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minimally invasive oesophagectomy

Philippe Rinieri, Moussa Ouattara, Geoffrey Brioude, Anderson Loundou, Henri de Lesquen, Delphine Trousse, Christophe Doddoli, Pascal Alexandre Thomas, Xavier Benoit D'Journo
OBJECTIVES: It has been suggested that laparoscopic Ivor Lewis (IL) oesophagectomy reduces postoperative morbidity and mortality rates. However, data related to the long-term outcomes of this hybrid minimally invasive procedure are scarce. METHODS: All of the patients who had an IL oesophagectomy for cancer were extracted from a prospective database. Patients were matched one to one according to the surgical approach (laparoscopy versus laparotomy) and on the basis of a propensity score including eight variables: age, gender, American Society of Anaesthesiologists score, forced expiratory volume in 1 s, surgery (first-line treatment, after neoadjuvant treatment and salvage surgery), histology, location and pathological stage...
September 4, 2016: European Journal of Cardio-thoracic Surgery
Ruben T H M Larue, Lien Van De Voorde, Maaike Berbée, Wouter J C van Elmpt, Ludwig J Dubois, Kranthi M Panth, Sarah G J A Peeters, Ann Claessens, Wendy M J Schreurs, Marius Nap, Fabiënne A R M Warmerdam, Frans L G Erdkamp, Meindert N Sosef, Philippe Lambin
BACKGROUND: Neo-adjuvant chemoradiotherapy followed by surgery is the standard treatment with curative intent for oesophageal cancer patients, with 5-year overall survival rates up to 50 %. However, patients' quality of life is severely compromised by oesophagectomy, and eventually many patients die due to metastatic disease. Most solid tumours, including oesophageal cancer, contain hypoxic regions that are more resistant to chemoradiotherapy. The hypoxia-activated prodrug evofosfamide works as a DNA-alkylating agent under these hypoxic conditions, which directly kills hypoxic cancer cells and potentially minimizes resistance to conventional therapy...
2016: BMC Cancer
Gijs H K Berkelmans, Bas J W Wilts, Ewout A Kouwenhoven, Koshi Kumagai, Magnus Nilsson, Teus J Weijs, Grard A P Nieuwenhuijzen, Marc J van Det, Misha D P Luyer
INTRODUCTION: Early start of an oral diet is safe and beneficial in most types of gastrointestinal surgery and is a crucial part of fast track or enhanced recovery protocols. However, the feasibility and safety of oral intake directly following oesophagectomy remain unclear. The aim of this study is to investigate the effects of early versus delayed start of oral intake on postoperative recovery following oesophagectomy. METHODS AND ANALYSIS: This is an open-label multicentre randomised controlled trial...
August 5, 2016: BMJ Open
Chris Metcalfe, Kerry Avery, Richard Berrisford, Paul Barham, Sian M Noble, Aida Moure Fernandez, George Hanna, Robert Goldin, Jackie Elliott, Timothy Wheatley, Grant Sanders, Andrew Hollowood, Stephen Falk, Dan Titcomb, Christopher Streets, Jenny L Donovan, Jane M Blazeby
BACKGROUND: Localised oesophageal cancer can be curatively treated with surgery (oesophagectomy) but the procedure is complex with a risk of complications, negative effects on quality of life and a recovery period of 6-9 months. Minimal-access surgery may accelerate recovery. OBJECTIVES: The ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) study aimed to establish the feasibility of, and methodology for, a definitive trial comparing minimally invasive and open surgery for oesophagectomy...
June 2016: Health Technology Assessment: HTA
J-H Egberts, H Aselmann, C Hauser, A Bernsmeier, A Carstens, J Hoecker, T Becker
BACKGROUND: Abdominothoracic oesophageal resections, also known as Ivor Lewis procedures, are complex visceral surgery procedures. In recent years, substeps have increasingly been performed using minimally invasive techniques. However, intrathoracic anastomosis is still a challenge given the instrumental and technological possibilities available to date. This article provides a detailed description of the use of the Da Vinci robotic system and our techniques in oesophageal surgery. METHODS: In a prospective data collection, we analysed the robotic-assisted oesophageal surgeries performed at the University Hospital of Schleswig-Holstein, Campus Kiel, between November 2013 and November 2015...
