-
Multimedia Manual of Cardiothoracic... Apr 2021Minimally invasive esophagectomy is increasingly becoming the surgical treatment of choice for esophageal cancer. The goal of this technique is to reduce the rate of...
Minimally invasive esophagectomy is increasingly becoming the surgical treatment of choice for esophageal cancer. The goal of this technique is to reduce the rate of respiratory complications associated with thoracotomy while taking advantage of the benefits of reduced mortality associated with minimally invasive techniques. However, minimally invasive esophagectomy is still not considered the gold standard for resectable esophageal cancer worldwide because it is a highly technical and complex procedure. The goal of this video tutorial is to present an easy step-by-step approach to a minimally invasive esophagectomy and to address technical considerations and potential pitfalls.
Topics: Adenocarcinoma; Aged, 80 and over; Esophageal Neoplasms; Esophagectomy; Female; Humans; Minimally Invasive Surgical Procedures; Postoperative Complications; Thoracotomy
PubMed: 33914420
DOI: 10.1510/mmcts.2021.020 -
Commentary: SARS-CoV-2 and Esophagectomy for Esophageal Cancer: Timely Operations and Good Outcomes.Seminars in Thoracic and Cardiovascular... 2022
Topics: COVID-19; Esophageal Neoplasms; Esophagectomy; Humans; SARS-CoV-2; Treatment Outcome
PubMed: 34271096
DOI: 10.1053/j.semtcvs.2021.07.003 -
World Journal of Gastroenterology Aug 2010Esophageal resection is associated with a high morbidity and mortality rate. Minimally invasive esophagectomy (MIE) might theoretically decrease this rate. We reviewed... (Review)
Review
Esophageal resection is associated with a high morbidity and mortality rate. Minimally invasive esophagectomy (MIE) might theoretically decrease this rate. We reviewed the current literature on MIE, with a focus on the available techniques, outcomes and comparison with open surgery. This review shows that the available literature on MIE is still crowded with heterogeneous studies with different techniques. There are no controlled and randomized trials, and the few retrospective comparative cohort studies are limited by small numbers of patients and biased by historical controls of open surgery. Based on the available literature, there is no evidence that MIE brings clear benefits compared to conventional esophagectomy. Increasing experience and the report of larger series might change this scenario.
Topics: Esophagectomy; Evidence-Based Medicine; Humans; Laparoscopy; Risk Assessment; Thoracoscopy; Treatment Outcome
PubMed: 20698044
DOI: 10.3748/wjg.v16.i30.3811 -
Current Problems in Surgery Oct 2021
Review
Topics: Esophageal Neoplasms; Esophagectomy; Humans; Laparoscopy; Thoracoscopy; Treatment Outcome
PubMed: 34629156
DOI: 10.1016/j.cpsurg.2021.100984 -
The Journal of Thoracic and... Sep 2021
Topics: Esophageal Neoplasms; Esophagectomy; Humans; Minimally Invasive Surgical Procedures
PubMed: 33832792
DOI: 10.1016/j.jtcvs.2021.02.054 -
Langenbeck's Archives of Surgery Dec 2020Surgery remains the cornerstone of esophageal cancer treatment but is burdened with high procedure-related morbidity. Anastomotic leakage as the most important surgical... (Review)
Review
BACKGROUND
Surgery remains the cornerstone of esophageal cancer treatment but is burdened with high procedure-related morbidity. Anastomotic leakage as the most important surgical complication after esophagectomy is a key indicator for quality in surgical outcome research.
PURPOSE
The aim of this narrative review is to assess and summarize the current knowledge on prevention of anastomotic leakage after esophagectomy and to provide orientation for the reader in this challenging field of surgery.
CONCLUSIONS
There are various strategies to reduce postoperative morbidity and to prevent anastomotic leakage after esophagectomy, including adequate patient selection and preparation, and many technical-surgical and anesthesiological details. The scientific evidence regarding those strategies is highly heterogeneous, ranging from expert's recommendations to randomized controlled trials. This review is intended to serve as an empirical guideline to improve the clinical management of patients undergoing esophagectomy with a special focus on anastomotic leakage prevention.
