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05.08.2019 | Ausgabe 6/2020

Surgical Endoscopy 6/2020

Evolving changes of minimally invasive esophagectomy: a single-institution experience

Zeitschrift:
Surgical Endoscopy > Ausgabe 6/2020
Autoren:
Sahil Gambhir, Shaun Daly, Shelley Maithel, Luke R. Putnam, James Nguyen, Brian R. Smith, Ninh T. Nguyen
Wichtige Hinweise
Presented as one of the five “Top Papers” at the Southern California Chapter of the American College of Surgeons, January 25, 2019 in Sana Barbara, CA.

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Abstract

Background

Initial adoption of minimally invasive esophagectomy (MIE) began in the late 1990s but its surgical technique, perioperative management, and outcome continues to evolve.

Methods

The aim of this study was to examine the evolving changes in the technique, outcome, and new strategies in management of postoperative leaks after MIE was performed at a single institution over a two-decade period. A retrospective chart review of 75 MIE operations was performed between November 2011 and September 2018 and this was compared to the initial series of 104 MIE operations performed by the same group between 1998 and 2007. Operative technique, outcomes, and management strategies of leaks were compared.

Results

There were 65 males (86.7%) with an average age of 61 years. The laparoscopic/thoracoscopic Ivor Lewis esophagectomy became the preferred MIE approach (49% of cases in the initial vs. 95% in the current series). Compared to the initial case series, there was no significant difference in median length of stay (8 vs. 8 days), major complications (12.5% vs. 14.7%, p = 0.68), incidence of leak (9.6% vs. 10.6%, p = 0.82), anastomotic stricture (26% vs. 32.0%, p = 0.38), or in-hospital mortality (2.9% vs. 2.6%, p = 0.47). Management of esophageal leaks has changed from primarily thoracotomy ± diversion initially (50% of leak cases) to endoscopic stenting ± laparoscopy/thoracoscopy currently (87.5% of leak cases).

Conclusion

In a single-institutional series of MIE over two decades, there was a shift toward a preference for the laparoscopic/thoracoscopic Ivor Lewis approach with similar outcomes. The management of postoperative leaks drastically changed with predilection toward minimally invasive option with endoscopic drainage and stenting.

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