April 2016: Zentralblatt Für Chirurgie
Amit Javed, John Mathew Manipadam, Amit Jain, R Kalayarasan, Rajeev Uppal, Anil K Agarwal
BACKGROUND: Thoracoscopic oesophageal mobilisation during a minimally invasive oesophagectomy (MIE) is most commonly performed with the patient placed in the lateral decubitus position (LDP). The prone position (PP) for thoracoscopic oesophageal mobilisation has been proposed as an alternative. MATERIALS AND METHODS: This was a retrospective, comparative study designed to compare early outcomes following a minimally invasive thoracolaparoscopic oesophagectomy for oesophageal cancer in LDP and in PP...
January 2016: Journal of Minimal Access Surgery
Paul Rodham, Jonathan A Batty, Philip J McElnay, Arul Immanuel
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: 'in patients undergoing oesophagectomy, does a minimally invasive approach convey a benefit in hospital length of stay (LOS), when compared to an open approach?' A total of 647 papers were identified, using an a priori defined search strategy; 24 papers represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group, study type, relevant outcomes and key results are tabulated...
March 2016: Interactive Cardiovascular and Thoracic Surgery
Juwei Mu, Shugeng Gao, Yousheng Mao, Qi Xue, Zuyang Yuan, Ning Li, Kai Su, Kun Yang, Fang Lv, Bin Qiu, Deruo Liu, Keneng Chen, Hui Li, Tiansheng Yan, Yongtao Han, Ming Du, Rongyu Xu, Zhaoke Wen, Wenxiang Wang, Mingxin Shi, Quan Xu, Shun Xu, Jie He
INTRODUCTION: Oesophageal cancer is the eighth most common cause of cancer worldwide. In 2009 in China, the incidence and death rate of oesophageal cancer was 22.14 per 100 000 person-years and 16.77 per 100 000 person-years, respectively, the highest in the world. Minimally invasive oesophagectomy (MIO) was introduced into clinical practice with the aim of reducing the morbidity rate. The mechanisms of MIO may lie in minimising the reaction to surgical injury and inflammation. There are some randomised trials regarding minimally invasive versus open oesophagectomy, with 100-850 subjects enrolled...
2015: BMJ Open
Jang-Ming Lee, Shun-Mao Yang, Pei-Wen Yang, Pei-Ming Huang
OBJECTIVES: Single-incision thoracoscopic and laparoscopic procedures have been applied in treating various diseases. However, it is unknown whether such procedures are feasible in treating oesophageal cancer. METHODS: Minimally invasive oesophagectomy (MIO) with a single-incision approach in the thoracoscopic and laparoscopic procedures was attempted in 16 patients with oesophageal cancer. RESULTS: One patient was converted to laparotomy and a four-port thoracoscopic procedure due to bleeding...
January 2016: European Journal of Cardio-thoracic Surgery
Gopal Singh, Joseph Costa, Marc Bessler, Joshua Sonett
Situs inversus totalis (SIT) is a rare congenital condition in which the internal organs of the thoracic and abdominal cavities experience a right-to-left reflection across the sagittal plane. We describe a case of locally advanced adenocarcinoma of the oesophagus treated with minimally invasive oesophagectomy using a laparoscopic and left video-assisted thoracoscopic surgery approach in a patient with situs inversus totalis.
February 2016: Interactive Cardiovascular and Thoracic Surgery
Jon O Wee
Oesophagectomy is a challenging operation involving multiple body cavities. The traditional open approach has several described techniques. The Ivor Lewis approach is one of the most commonly utilized approaches and includes a laparotomy and a thoracotomy. Traditionally, this has resulted in some morbidity. This article describes a stepwise approach to a minimally invasive Ivor Lewis oesophagectomy including laparoscopic mobilization of the stomach, formation of the gastric conduit, placement of a feeding jejunostomy tube, thoracoscopic oesophageal mobilization and resection and a stapled oesophago-gastric anastomosis...
2015: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Wen-Ling Xiong, Rui Li, Hai-Ke Lei, Zheng-Ying Jiang
BACKGROUND: A systematic review with meta-analysis was performed to compare perioperative outcomes between minimally invasive oesophagectomy (MIE) and open oesophagectomy (OE). METHODS: PubMed and Cochrane databases were searched up to January 2015 using keywords: esophageal cancer, MIE, OE, hybrid MIE. Randomized controlled trials or prospective studies comparing the efficacy of OE with MIE or hybrid MIE in oesophageal cancer patients were included. Sensitivity analysis and quality assessment were performed...
