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      About Digestion: 3.2 Impact Factor I 6.4 CiteScore I 0.914 Scimago Journal & Country Rank (SJR)

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      Minimally invasive oesophagectomy: preliminary results after introduction of an intrathoracic anastomosis.

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          Intrathoracic anastomosis after oesophagectomy has recently been associated with reduced functional morbidity compared to a cervical anastomosis.

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          Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial.

          Surya S A Y Biere, Mark I van Berge Henegouwen, Kirsten W. Maas … (2012)
          Surgical resection is regarded as the only curative option for resectable oesophageal cancer, but pulmonary complications occurring in more than half of patients after open oesophagectomy are a great concern. We assessed whether minimally invasive oesophagectomy reduces morbidity compared with open oesophagectomy. We did a multicentre, open-label, randomised controlled trial at five study centres in three countries between June 1, 2009, and March 31, 2011. Patients aged 18-75 years with resectable cancer of the oesophagus or gastro-oesophageal junction were randomly assigned via a computer-generated randomisation sequence to receive either open transthoracic or minimally invasive transthoracic oesophagectomy. Randomisation was stratified by centre. Patients, and investigators undertaking interventions, assessing outcomes, and analysing data, were not masked to group assignment. The primary outcome was pulmonary infection within the first 2 weeks after surgery and during the whole stay in hospital. Analysis was by intention to treat. This trial is registered with the Netherlands Trial Register, NTR TC 2452. We randomly assigned 56 patients to the open oesophagectomy group and 59 to the minimally invasive oesophagectomy group. 16 (29%) patients in the open oesophagectomy group had pulmonary infection in the first 2 weeks compared with five (9%) in the minimally invasive group (relative risk [RR] 0·30, 95% CI 0·12-0·76; p=0·005). 19 (34%) patients in the open oesophagectomy group had pulmonary infection in-hospital compared with seven (12%) in the minimally invasive group (0·35, 0·16-0·78; p=0·005). For in-hospital mortality, one patient in the open oesophagectomy group died from anastomotic leakage and two in the minimally invasive group from aspiration and mediastinitis after anastomotic leakage. These findings provide evidence for the short-term benefits of minimally invasive oesophagectomy for patients with resectable oesophageal cancer. Digestive Surgery Foundation of the Unit of Digestive Surgery of the VU University Medical Centre. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Outcomes after minimally invasive esophagectomy: review of over 1000 patients.

            Ghulam Abbas, Arjun Pennathur, H S Keeley … (2012)
            Esophagectomy is a complex operation and is associated with significant morbidity and mortality. In an attempt to lower morbidity, we have adopted a minimally invasive approach to esophagectomy. Our primary objective was to evaluate the outcomes of minimally invasive esophagectomy (MIE) in a large group of patients. Our secondary objective was to compare the modified McKeown minimally invasive approach (videothoracoscopic surgery, laparoscopy, neck anastomosis [MIE-neck]) with our current approach, a modified Ivor Lewis approach (laparoscopy, videothoracoscopic surgery, chest anastomosis [MIE-chest]). We reviewed 1033 consecutive patients undergoing MIE. Elective operation was performed on 1011 patients; 22 patients with nonelective operations were excluded. Patients were stratified by surgical approach and perioperative outcomes analyzed. The primary endpoint studied was 30-day mortality. The MIE-neck was performed in 481 (48%) and MIE-Ivor Lewis in 530 (52%). Patients undergoing MIE-Ivor Lewis were operated in the current era. The median number of lymph nodes resected was 21. The operative mortality was 1.68%. Median length of stay (8 days) and ICU stay (2 days) were similar between the 2 approaches. Mortality rate was 0.9%, and recurrent nerve injury was less frequent in the Ivor Lewis MIE group (P < 0.001). MIE in our center resulted in acceptable lymph node resection, postoperative outcomes, and low mortality using either an MIE-neck or an MIE-chest approach. The MIE Ivor Lewis approach was associated with reduced recurrent laryngeal nerve injury and mortality of 0.9% and is now our preferred approach. Minimally invasive esophagectomy can be performed safely, with good results in an experienced center.
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              Cervical or Thoracic Anastomosis after Esophagectomy for Cancer: A Systematic Review and Meta-Analysis

              S.S.A.Y. Biere, K.W. Maas, M.A. Cuesta … (2011)
              Background: Cervical anastomosis and thoracic anastomosis are used for gastric tube reconstruction after esophagectomy for cancer. This systematic review was conducted in order to identify randomized trials that compare cervical with thoracic anastomosis. Methods: A literature search for randomized trials was performed in the following databases: Medline, Embase and the Cochrane Library. Results: A total of 4 trials were included. All studies had a small sample size and were of moderate quality. One trial was excluded from the meta-analysis. The following outcomes were significantly associated with a cervical anastomosis: recurrent laryngeal nerve trauma (OR: 7.14; 95% CI: 1.75–29.14; p = 0.006) and anastomotic leakage (OR: 3.43; 95% CI: 1.09–10.78; p = 0.03). None of the following outcomes were associated with the location of the anastomosis: pulmonary complications (OR: 0.86; 95% CI: 0.13–5.59; p = 0.87), perioperative mortality (OR: 1.24; 95% CI: 0.35–4.41; p = 0.74), benign stricture formation (OR: 0.79; 95% CI: 0.17–3.87; p = 0.79) or tumor recurrence (OR: 2.01; 95% CI: 0.68–5.91; p = 0.21). Conclusion: Cervical anastomosis could be associated with a higher leak rate and recurrent nerve trauma. However, the currently available randomized evidence is limited. Further randomized trials are needed to provide sufficient evidence for the preferred location of the anastomosis after esophagectomy.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Dig Surg
                Title: Digestive surgery
                Publisher: S. Karger AG
                ISSN (Electronic): 1421-9883
                ISSN (Print): 0253-4886
                Publication date (Electronic): 2014
                Volume: 31
                Issue: 2
                Affiliations
                [1 ] Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
                Article
                Publisher Item ID: 000358812
                DOI: 10.1159/000358812
                PubMed ID: 24776753
                SO-VID: b36e56a5-cbd2-4cd5-abba-755f4e1712dc
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