Topics: Anastomosis, Surgical; Anastomotic Leak; Esophageal Neoplasms; Esophagectomy; Humans; Retrospective Studies
PubMed: 32651652
DOI: 10.1007/s00423-020-01926-8 -
Annals of Thoracic and Cardiovascular... Oct 2018Esophageal cancer is one of the leading causes of cancer-related death worldwide. Surgery plays an important role in the treatment strategies for esophageal cancer....
Esophageal cancer is one of the leading causes of cancer-related death worldwide. Surgery plays an important role in the treatment strategies for esophageal cancer. Recent advances in surgical techniques and perioperative management have dramatically improved the mortality rate; however, esophagectomy remains a highly invasive procedure that can lead to severe postoperative complications. Future advances in thoracoscopic surgery with the development of surgical endoscopy systems such as three-dimensional (3D) imaging systems with a 4K ultra high-definition camera or two-dimensional (2D) imaging systems with an 8K camera, which is expected to provide 3D-like visual sensation, will enable us to further understand the microscopic anatomy of the thoracic cavity and mediastinum, and to perform delicate surgical procedures that enable minimally invasive esophagectomy with mediastinal lymphadenectomy. A robot-assisted thoracoscopic esophagectomy is attractive for surgeons and may be beneficial to esophageal cancer patients. Preoperative simulation and intraoperative real-time navigation are expected to further help surgeons safely perform esophagectomy with lymphadenectomy. Reduction of the lymphadenectomy field and setting of lymphadenectomy areas with highest priority may be feasible when sentinel node (SN) navigation is appropriately performed in cN0 early-stage esophageal cancer. These technical advances are expected to decrease the morbidity and mortality rate of surgery for esophageal cancer and hopefully improve oncological outcomes.
Topics: Diffusion of Innovation; Esophageal Neoplasms; Esophagectomy; Forecasting; Humans; Lymph Node Excision; Risk Factors; Treatment Outcome
PubMed: 29962387
DOI: 10.5761/atcs.ed.18-00126 -
Thoracic Cancer Mar 2023The study aimed to fully understand small bowel necrosis, a rare but fatal complication after esophagectomy.
BACKGROUND
The study aimed to fully understand small bowel necrosis, a rare but fatal complication after esophagectomy.
METHODS
Patients who underwent esophagectomy for esophageal cancer at the Fudan University Shanghai Cancer Center from January 2013 to December 2021 were retrospectively reviewed. Clinical information on the demographics, presenting features, and outcomes of the cases were collected.
RESULTS
Of the 6607 patients during the study period, 11 (0.2%) underwent reoperation due to bowel necrosis, including nine males (81.8%) and two females (18.2%). Among them, eight cases (72.7%) had hypertension and seven (63.6%) suffered from lower thoracic esophageal cancer. Eight (72.7%) and three (27.3%) patients underwent the Ivor-Lewis and McKewon procedures, respectively. Jejunostomy was performed in nine patients (81.8%). The first signs of bowel necrosis appeared within 5 days after esophagectomy. Abdominal distension and deteriorating renal function were observed in seven patients (63.6%). There was no evidence of mesenteric vascular occlusion in any of the 11 cases, except for the hepatic portal venous gas found in seven patients on the computed tomography (CT) scan. Eight (72.7%) of the 11 patients underwent reoperation within 24 h due to the onset of the first symptoms. Eight (72.7%) had ileal necrosis, and three (27.3%) died.
CONCLUSION
Close attention should be paid to patients with abdominal distension, renal function damage, and portal hepatic venous gas after esophagectomy. These patients may suffer from small bowel necrosis, which may result in rapid disease progression. Exploratory laparotomy and bowel resection are effective treatments for such patients.