October 19, 2015: ANZ Journal of Surgery
Can Zhou, Li Zhang, Hua Wang, Xiaoxia Ma, Bohui Shi, Wuke Chen, Jianjun He, Ke Wang, Peijun Liu, Yu Ren
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...
2015: PloS One
R D L Akkerman, L Haverkamp, P S N van Rossum, R van Hillegersberg, J P Ruurda
BACKGROUND: Gaining insight in long-term health-related quality of life more than 1year after oesophagectomy will assist clinical decision-making and inform patients about the long-term consequences of surgery. METHODS: In this cross-sectional study, all consecutive patients who underwent oesophageal resection with gastric interposition for cancer at a tertiary referral centre between January 2007 and July 2012 were included. European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30 and QLQ-OES18 were sent to all patients alive without recurrence more than 1year after surgery...
August 2015: European Journal of Cancer
Xinyu Mei, Meiqing Xu, Mingfa Guo, Mingran Xie, Changqing Liu, Zhou Wang
BACKGROUND: Minimally invasive approaches are increasingly being used in oesophagectomy. The aim of this study was to compare the short-term clinical outcomes of the minimally invasive Ivor-Lewis oesophagectomy (MIILE) technique with those of the open Ivor-Lewis oesophagectomy (OILE) technique. METHODS: We identified 131 patients who underwent MIILE combined with thoracoscopy and laparoscopy. These patients were compared with 248 patients who underwent OILE between January 2012 and December 2013...
April 2016: ANZ Journal of Surgery
Rehan Haidry, Laurence Lovat, Prateek Sharma
Barrett's oesophagus is the only know pre-cursor to oesophageal adenocarcinoma. The incidence of OAC is growing rapidly in the western world with a poor prognosis for most with a 5-year survival of only 15%. The approach to treating patients with neoplasia arising within BE has dramatically changed in the past 5 years. Resection of visible lesions with endoscopic mucosal resection followed by field ablation with radio-frequency ablation is now the accepted standard of care in these patients worldwide. This combined approach has shown high rates of disease reversal in several high quality clinical trials but also large volume registry studies...
March 2015: Current Gastroenterology Reports
M Diana, J Marescaux
BACKGROUND: Proficiency in minimally invasive surgery requires intensive and continuous training, as it is technically challenging for unnatural visual and haptic perceptions. Robotic and computer sciences are producing innovations to augment the surgeon's skills to achieve accuracy and high precision during complex surgery. This article reviews the current use of robotically assisted surgery, focusing on technology as well as main applications in digestive surgery, and future perspectives...
January 2015: British Journal of Surgery
David S Y Chan, Andrew L Baker
INTRODUCTION: The uptake of minimally invasive oesophagectomy remains low in the UK. As the only centre in Wales which offers this approach, our aim was to determine the short-term outcomes following endoscopic 2-stage oesophagectomy with stapled intra-thoracic anastomosis. METHODS: Details of 50 consecutive patients [88% (44) male, median age (range) 66 (42-83) years] with operable mid to distal oesophageal and gastro-oesophageal junctional cancer who underwent endoscopic 2-stage oesophagectomy were analysed prospectively between June 2009 to November 2013...
August 2016: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
M Uittenbogaart, M N Sosef, J van Bastelaar
Gastroaortic fistula formation is a very rare complication following oesophageal resection and, in most cases, leads to sudden death. We report the case of a 65-year-old male with an adenocarcinoma of the oesophagus who underwent neoadjuvant chemoradiation followed by a minimally invasive transthoracic oesophagectomy with gastric tube reconstruction and intrathoracic anastomosis. After an uneventful postoperative course and hospital discharge, the patient reported blood regurgitation on postoperative day 23...
2014: Case Reports in Surgery
Jun Wang, Nan-Qing Jiang, Bo Jiang, Zhong-Lin Wang, Xiao-Ying Zhang
OBJECTIVES: Transthoracic oesophagectomy is associated with high morbidity and mortality. Some oesophageal cancer (OC) patients with serious comorbidities cannot tolerate transthoracic oesophagectomy. Therefore, we have adopted a minimally invasive approach to oesophagectomy for such patients. METHODS: Eighty-five OC patients, who could not tolerate transthoracic oesophagectomy, received mediastinoscopy-assisted oesophagectomy (MAO) from January 2007 to January 2010 in our hospital...
April 2015: Interactive Cardiovascular and Thoracic Surgery
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