Comparison of the Outcomes Between Open and Minimally Invasive Esophagectomy

Upper Gastrointestinal and Soft Tissue Unit, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
Annals of Surgery (Impact Factor: 8.33). 03/2007; 245(2):232-40. DOI: 10.1097/01.sla.0000225093.58071.c6
Source: PubMed


We report patient outcomes from esophageal resection with respect to morbidity and cancer survival comparing open thoracotomy and laparotomy (Open), with a thoracoscopic/laparotomy approach (Thoracoscopic-Assisted) and a total thoracoscopic/laparoscopic approach (Total MIE).
From a prospective database of all patients managed with cancer of the esophagus or esophagogastric junction, patients who had a resection using one of three techniques were analyzed to assess postoperative variables, adequacy of cancer clearance, and survival.
The number of patients for each procedure was as follows: Open, 114; Thoracoscopic-Assisted, 309; and Total MIE, 23. The groups were comparable with respect to preoperative variables. The differences in the postoperative variables were: less median blood loss in the Thoracoscopic-Assisted (400 mL) and Total MIE (300 mL) groups versus Open (600 mL); longer time for Total MIE (330 minutes) versus Thoracoscopic-Assisted (285 minutes) and Open (300 minutes); longer median time in hospital for Open (14 days) versus Thoracoscopic-Assisted (13 days), Total MIE (11 days) and less stricture formation in the Open (6.1%) versus Thoracoscopic-Assisted (21.6%), Total MIE (36%). There were no differences in lymph node retrieval for each of the approaches. Open had more stage III patients (65.8%) versus Thoracoscopic-Assisted (34.4%), Total MIE (52.1%). There was no difference in survival when the groups were compared stage for stage for overall median or 3-year survival.
Minimally invasive techniques to resect the esophagus in patients with cancer were confirmed to be safe and comparable to an open approach with respect to postoperative recovery and cancer survival.

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Available from: Bernard Mark Smithers, Oct 01, 2015
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    • "Minimally invasive esophagectomy is a well-established intervention for esophageal resection. It is a complex procedure requiring greater operative time, but it is associated with shorter hospital stay and lesser blood transfusion requirements [5] [6] [7] [8]. At our institution open esophagectomy remains the standard mode of intervention since 1998. "
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    ABSTRACT: Background: Two common procedures for esophageal resection are Ivor Lewis esophagectomy and transhiatal esophagectomy. Both procedures have high morbidity rates of 20-46%. Minimally invasive esophagectomy has been introduced to decrease morbidity. We report initial experience of MIE to determine the morbidity and mortality associated with this procedure during learning phase. Material and methods: Patients undergoing MIE at our institute from January 2011 to May 2013 were reviewed. Record was kept for any morbidity and mortality. Descriptive statistics were presented as frequencies and continuous variables were presented as median. Survival analysis was performed using Kaplan Meier curves. Results: We performed 51 minimally invasive esophagectomies. Perioperative morbidity was in 16 (31.37%) patients. There were 3 (5.88%) anastomotic leaks. We encountered 1 respiratory complication. Reexploration was required in 3 (5.88%) patients. Median operative time was 375 minutes. Median hospital stay was 10 days. The most frequent long-term morbidity was anastomotic narrowing observed in 5 (9.88%) patients. There were no perioperative mortalities. Our mean overall survival was 37.66 months (95% confidence interval 33.75 to 41.56 months). Mean disease-free survival was 24.43 months (95% CI 21.26 to 27.60 months). Conclusion: Minimally invasive esophagectomy, when performed in the learning phase, has acceptable morbidity and mortality.
    International Journal of Surgical Oncology 07/2014; 2014:864705. DOI:10.1155/2014/864705
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    • "Such studies are subject to the same caveats as stated above, and whilst they suggest that minimally invasive techniques may improve short-term clinical outcomes (such as morbidity and physiological measures) [18] and reduce impact on HRQL during recovery [19], these results must be interpreted with caution. Furthermore, even these weak studies tell us little about long-term survival [20], cost effectiveness, and impact on long-term HRQL [8,21]. "
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    ABSTRACT: Background: There is a need for evidence of the clinical effectiveness of minimally invasive surgery for the treatment of esophageal cancer, but randomized controlled trials in surgery are often difficult to conduct. The ROMIO (Randomized Open or Minimally Invasive Oesophagectomy) study will establish the feasibility of a main trial which will examine the clinical and cost-effectiveness of minimally invasive and open surgical procedures for the treatment of esophageal cancer. Methods/design: A pilot randomized controlled trial (RCT), in two centers (University Hospitals Bristol NHS Foundation Trust and Plymouth Hospitals NHS Trust) will examine numbers of incident and eligible patients who consent to participate in the ROMIO study. Interventions will include esophagectomy by: (1) open gastric mobilization and right thoracotomy, (2) laparoscopic gastric mobilization and right thoracotomy, and (3) totally minimally invasive surgery (in the Bristol center only). The primary outcomes of the feasibility study will be measures of recruitment, successful development of methods to monitor quality of surgery and fidelity to a surgical protocol, and development of a core outcome set to evaluate esophageal cancer surgery. The study will test patient-reported outcomes measures to assess recovery, methods to blind participants, assessments of surgical morbidity, and methods to capture cost and resource use. ROMIO will integrate methods to monitor and improve recruitment using audio recordings of consultations between recruiting surgeons, nurses, and patients to provide feedback for recruiting staff. Discussion: The ROMIO study aims to establish efficient methods to undertake a main trial of minimally invasive surgery versus open surgery for esophageal cancer. Trial registration: The pilot trial has Current Controlled Trials registration number ISRCTN59036820(25/02/2013) at; the ROMIO trial record at that site gives a link to the original version of the study protocol.
    Trials 06/2014; 15(1):200. DOI:10.1186/1745-6215-15-200 · 1.73 Impact Factor
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    • "Luketich et al. [14] observed that patient survival at 40 months after surgery was about 70% for stage I patients, but it was as low as 30% and 20% for stage II and III patients, respectively. On the other hand, Smithers et al. [31] analyzed patients who underwent resection using one of three esophagectomy techniques, including open, thoracoscopic-assisted, or a thoracoscopic/laparoscopic approach (total minimally invasive esophagectomy), to assess postoperative variables, adequacy of cancer clearance, and patient survival from a prospective database of all the patients treated for cancer of the esophagus or the esophagogastric junction [31]. The number of patients undergoing each procedure was as follows: open, 114; thoracoscopic-assisted, 309; and total minimally invasive esophagectomy, 23. "
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    ABSTRACT: Esophageal cancer has one of the highest malignant potentials of any type of tumor. The 3-field lymph node dissection is the standard procedure in Japan for surgically curable esophageal cancer in the middle or upper thoracic esophagus. Minimally invasive esophagectomy is being increasingly performed in many countries, and several studies report its feasibility and curability; further, the magnifying effect of the thoracoscope is another distinct advantage. However, few studies have reported that minimally invasive esophagectomy is more beneficial than open esophagectomy. A recent meta-analysis revealed that minimally invasive esophagectomy reduces blood loss, respiratory complications, the total morbidity rate, and hospitalization duration. A randomized study reported that the pulmonary infection rate, pain score, intraoperative blood loss, hospitalization duration, and postoperative 6-week quality of life were significantly better with the minimally invasive procedure than with other procedures. In the future, sentinel lymph node mapping might play a significant role by obtaining individualized information to customize the surgical procedure for individual patients' specific needs.
    Korean Journal of Thoracic and Cardiovascular Surgery 08/2013; 46(4):241-248. DOI:10.5090/kjtcs.2013.46.4.241
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