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Lee DH, Lee DN, Jang HB, Lee JK, Lim SC, Yun JS, Na KJ. Treatment outcomes of elective neck dissection in intrathoracic esophageal carcinoma. Oncol Lett 2024; 28:386. [PMID: 38966579 PMCID: PMC11222913 DOI: 10.3892/ol.2024.14519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/10/2024] [Indexed: 07/06/2024] Open
Abstract
In the present study, the outcomes of elective neck dissection in patients with intrathoracic esophageal squamous cell carcinoma were investigated. From January 2016 to December 2022, 21 patients who underwent esophagectomy and elective neck dissection (both neck level IV) for intrathoracic esophageal squamous cell carcinoma were enrolled. Of these 21 patients, 19 patients were male and 2 were female. A total of 11 patients received concurrent chemoradiotherapy (CCRT) as preoperative treatment. As a result of elective neck dissection at both neck level IV, occult neck metastasis of esophageal squamous cell carcinoma was diagnosed in 3 cases, all of which involved left neck lymph nodes. The incidence of occult neck metastasis was statistically significant in patients with preoperative CCRT, high T stage and high N stage (P<0.05). In addition, 16 out of 21 patients had been under follow-up without disease recurrence after the completion of treatment. However, 3 out of 21 patients succumbed to esophageal squamous cell carcinoma and 2 out of 21 patients were alive with stable disease of esophageal carcinoma. The follow-up period was 19.2±18.4 months. In conclusion, three-field lymph node dissection for intrathoracic esophageal squamous cell carcinoma may be necessary in patients with certain phenotypes, such that collaboration between thoracic surgeons and otolaryngologists may help reduce surgical complications.
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Affiliation(s)
- Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasu, Jeollanam 58128, Republic of Korea
| | - Dae-Neung Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasu, Jeollanam 58128, Republic of Korea
| | - Hye-Bin Jang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasu, Jeollanam 58128, Republic of Korea
| | - Joon Kyoo Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasu, Jeollanam 58128, Republic of Korea
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasu, Jeollanam 58128, Republic of Korea
| | - Ju Sik Yun
- Lung and Esophageal Cancer Clinic, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Jeollanam 58128, Republic of Korea
| | - Kook Joo Na
- Lung and Esophageal Cancer Clinic, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Jeollanam 58128, Republic of Korea
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Matsuda A, Maruyama H, Akagi S, Inoue T, Uemura K, Kobayashi M, Shiomi H, Watanabe M, Arai H, Kojima Y, Mizuuchi Y, Yokomizo H, Toiyama Y, Miyake T, Yokoyama Y, Ishimaru K, Takeda S, Yaguchi Y, Kitagawa Y. Do postoperative infectious complications really affect long-term survival in colorectal cancer surgery? A multicenter retrospective cohort study. Ann Gastroenterol Surg 2023; 7:110-120. [PMID: 36643360 PMCID: PMC9831895 DOI: 10.1002/ags3.12615] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/08/2022] [Indexed: 01/18/2023] Open
Abstract
Aim To investigate the impact of postoperative infection (PI), surgical site infection, and remote infection (RI), on long-term outcomes in patients with colorectal cancer (CRC). Methods The Japan Society for Surgical Infection conducted a multicenter retrospective cohort study involving 1817 curative stage I/II/III CRC patients from April 2013 to March 2015. Patients were divided into the No-PI group and the PI group. We examined the association between PI and oncological outcomes for cancer-specific survival (CSS) and overall survival (OS) using Cox proportional hazards models and propensity score matching. Results Two hundred and ninety-nine patients (16.5%) had PIs. The 5-year CSS and OS rates in the No-PI and PI groups were 92.8% and 87.6%, and 87.4% and 83.8%, respectively. Both the Cox proportional hazards models and propensity score matching demonstrated a significantly worse prognosis in the PI group than that in the No-PI group for CSS (hazard ratio: 1.60; 95% confidence interval: 1.10-2.34; P = .015 and P = .031, respectively) but not for OS. RI and the PI severity were not associated with oncological outcomes. The presence of PI abolished the survival benefit of adjuvant chemotherapy. Conclusions These results suggest that PI after curative CRC surgery is associated with impaired oncological outcomes. This survival disadvantage of PI was primarily derived from surgical site infection, not RI, and PI induced lower efficacy of adjuvant chemotherapy. Strategies to prevent PI and implement appropriate postoperative treatment may improve the quality of care and oncological outcomes in patients undergoing curative CRC surgery.
