterogeneity among studies was evaluated by using Cochran’s Q and I2 statistics. Results A total of 48 studies involving 14,311 cases of resectable oesophageal cancer were included in the meta-analysis. Compared to patients undergoing OE, patients undergoing MIO had statistically reduced occurrence of IHM (OR=0.69, 95%CI =0.55 -0.86). Patients undergoing MIO also had significantly reduced incidence of pulmonary complications (PCs) (RR=0.73, 95%CI = 0.63-0.86), pulmonary embolism (PE) (OR=0.71, 95%CI= 0.51-0.99) and arrhythmia (OR=0.79, 95%CI = 0.68-0.92). Non-significant reductions were observed among the included studies in the occurrence of anastomotic leak (AL) (OR=0.93, 95%CI =0.78-1.11), or Gastric Tip Necrosis (GTN) (OR=0.89, 95%CI =0.54-1.49). Limitation Most of the included studies were non-randomized case-control studies, with a diversity of study designs, demographics of participants and surgical intervention. Conclusions Minimally invasive oesophagectomy (MIO) has superiority over open oesophagectomy (OE) in terms of the occurrence of in-hospital mortality (IHM) and should be the first-choice surgical procedure in esophageal surgery.
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Abbott A, Shridhar R, Hoffe S, Almhanna K, Doepker M, Saeed N, Meredith K. Robotic assisted Ivor Lewis esophagectomy in the elderly patient. J Gastrointest Oncol 2015; 6:31-8. [PMID: 25642335 DOI: 10.3978/j.issn.2078-6891.2014.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/29/2014] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Robotic assisted approaches to esophagectomy have demonstrated decreased complications and length of hospitalization. We sought to examine the impact of age on outcomes in patients undergoing robotic assisted Ivor Lewis esophagectomy (RAIL). METHODS A retrospective review of all patients undergoing RAIL from 2009-2013 was conducted. Statistical analysis was performed for the entire cohort and by stratifying patients into three age cohorts: ≤49, 50-69, ≥70. RESULTS We identified 134 patients and found no statistically significant difference for operative time, length of hospitalization, adverse events (AE), or mortality. There was a higher median blood loss (150 cc) seen in cohorts 1 (50-600 cc) and 3 (50-400 cc) compared to cohort 2 [100 (range, 25-400) cc; P<0.01]. The overall AE rate was 10% (cohort 1), 22% (cohort 2), 35% (cohort 3), P=0.13. There were 5 (4%) leaks and 2 (1.5%) deaths, but this was not significantly different between cohorts (P=0.40, P=0.91, respectively). CONCLUSIONS RAIL is a safe surgical technique for use in an aging patient population. There was no increased risk of AE or death in the elderly patients compared to younger patients undergoing the robotic approach.
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Affiliation(s)
- Andrea Abbott
- 1 Moffitt Cancer Center, Tampa, FL, USA ; 2 Department of Surgery, University of Wisconsin, 600 Highlands Avenue, Madison, WI 53792, USA
| | - Ravi Shridhar
- 1 Moffitt Cancer Center, Tampa, FL, USA ; 2 Department of Surgery, University of Wisconsin, 600 Highlands Avenue, Madison, WI 53792, USA
| | - Sarah Hoffe
- 1 Moffitt Cancer Center, Tampa, FL, USA ; 2 Department of Surgery, University of Wisconsin, 600 Highlands Avenue, Madison, WI 53792, USA
| | - Khaldoun Almhanna
- 1 Moffitt Cancer Center, Tampa, FL, USA ; 2 Department of Surgery, University of Wisconsin, 600 Highlands Avenue, Madison, WI 53792, USA
| | - Matt Doepker
- 1 Moffitt Cancer Center, Tampa, FL, USA ; 2 Department of Surgery, University of Wisconsin, 600 Highlands Avenue, Madison, WI 53792, USA
| | - Nadia Saeed
- 1 Moffitt Cancer Center, Tampa, FL, USA ; 2 Department of Surgery, University of Wisconsin, 600 Highlands Avenue, Madison, WI 53792, USA
| | - Kenneth Meredith
- 1 Moffitt Cancer Center, Tampa, FL, USA ; 2 Department of Surgery, University of Wisconsin, 600 Highlands Avenue, Madison, WI 53792, USA
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Knab LM, Belotte J, Munshi HG, Bentrem DJ. Comparative effectiveness in esophagogastric cancer. Cancer Treat Res 2015; 164:121-142. [PMID: 25677022 DOI: 10.1007/978-3-319-12553-4_8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cancer of the esophagus and the gastroesophageal junction (GEJ) continues to have a dismal prognosis, with the incidence of esophageal cancer increasing in the United States. Although radical resection was initially the primary treatment for this disease process, systemic chemotherapy and radiation have been shown to play a role in prolonging survival in most patient populations. This chapter explores the evidence that guides treatment for esophageal and GEJ cancer today. Chemotherapy and radiation therapy were introduced as treatment modalities for esophageal and GEJ cancers when it became evident that surgical therapy alone provided poor long-term survival rates. A variety of treatment strategies have been explored including preoperative (neoadjuvant) and postoperative (adjuvant) chemotherapy, with and without radiation. The evidence suggests that neoadjuvant chemotherapy or chemoradiotherapy provides better outcomes compared to surgery alone for esophageal, GEJ, and gastric cancers. Studies indicate a trend towards improved survival when neoadjuvant chemoradiotherapy is compared to chemotherapy alone. When patients have undergone resection with node-positive disease without receiving neoadjuvant therapy, some form of adjuvant treatment is recommended. This chapter also explores the surgical management of esophageal, GEJ, and gastric cancers including the extent of the gastric lymph node dissection. It also includes a discussion about adherence to national guidelines in terms of gastric cancer treatment and esophageal and gastric lymph node examinations.
