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Thoracoscopic esophagectomy in total pharyngolaryngoesophagectomy for esophageal cancer; A case series.

ABSTRACT: Background:Total pharyngolaryngoesophagectomy (TPLE) is associated with major complications and is extremely invasive. In 2011, our institution introduced thoracoscopic esophagectomy in the left hemi-prone position and laparoscopic reconstruction with a gastric tube in patients undergoing TPLE. Herein, we describe the use of this operative method in 26 patients, focusing on the technical aspects of the surgery. Materials and methods:From January 2011 to December 2018, 26 patients underwent minimally invasive TPLE with gastric tube reconstruction in our institute. The thoracoscopic procedure was performed with the patient in the semi-prone position. The patient was then moved to the supine position, and the laparoscopic procedure and pharyngolaryngectomy were started simultaneously. After pharyngolaryngectomy, microvascular anastomoses or free jejunal flap interposition were performed at the site of the gastric tube reconstruction. The data from these 26 patients were retrospectively analyzed. Results:The median age was 66 years, and 3.8% of the patients were female. The Union for International Cancer Control stages of esophageal cancer were 0 (n = 2), I (n = 4), II (n = 7), III (n = 8), and IV (n = 5). Eight patients had concomitant esophageal cancer and head and neck cancer. Reconstruction with only a narrow gastric tube was used in 16 patients, while free jejunal flap interposition was used in 10 patients. The surgical procedures resulted in minimal complications. Postoperative complications of Clavien-Dindo grade ?1 included anastomotic leakage in two patients and pneumonia in one. Conclusion:Thoracoscopic esophagectomy in the left hemi-prone position and laparoscopic reconstruction with a gastric tube in patients undergoing TPLE was safe and effective. The complications were improved via the development of various procedures. Further improvement is necessary before this thoracoscopic approach is established as a standard procedure for TPLE.

SUBMITTER: Kimura Y

PROVIDER: S-EPMC7567906 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Thoracoscopic esophagectomy in total pharyngolaryngoesophagectomy for esophageal cancer; A case series.

Kimura Yasue Y Saeki Hiroshi H Hu Qingjiang Q Hisamatsu Yuichi Y Matsuo Mioko M Yoshida Sei S Oki Eiji E Yasumatsu Ryuji R Kadota Hideaki H Mori Masaki M

Annals of medicine and surgery (2012) 20201012

<h4>Background</h4>Total pharyngolaryngoesophagectomy (TPLE) is associated with major complications and is extremely invasive. In 2011, our institution introduced thoracoscopic esophagectomy in the left hemi-prone position and laparoscopic reconstruction with a gastric tube in patients undergoing TPLE. Herein, we describe the use of this operative method in 26 patients, focusing on the technical aspects of the surgery.<h4>Materials and methods</h4>From January 2011 to December 2018, 26 patients ...[more]

PMID: 33088500

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Project description:Background:Robot-assisted minimally invasive esophagectomy (RAMIE) reduces postoperative respiratory complications and enables meticulous mediastinal lymphadenectomy. However, whether adding a robotic abdominal procedure to a robotic thoracic procedure can result in better outcomes is unclear. We examined outcomes after total-RAMIE (T-RAMIE) and compared them with the outcomes after hybrid-RAMIE (H-RAMIE). Methods:Total of 227 patients who underwent robotic esophagectomy for esophageal cancer were included. T-RAMIE was defined as esophagectomy performed robotically in both the thoracic and abdominal cavities. Laparotomy was used instead of the robotic procedure in H-RAMIE. T-RAMIE was performed in 144 patients (63.4%), and propensity score matching produced 49 matched pairs from each group. Early and long-term clinical outcomes between the two groups were compared. Results:T-RAMIE was mostly performed for upper or mid-thoracic squamous cell carcinoma (n=119, 82.6%) and cervical anastomosis, and three-field lymphadenectomy was performed in 113 (78.5%) and 54 (37.5%) patients, respectively. One laparotomy conversion was necessary because of severe obesity. The propensity-matched analysis demonstrated that T-RAMIE showed a comparable 90-day mortality rate with H-RAMIE (0% vs. 6.1%, P=0.083). The incidence rates of total (63.3% vs. 63.3%; P=1.000), abdominal (8.2% vs. 14.3%; P=0.366), and respiratory complications (10.2% vs. 10.2%; P=1.000) were not different between two groups. The number of harvested abdominal lymph nodes was similar (12.4±9.0 vs. 12.3±8.9; P=0.992). Median follow-up duration for T-RAMIE and H-RAMIE was 16.3 and 23.5 months, respectively. Two-year overall survival rate (86.2% in T-RAMIE vs. 77.6% in H-RAMIE; P=0.150) and recurrence-free survival (76.6% in T-RAMIE vs. 62.2% in H-RAMIE; P=0.280) were comparable between the two groups. Conclusions:In this matched analysis, T-RAMIE and H-RAMIE showed comparable early outcomes and long-term survival. The low tendencies of early mortality and conversion rate of T-RAMIE suggest that it might be a safe alternative to open stomach mobilization and abdominal lymphadenectomy.