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Affiliation(s)
- Akihisa Matsuda
- Department of Gastrointestinal and Hepato‐Biliary‐Pancreatic SurgeryNippon Medical SchoolTokyoJapan
- Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan
| | - Hiroshi Maruyama
- Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan
- Department of SurgeryNippon Medical School Tama Nagayama HospitalTokyoJapan
| | - Shinji Akagi
- Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan
- Department of SurgeryMazda HospitalHiroshimaJapan
| | - Toru Inoue
- Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan
- Department of Gastroenterological SurgeryOsaka City General HospitalOsakaJapan
| | - Kenichiro Uemura
- Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan
- Department of SurgeryGraduate School of Biochemical and Health Sciences, Hiroshima UniversityHiroshimaJapan
| | - Minako Kobayashi
- Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan
- Department of Infection Control and PreventionNippon Medical School Musashikosugi HospitalKanagawaJapan
| | - Hisanori Shiomi
- Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan
- Department of SurgeryNagahama Red Cross HospitalShigaJapan
| | - Manabu Watanabe
- Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Hiroki Arai
- Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Yutaka Kojima
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Yusuke Mizuuchi
- Department of Surgery and OncologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
| | - Hajime Yokomizo
- Department of SurgeryTokyo Women's Medical University Adachi Medical CenterTokyoJapan
| | - Yuji Toiyama
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric SurgeryInstitute of Life Sciences, Mie University Graduate School of MedicineMieJapan
| | - Toru Miyake
- Department of SurgeryShiga University of Medical ScienceShigaJapan
| | - Yasuyuki Yokoyama
- Department of Digestive SurgeryNippon Medical School Musashikosugi HospitalKanagawaJapan
| | - Kei Ishimaru
- Department of Minimally Invasive GastroenterologyEhime University Graduate School of MedicineEhimeJapan
| | - Shigeru Takeda
- Department of Gastroenterological, Breast and Endocrine SurgeryYamaguchi University Graduate School of MedicineYamaguchiJapan
| | | | - Yuko Kitagawa
- Department of SurgeryKeio University School of MedicineShinjukuJapan
- The Japan Society of Surgical InfectionTokyoJapan
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SPILIOTIS AE, GÄBELEIN G, MALINOWSKI M, HOLLÄNDER S, SCHERBER PR, GLANEMANN M. Introduction of laparoscopic Ivor Lewis esophagectomy as hybrid procedure and comparison with open esophagectomy. A propensity-matched retrospective study. Minerva Surg 2022; 77:1-13. [DOI: 10.23736/s2724-5691.21.08912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Harriott CB, Angeramo CA, Casas MA, Schlottmann F. Open vs. Hybrid vs. Totally Minimally Invasive Ivor Lewis Esophagectomy: Systematic Review and Meta-analysis. J Thorac Cardiovasc Surg 2022; 164:e233-e254. [DOI: 10.1016/j.jtcvs.2021.12.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/03/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023]
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Siaw‐Acheampong K, Kamarajah SK, Gujjuri R, Bundred JR, Singh P, Griffiths EA. Minimally invasive techniques for transthoracic oesophagectomy for oesophageal cancer: systematic review and network meta-analysis. BJS Open 2020; 4:787-803. [PMID: 32894001 PMCID: PMC7528517 DOI: 10.1002/bjs5.50330] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Oesophagectomy is a demanding operation that can be performed by different approaches including open surgery or a combination of minimal access techniques. This systematic review and network meta-analysis aimed to evaluate the clinical outcomes of open, minimally invasive and robotic oesophagectomy techniques for oesophageal cancer. METHODS A systematic literature search was conducted for studies reporting open oesophagectomy, laparoscopically assisted oesophagectomy (LAO), thoracoscopically assisted oesophagectomy (TAO), totally minimally invasive oesophagectomy (MIO) or robotic MIO (RAMIO) for oesophagectomy. A network meta-analysis of intraoperative (operating time, blood loss), postoperative (overall complications, anastomotic leaks, chyle leak, duration of hospital stay) and oncological (R0 resection, lymphadenectomy) outcomes, and survival was performed. RESULTS Ninety-eight studies involving 32 315 patients were included in the network meta-analysis (open 17 824, 55·2 per cent; LAO 1576, 4·9 per cent; TAO 2421 7·5 per cent; MIO 9558, 29·6 per cent; RAMIO 917, 2·8 per cent). Compared with open oesophagectomy, both MIO and RAMIO were associated with less blood loss, significantly lower rates of pulmonary complications, shorter duration of stay and higher lymph node yield. There were no significant differences between surgical techniques in surgical-site infections, chyle leak, and 30- and 90-day mortality. MIO and RAMIO had better 1- and 5-year survival rates respectively compared with open surgery. CONCLUSION Minimally invasive and robotic techniques for oesophagectomy are associated with reduced perioperative morbidity and duration of hospital stay, with no compromise of oncological outcomes but no improvement in perioperative mortality.