Topics: Male; Female; Humans; Esophagectomy; Retrospective Studies; China; Esophageal Neoplasms; Necrosis
PubMed: 36734100
DOI: 10.1111/1759-7714.14817 -
The Journal of Surgical Research Nov 2020Preoperative type and screen (TS) is routinely performed before elective thoracic surgery. We sought to evaluate the utility of this practice by examining our...
BACKGROUND
Preoperative type and screen (TS) is routinely performed before elective thoracic surgery. We sought to evaluate the utility of this practice by examining our institutional data related to intraoperative and postoperative transfusions for two common, complex procedures.
MATERIALS AND METHODS
A single-center, retrospective review of a prospective thoracic surgery database was performed. Patients who underwent consecutive elective anatomic lung resection (ALR) and esophagectomy from January 2015 to April 2018 were included. Perioperative characteristics between patients who received transfusion of packed red blood cells and those who did not were compared. The rates of emergent and nonemergent transfusions were evaluated. Cost data were derived from institutional charges and Centers for Medicare & Medicaid Services fee schedules.
RESULTS
Of 370 patients, 16 (4.3%) received a transfusion and four (1.1%) were deemed emergent by the surgeons and 0 (0%) by blood bank criteria. For ALR (n = 321), 13 (4.0%) received a transfusion, and four (1.2%) were emergent. For esophagectomies (n = 49), three (6.1%) received a transfusion, and none were emergent. Patients who underwent ALR requiring a transfusion had a lower preoperative hemoglobin (11.7 versus 13.4 gm/dL, P = 0.001), higher estimated blood loss (1325 versus 196 mL, P < 0.001), and longer operative time (291 versus 217 min, P = 0.003) than nontransfused patients. Based on current volumes, eliminating TS in these patients would save at least an estimated $60,100 per year.
CONCLUSIONS
Emergent transfusion in ALR and esophagectomy is rare. Routine preoperative TS is most likely unnecessary for these cases. These results will be used in a quality improvement initiative to change practice at our institution.
Topics: Aged; Blood Transfusion; Esophagectomy; Female; Humans; Male; Middle Aged; Preoperative Care; Pulmonary Surgical Procedures; Retrospective Studies; Unnecessary Procedures
PubMed: 32619855
DOI: 10.1016/j.jss.2020.05.087 -
Annals of Surgical Oncology May 2024Esophagectomy for esophageal cancer has a complication rate of up to 60%. Prediction models could be helpful to preoperatively estimate which patients are at increased... (Review)
Review
BACKGROUND
Esophagectomy for esophageal cancer has a complication rate of up to 60%. Prediction models could be helpful to preoperatively estimate which patients are at increased risk of morbidity and mortality. The objective of this study was to determine the best prediction models for morbidity and mortality after esophagectomy and to identify commonalities among the models.
PATIENTS AND METHODS
A systematic review was performed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and was prospectively registered in PROSPERO ( https://www.crd.york.ac.uk/prospero/ , study ID CRD42022350846). Pubmed, Embase, and Clarivate Analytics/Web of Science Core Collection were searched for studies published between 2010 and August 2022. The Prediction model Risk of Bias Assessment Tool was used to assess the risk of bias. Extracted data were tabulated and a narrative synthesis was performed.
RESULTS
Of the 15,011 articles identified, 22 studies were included using data from tens of thousands of patients. This systematic review included 33 different models, of which 18 models were newly developed. Many studies showed a high risk of bias. The prognostic accuracy of models differed between 0.51 and 0.85. For most models, variables are readily available. Two models for mortality and one model for pulmonary complications have the potential to be developed further.
CONCLUSIONS
The availability of rigorous prediction models is limited. Several models are promising but need to be further developed. Some models provide information about risk factors for the development of complications. Performance status is a potential modifiable risk factor. None are ready for clinical implementation.
Topics: Humans; Esophagectomy; Prognosis; Morbidity; Bias; Risk Factors
PubMed: 38383661
DOI: 10.1245/s10434-024-14997-4