Project description:To update our experiences with minimally invasive McKeown esophagectomy for esophageal cancer.We retrospectively reviewed the medical records of 445 consecutive patients who underwent minimally invasive McKeown esophagectomy between January 2009 and July 2015 at the Cancer Hospital of Chinese Academy of Medical Sciences and used 103 patients who underwent open McKeown esophagectomy in the same period as controls. Among 375 patients who underwent total minimally invasive McKeown esophagectomy, 180 in the early period were chosen for the study of learning curve of total minimally invasive McKeown esophagectomy. These 180 minimally invasive McKeown esophagectomies performed by five surgeons were divided into three groups according to time sequence as group 1 (n = 60), group 2 (n = 60) and group 3 (n = 60).Patients who underwent total minimally invasive McKeown esophagectomy had significantly less intraoperative blood loss than patients who underwent hybrid minimally invasive McKeown esophagectomy or open McKeown esophagectomy (100 mL vs 300 mL vs 200 mL, P = 0.001). However, there were no significant differences in operation time, number of harvested lymph nodes, or postoperative morbidity including incidence of pulmonary complication and anastomotic leak between total minimally invasive McKeown esophagectomy, hybrid minimally invasive McKeown esophagectomy and open McKeown esophagectomy groups. There were no significant differences in 5-year survival between these three groups (60.5% vs 47.9% vs 35.6%, P = 0.735). Patients in group 1 had significantly longer duration of operation than those in groups 2 and 3. There were no significant differences in intraoperative blood loss, number of harvested lymph nodes, or postoperative morbidity including incidence of pulmonary complication and anastomotic leak between groups 1, 2 and 3.Total minimally invasive McKeown esophagectomy was associated with reduced intraoperative blood loss and comparable short term and long term survival compared with hybrid minimally invasive McKeown esophagectomy or open Mckeown esophagectomy. At least 12 cases are needed to master total minimally invasive McKeown esophagectomy in a high volume center.

Project description:BackgroundVideo-assisted thoracoscopic surgery (VATS) is being used to treat esophageal submucosal tumors (SMTs) all over the world. However, this technique is difficult when the tumor is large and located on the left side wall of the esophagus, within the upper mediastinum. This is because, with VATS, the surgical forceps have a limited range of motion. Robot-assisted thoracoscopic surgery (RATS) using the da Vinci surgical system may be extremely useful for enucleation of esophageal SMTs within the narrow upper mediastinum.Case presentationA female in her thirties experiencing epigastric pain visited our hospital and was diagnosed with a large esophageal leiomyoma within the upper mediastinum. From its size (10 cm), it was judged to have malignant potential. We performed SMT enucleation using RATS with a da Vinci surgical system Xi. This was our second case using this system. The patient was placed in the left lateral position. Four da Vinci trocars (8 mm) were inserted into the 10th, 7th, 5th and 3rd intercostal spaces (ICS), and an assist port was added in the 5th ICS. We opened the superior mediastinal pleura cranially and caudally from the arch of the azygos vein and expanded the superior mediastinum after dividing the azygos vein. We made an incision in the muscular layer of the esophagus and, using a monopolar hook and monopolar scissors, enucleated the esophageal tumor in a protective manner so as not to damage its capsule or mucosa while applying appropriate robot-specific counter traction. We then sewed up the muscularis using 4-0 Vicryl, inserting the endoscope into the thoracic esophagus to substitute for a bougie. In addition, the pleura was sutured using barbed suture. The surgical procedure was straightforward and smooth. The patient was discharged on postoperative day 4 with no surgical complications. The tumor was definitively diagnosed pathologically from paraffin sections as a benign esophageal leiomyoma.ConclusionsRATS enables more delicate and precise esophageal SMT enucleation without surgical complications, though various challenges remain to be overcome.

Dataset Information

Thoracoscopic esophagectomy in total pharyngolaryngoesophagectomy for esophageal cancer; A case series.

Publications

Thoracoscopic esophagectomy in total pharyngolaryngoesophagectomy for esophageal cancer; A case series.

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