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Affiliation(s)
| | - S. K. Kamarajah
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman HospitalNewcastle University NHS Foundation Trust HospitalsNewcastle upon TyneUK
- Institute of Cellular MedicineUniversity of NewcastleNewcastle upon TyneUK
| | - R. Gujjuri
- College of Medical and Dental SciencesNewcastle upon TyneUK
| | - J. R. Bundred
- College of Medical and Dental SciencesNewcastle upon TyneUK
| | - P. Singh
- Regional Oesophago‐Gastric UnitRoyal Surrey County Hospital NHS Foundation TrustGuildfordUK
| | - E. A. Griffiths
- Institute of Cancer and Genomic Sciences, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- Department of Upper Gastrointestinal SurgeryUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
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Propensity score-matched comparison between open and minimal invasive hybrid esophagectomy for esophageal adenocarcinoma. Langenbecks Arch Surg 2020; 405:521-532. [PMID: 32388717 DOI: 10.1007/s00423-020-01882-3] [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: 10/12/2019] [Accepted: 04/15/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND This study compared the outcome between patients who had an open and those who had a hybrid esophagectomy for T1 or T3 esophageal adenocarcinoma (eAC). No clear data are available concerning this question based on T-category. METHODS Two groups of patients with esophagectomy and high intrathoracic esophagogastrostomy for eAC were analyzed: hybrid (laparoscopy + right thoracotomy) (n = 835) and open (laparotomy + right thoracotomy) (n = 188). Outcome criteria were 30- and 90-day mortality, R0-resection rate (R0), number of resected lymph nodes (rLNs), and 5-year survival rate (5y-SR). For each type of surgery, three patient groups were analyzed: pT1-carcinoma (group-1), cT3Nx and neoadjuvant chemoradiation (group-2), and pT3N0-3 without neoadjuvant therapy (group-3). The comparison was based on a propensity score matching in relation of 1:2 for open versus hybrid. RESULTS In group-1 (38 open vs 76 hybrid) R0-resection (100%), 30-day mortality (0%), 90-day mortality (2.6% vs 0%), and rLNs (median 29.5 vs 28.5) were not significantly different. The pN0-rate was 76% in the open and 92% in the hybrid group (p = 0.036). Accordingly, the 5y-SR was 69% and 87% (p = 0.016), but the prognosis of the subgroups pT1pN0 or pT1pN+ was not significantly different between open or hybrid. In group-2 (68 open vs 135 hybrid) R0-resection (97%), 30-day (0% vs 0.7%) and 90-day (4%) mortality, rLNs (28.5 vs 26), and 5y-SR (36% vs 41%) were not significantly different. In group-3 (37 open vs 75 hybrid) R0, postoperative mortality, rLNs, and 5y-SR were not significantly different. CONCLUSION In a propensity score-matched comparison of patients with an open or hybrid esophagectomy for esophageal adenocarcinoma the quality of oncologic resection, postoperative mortality and prognosis are not different.