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Affiliation(s)
- Lawrence M Knab
- Division of Surgical Oncology, Department of Surgery, Northwestern University, Chicago, USA,
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Minimally invasive surgery for esophageal cancer - benefits and controversies. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 11:151-5. [PMID: 26336413 PMCID: PMC4283863 DOI: 10.5114/kitp.2014.43842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 08/14/2013] [Accepted: 06/06/2014] [Indexed: 02/08/2023]
Abstract
Open esophagectomy (OE) requires extensive surgery and is associated with significant morbidity and mortality. Furthermore, the long-term results of esophageal cancer surgery are not satisfactory; hence, the best surgical approach is constantly under debate. During the last twenty years, minimally invasive esophagectomy (MIE) employing laparoscopy and/or thoracoscopy has been introduced in a growing number of centers worldwide. To date, several studies have demonstrated that MIE has better outcomes than OE, as it results in shorter hospital stay and decreased overall morbidity. However, the length of operating time in MIE is increased in comparison to OE. The survival benefit has been demonstrated to be similar in OE and MIE. Highly advanced laparo-thoracoscopic skills are required to perform MIE; along with the relatively long learning curve, this makes MIE feasible only in high-volume, experienced university surgical centers. There is a need for further large-scale comparative studies to prove the superiority of MIE over open surgery.
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Benedix F, Dalicho S, Stübs P, Schubert D, Bruns C. Evidenzlage zur minimalinvasiven Chirurgie beim Ösophaguskarzinom. Chirurg 2014; 85:668-74. [DOI: 10.1007/s00104-014-2754-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
BACKGROUND Esophageal cancer (EC) is the eighth most common cancer worldwide. A worldwide-established consensus on therapeutic pathways for EC is still missing. Debate exists on whether neoadjuvant and adjuvant treatment regimens improve the prognosis and which surgical approach reaches objective benefits. SUMMARY This article discusses the appropriate option of the current different curative treatments in patients with EC, including surgical treatment and adjuvant therapy. KEY MESSAGE To maximize survival and quality of life and also decrease postoperative complications, the present recommended therapeutic management of EC should be individualized multidisciplinary team approaches according to patients' staging and physiologic reserve. PRACTICAL IMPLICATIONS The aim of this article is to provide a decision support and also a discussion based on clinical therapeutic strategy in order to characterize the beneficial approach which reaches an optimal balance between radical resection, postoperative outcome and long-term survival of EC.
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Affiliation(s)
- Li Sun
- Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hongwei Zhang
- Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Kaichun Wu
- Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Warner S, Chang YH, Paripati H, Ross H, Ashman J, Harold K, Day R, Stucky CC, Rule W, Jaroszewski D. Outcomes of Minimally Invasive Esophagectomy in Esophageal Cancer After Neoadjuvant Chemoradiotherapy. Ann Thorac Surg 2014; 97:439-45. [DOI: 10.1016/j.athoracsur.2013.09.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/04/2013] [Accepted: 09/13/2013] [Indexed: 12/31/2022]
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Anderegg MCJ, Gisbertz SS, van Berge Henegouwen MI. Minimally invasive surgery for oesophageal cancer. Best Pract Res Clin Gastroenterol 2014; 28:41-52. [PMID: 24485254 DOI: 10.1016/j.bpg.2013.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 11/20/2013] [Indexed: 01/31/2023]
Abstract
Worldwide an increasing part of oncologic oesophagectomies is performed in a minimally invasive way. Over the past decades multiple reports have addressed the perioperative outcomes and oncologic safety of minimally invasive oesophageal surgery. Although many of these (retrospective) case-control studies identified minimally invasive oesophagectomy as a safe alternative to open techniques, the clear benefit remained subject to debate. Recently, this controversy has partially resolved due to the results of the first randomized controlled trial that compared both techniques. In this trial short-term benefits of minimally invasive oesophagectomy were demonstrated in terms of lower incidence of pulmonary infections, shorter hospital stay and better postoperative quality of life. However, the current lack of long-term data on recurrence rate and overall survival precludes a comprehensive comparison of minimally invasive and open oesophagectomy. Proclaiming minimally invasive oesophagectomy as the standard of care for patients with resectable oesophageal cancer would therefore be a premature decision.
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Affiliation(s)
- Maarten C J Anderegg
- Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Suzanne S Gisbertz
- Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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