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Wei ZD, Zhang HL, Yang YS, Chen LQ. Effectiveness of Transthoracic Hybrid Minimally Invasive Esophagectomy: A Meta-Analysis. J INVEST SURG 2020; 34:963-973. [PMID: 32036710 DOI: 10.1080/08941939.2020.1725189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transthoracic hybrid minimally invasive esophagectomy (HMIE) is frequently performed in patients with esophageal cancer. However, no conclusive benefit has been defined for HMIE compared with open esophagectomy (OE) or totally MIE (TMIE). The aim of this meta-analysis is to evaluate the effectiveness of HMIE compared with OE and TMIE. METHODS PubMed, Embase (via OVID) and Cochrane databases were comprehensively searched for relevant studies up to January 2019. Studies comparing the efficacy of transthoracic HMIE with OE or TMIE were included in this meta-analysis. RESULTS Twenty-nine relevant studies comprising 3994 patients were identified and included in the analysis of HMIE vs OE. HMIE decreased the incidence of postoperative total morbidity (OR = 0.66, 95% CI 0.55 to 0.80, p = 0.00), pneumonia (OR = 0.55, 95% CI 0.45 to 0.66, p = 0.00), in-hospital mortality (OR = 0.54, 95% CI 0.36 to 0.83, p = 0.01), duration of hospitalization (SMD=-1.03, 95% CI -1.73 to -0.33, p = 0.00) and the estimated intraoperative blood loss (SMD=-1.01, 95% CI -1.62 to -0.40, p = 0.00) compared with OE. Twenty-one relevant studies comprising 3007 patients were identified and included in the analysis of HMIE vs TMIE. HMIE increased estimated intraoperative blood loss [standardized mean difference (SMD) = 1.02, 95% CI 0.45 to 1.58, p = 0.00] and the incidence of postoperative pneumonia (OR = 1.69, 95% CI 1.26 to 2.26, p = 0.00) compared with TMIE. No statistical differences were observed for other surgical outcomes. CONCLUSIONS In our opinion, HMIE is a promising surgical technique. But further RCTs are still needed to confirm the advantages and disadvantages of HMIE mentioned above.
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Affiliation(s)
- Zheng-Dao Wei
- Medical Office Administration, The General Hospital of Western Theater Command, Chengdu, China.,Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Han-Lu Zhang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
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Yang J, Chen L, Ge K, Yang JL. Efficacy of hybrid minimally invasive esophagectomy vs open esophagectomy for esophageal cancer: A meta-analysis. World J Gastrointest Oncol 2019; 11:1081-1091. [PMID: 31798787 PMCID: PMC6883181 DOI: 10.4251/wjgo.v11.i11.1081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/14/2019] [Accepted: 08/19/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The first line treatment regimen for esophageal cancer is still surgical resection and the choice of surgical scheme depends on surgeon. Now the efficacy comparison of hybrid minimally invasive esophagectomy (HMIE) and open esophagectomy (OE) is still controversial.
AIM To compare the perioperative and postoperative outcomes of HMIE and OE in patients with esophageal cancer.
METHODS PubMed, EMBASE, and Cochrane Library databases were searched for related articles. The odds ratio (OR) or standard mean difference (SMD) with a 95% confidence interval (CI) was used to evaluate the effectiveness of HMIE and OE.
RESULTS Seventeen studies including a total of 2397 patients were selected. HMIE was significantly associated with less blood loss (SMD = -0.43, 95%CI: -0.66, -0.20; P = 0.0002) and lower incidence of pulmonary complications (OR = 0.72, 95%CI: 0.57, 0.90; P = 0.004). No significant differences were seen in the lymph node yield (SMD = 0.11, 95%CI: -0.08, 0.30; P = 0.26), operation time (SMD = 0.24, 95%CI: -0.14, 0.61; P = 0.22), total complications rate (OR = 0.68, 95%CI: 0.46, 0.99; P = 0.05), cardiac complication rate (OR = 0.91, 95%CI: 0.62, 1.34; P = 0.64), anastomotic leak rate (OR = 0.95, 95%CI: 0.67, 1.35; P = 0.78), duration of intensive care unit stay (SMD = -0.01, 95%CI: -0.21, 0.19; P = 0.93), duration of hospital stay (SMD = -0.13, 95%CI: -0.28, 0.01; P = 0.08), and total mortality rates (OR = 0.70, 95%CI: 0.47, 1.06; P = 0.09) between the two treatment groups.
CONCLUSION Compared with the OE, HMIE shows less blood loss and pulmonary complications. However, further studies are necessary to evaluate the long-term oncologic outcomes of HMIE.
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Affiliation(s)
- Jiao Yang
- Department of Infectious Diseases, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310013, Zhejiang Province, China
| | - Ling Chen
- Department of Infectious Diseases, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310013, Zhejiang Province, China
| | - Ke Ge
- Department of Infectious Diseases, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310013, Zhejiang Province, China
| | - Jian-Le Yang
- Department of Infectious Diseases, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310013, Zhejiang Province, China
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Yun JS, Na KJ, Song SY, Kim S, Kim E, Jeong IS, Oh SG. Laparoscopic repair of hiatal hernia. J Thorac Dis 2019; 11:3903-3908. [PMID: 31656664 DOI: 10.21037/jtd.2019.08.94] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Laparoscopic hiatal hernia repair is a complex surgery typically performed by general abdominal surgeons because it typically involves an abdominal approach. Here, we report our experiences on laparoscopic repair of hiatal hernia as thoracic surgeons. Methods Based on our experience of minimally invasive esophageal surgery (MIES) for esophageal cancer, we began performing laparoscopic repair of hiatal hernia in 2009. We analyzed the surgery-related data and postoperative outcomes of 18 consecutive patients we operated on from 2009 to 2017. Results There were 1 male and 17 female patients with a median age of 73 years (range, 37-81 years). Ten of 14 symptomatic patients experienced reflux symptoms, such as heartburn. Four patients had a history of prior abdominal surgery. Hiatal hernia types I, II, III, and IV were observed in 3, 9, 5, and 1 patients, respectively. Two (11.1%) laparoscopic procedures required conversion. Modified Collis gastroplasty was used as an esophageal lengthening procedure in 5 patients (27.8%). Mean operation time was 213.8±70.1 minutes and mean hospital stay was 6.2±1.5 days. There were no postoperative complications. At the last follow-up, 15 patients (83.3%) were asymptomatic; however, 3 (16.7%) complained of reflux or dysphagia. Recurrent hiatal hernia was detected on an esophagogram in only 1 patient at 3.5 years after laparoscopic surgery. Conclusions Laparoscopic repair of hiatal hernia is a feasible technique with a satisfactory surgical outcome. Importantly, it can be performed by thoracic surgeons who are experienced in the laparoscopic approach.
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Affiliation(s)
- Ju Sik Yun
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Jeollanam-do, South Korea
| | - Kook Joo Na
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Jeollanam-do, South Korea
| | - Sang Yun Song
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Jeollanam-do, South Korea
| | - Seok Kim
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Jeollanam-do, South Korea
| | - Eunchong Kim
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwang-ju, South Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwang-ju, South Korea
| | - Sang Gi Oh
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwang-ju, South Korea
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Vrba R, Neoral C, Vomackova K, Vrana D, Melichar B, Lubuska L, Loveckova Y, Aujesky R. Complications of the surgical treatment of esophageal cancer and microbiological analysis of the respiratory tract. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:284-291. [PMID: 31551607 DOI: 10.5507/bp.2019.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/12/2019] [Indexed: 11/23/2022] Open
Abstract
AIM The aim of this study was to reduce the severe respiratory complications of esophageal cancer surgery often leading to death. METHODS Two groups of patients operated on for esophageal cancer were evaluated in this retrospective analysis. The first group was operated between 2006-2011, prior to the implementation of preoperative microbiological examination while the second group had surgery between 2012-2017 after implementation of this examination. RESULTS In total, 260 patients, 220 males and 40 females underwent esophagectomy. Between 2006-2011, 113 (87.6%) males and 16 (12.4%) females and between 2012-2017, esophagectomy was performed in 107 (81.7%) males and 24 (18.3%) females. In the first cohort, 10 patients died due to respiratory complications. The 30-day mortality was 6.9% and 90-day was 9.3%. In the second cohort, 4 patients died from respiratory complications. The 30-day mortality was 1.5% and 90-day mortality was 3.1%. With regard to the incidence of respiratory complications (P=0.014), these occurred more frequently in patients with sputum collection, however, severe respiratory complications were more often observed in patients without sputum collection. Significantly fewer patients died (P=0.036) in the group with sputum collection. The incidence of respiratory complications was very significantly higher in the patients who died (P<0.0001). CONCLUSION The incidence of severe respiratory complications (causing death) may be reduced by identifying clinically silent respiratory tract infections.
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Affiliation(s)
- Radek Vrba
- Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Cestmir Neoral
- Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Katherine Vomackova
- Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - David Vrana
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Bohuslav Melichar
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Lucie Lubuska
- Department of Surgical Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Yvona Loveckova
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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Hagihara M, Kusachi S, Kato Y, Yamagishi Y, Niitsuma T, Mikamo H, Takesue Y, Sumiyama Y. Current status of post-operative infections due to antimicrobial-resistant bacteria after digestive tract surgery in Japan: Japan Postoperative Infectious Complications Survey in 2015 (JPICS'15). Surg Today 2019; 50:56-67. [PMID: 31399783 DOI: 10.1007/s00595-019-01857-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/01/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE We herein report the findings of the Japan Postoperative Infectious Complication Survey in 2015 (JPICS'15), which evaluated the rate of post-operative infections and colonization due to antimicrobial-resistant (AMR) bacteria after digestive tract surgery. METHODS This survey by the Japan Society of Surgical Infection included patients undergoing digestive tract surgery at 28 centers between September 2015 and March 2016. Data included patient background characteristics, type of surgery, contamination status, and type of post-operative infections, including surgical site infections (SSIs), remote infections (RIs), and colonization. RESULTS During the study period, 7,565 surgeries (of 896 types) were performed; among them, 905 cases demonstrated bacteria after digestive tract surgery. The survey revealed that post-operative infections or colonization by AMR bacteria occurred in 0.9% of the patient cohort, constituting 7.5% of post-operative infections, including 5.6% of SSIs and 1.8% of RIs. Extended-spectrum β-lactamase-producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus were the predominant AMR bacteria isolated from patients after digestive tract surgery. Patients infected with AMR bacteria had a poor prognosis. CONCLUSION Our results reveal that 7.5% of the post-operative infections were due to AMR bacteria, indicating the need for antibacterial coverage against AMR bacteria in patients with critical post-operative infections.
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Affiliation(s)
- Mao Hagihara
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Shinya Kusachi
- Department of Surgery, Ohashi Medical Center, Toho University, Tokyo, Japan
| | - Yukiko Kato
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Toru Niitsuma
- Department of Surgery, Ohashi Medical Center, Toho University, Tokyo, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan.
| | - Yoshio Takesue
- Department of Infection Prevention and Control, Hyogo College of Medicine, Hyogo, Japan
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Niitsuma T, Kusachi S, Takesue Y, Mikamo H, Asai K, Watanabe M. Current status of postoperative infections after digestive surgery in Japan: The Japan Postoperative Infectious Complications Survey in 2015. Ann Gastroenterol Surg 2019; 3:276-284. [PMID: 31131356 PMCID: PMC6524110 DOI: 10.1002/ags3.12236] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/08/2018] [Accepted: 01/03/2019] [Indexed: 01/27/2023] Open
Abstract
AIM To survey postoperative infections (PI) after digestive surgery. METHODS This survey, conducted by the Japan Society of Surgical Infection, included patients undergoing digestive surgery at 28 centers between September 2015 and March 2016. Data collected included patient background characteristics, type of surgery, contamination status, and type of PI, including surgical site infection (SSI), remote infection (RI), and antimicrobial-resistant (AMR) bacterial infections and colonization. RESULTS Postoperative infections occurred in 10.7% of 6582 patients who underwent digestive surgery (6.8% for endoscopic surgery and 18.7% for open surgery). SSI and RI, including respiratory tract infection, urinary tract infection, antibiotic-associated diarrhea, drain infection, and catheter-related bloodstream infection, occurred in 8.9% and 3.7% of patients, respectively. Among all PI, 13.2% were overlapping infections. The most common overlapping infections were incisional and organ/space SSI, which occurred in 4.2% of patients. AMR bacterial infections occurred in 1.2% of patients after digestive surgery and comprised 11.5% of all PI. Rate of AMR bacterial colonization after digestive surgery was only 0.3%. CONCLUSION Periodic surveillance of PI, including AMR bacteria, is necessary for a detailed evaluation of nosocomial infections.
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Affiliation(s)
- Toru Niitsuma
- Department of SurgeryToho University Graduate School of MedicineTokyoJapan
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Shinya Kusachi
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Yoshio Takesue
- Department of Infection Prevention and ControlHyogo College of MedicineHyogoJapan
| | - Hiroshige Mikamo
- Department of Clinical Infectious DiseasesAichi Medical UniversityAichiJapan
| | - Koji Asai
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Manabu Watanabe
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
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Voron T, Lintis A, Piessen G. Hybrid esophagectomy. J Thorac Dis 2019; 11:S723-S727. [PMID: 31080650 PMCID: PMC6503280 DOI: 10.21037/jtd.2018.12.92] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/18/2018] [Indexed: 12/16/2022]
Abstract
Esophagectomy is a complex surgical procedure associated with high rates of mortality and morbidity, mainly dominated by pulmonary complications. Minimally invasive approaches have been developed in order to decrease postoperative morbidity, including totally minimally invasive esophagectomy (MIE) and hybrid esophagectomy in which one surgical step is achieved either by laparoscopy or thoracoscopy and the other step by open approach. In this review, we will discuss the main results of this hybrid approach in esophagectomy for cancer. Hybrid esophagectomy is associated with better postoperative outcomes compared to open approach, and similar outcomes compared to totally MIE, especially concerning pulmonary complications. For long-terms outcomes, hybrid approach showed similar, or even better, overall survival than open approach. With a short learning curve, hybrid esophagectomy with laparoscopic gastric mobilization will be the future gold standard for esophagectomy and should be further compared with totally MIE.
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Affiliation(s)
- Thibault Voron
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
- Cellule Innovation, DRCI, CHU Lille, Lille, France
| | - Alexandru Lintis
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
- Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille, France
- Inserm, UMR-S, Lille, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
- Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille, France
- Inserm, UMR-S, Lille, France
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Naffouje SA, Salloum RH, Khalaf Z, Salti GI. Outcomes of Open Versus Minimally Invasive Ivor-Lewis Esophagectomy for Cancer: A Propensity-Score Matched Analysis of NSQIP Database. Ann Surg Oncol 2019; 26:2001-2010. [PMID: 30927192 DOI: 10.1245/s10434-019-07319-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We conducted this analysis to compare the outcomes of open transthoracic esophagectomy (OTTE) and minimally invasive transthoracic esophagectomy (MITTE) when performed for oncologic indications. METHODS The NSQIP esophagectomy-targeted database during 2-year period was used. Only patients who underwent elective TTE for oncologic indications were included. Patients were matched per a propensity score for the likelihood of receiving OTTE versus MITTE. RESULTS Overall, 2098 esophagectomies were reported; 576 met the inclusion criteria. A total of 161 purely OTTE patients were matched 1:1 with patients who received purely MITTE. OTTE was associated with higher reported rates of abdominal and mediastinal lymphadenectomies (LAD) (26.7% vs. 3.1% and 38.5% vs. 16.1%, respectively; p < 0.001) and had shorter mean operative time (329 vs. 414 min; p < 0.001). However, OTTE patients had higher rates of wound infection (7.5% vs. 1.9%), longer median hospitalization (10 vs. 8 days), more non-home discharges (18.0 vs. 8.1%), and a tendency toward higher rates of postoperative transfusion (13.0% vs. 6.8%; p = 0.092). The overall complications rate was higher in OTTE (46.0% vs. 33.5%; p = 0.028). No difference was noted in the rates of anastomotic leak, negative margins, reoperation, readmission, or mortality. Laparoscopic versus robotic approaches were uniformly comparable, except for higher rates of reported abdominal LAD in laparoscopic and higher rates of reported mediastinal LAD in robotic approach. CONCLUSIONS MITTE is comparable to OTTE for oncologic indications in immediate postoperative outcomes. A concern is raised regarding the oncologic outcome given the lower reported rates of lymphadenectomies. Comparison of long-term outcomes is essential to address this concern.
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Affiliation(s)
- Samer A Naffouje
- Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
| | - Rony H Salloum
- Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Zaynab Khalaf
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - George I Salti
- Division of Surgical Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.,Department of Surgical Oncology, Edward Hospital Cancer Center, Naperville, IL, USA
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