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A prospective comparison of totally minimally invasive versus open Ivor Lewis esophagectomy

A prospective comparison of totally minimally invasive versus open Ivor Lewis esophagectomy
A prospective comparison of totally minimally invasive versus open Ivor Lewis esophagectomy
The majority of esophagectomies in Western parts of the world are performed by a transthoracic approach reflecting the prevalence of adenocarcinoma of the lower esophagus or esophagogastric junction. Minimally invasive esophagectomy (MIE) has been reported in a variety of formats, but there are no series that directly compare totally minimally invasive thoracolaparoscopic 2 stage esophagectomy (MIE-2) with open Ivor Lewis (IVL). A prospective single-center cohort study of patients undergoing elective MIE-2 or IVL between January 2005 and November 2010 was performed. Short-term clinicopathologic outcomes were recorded using validated systems. One hundred and six patients (median age 66, range 36–85, 88 M : 18 F) underwent two-stage esophagectomy (53 MIE-2 and 53 IVL). Patient demographics (age, sex, body mass index, American Society of Anesthesiologists grade, tumor characteristics, neoadjuvant chemotherapy, and TNM stage) were comparable between the two groups. Outcomes for MIE-2 and IVL were comparable for anastomotic leak rates (5 [9%] vs. 2 [4%], P= 0.241), resection margin clearance (R0) (43 [81%] vs. 38 [72%], P= 0.253), median lymph node yield (19 vs. 18, P= 0.584), and median length of stay (12 [range 7–91] vs. 12 [range 7–101] days), respectively. Blood loss was significantly less for MIE-2 compared with IVL (median 300 [range 0–1250] mL vs. 400 [range 0–3000] mL, respectively, P= 0.021). MIE-2 in this series of selected patients supports its efficacy, when performed by an experienced minimally invasive surgical team. A well-designed multicenter trial addressing clinical effectiveness is now required.
1120-8694
263-271
Noble, F.
4f14574c-28f2-4e04-bd95-f53c7649e1fa
Kelly, J.J.
ab65aaf7-98c0-4b4f-8956-ce5d2a172dcf
Bailey, I.S.
e2865954-5f8c-480f-90a2-d1468a59645c
Byrne, J.P.
e3d5b8fe-1b69-441c-a173-e084fe5372a6
Underwood, T.J.
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Noble, F.
4f14574c-28f2-4e04-bd95-f53c7649e1fa
Kelly, J.J.
ab65aaf7-98c0-4b4f-8956-ce5d2a172dcf
Bailey, I.S.
e2865954-5f8c-480f-90a2-d1468a59645c
Byrne, J.P.
e3d5b8fe-1b69-441c-a173-e084fe5372a6
Underwood, T.J.
8e81bf60-edd2-4b0e-8324-3068c95ea1c6

Noble, F., Kelly, J.J., Bailey, I.S., Byrne, J.P. and Underwood, T.J. (2013) A prospective comparison of totally minimally invasive versus open Ivor Lewis esophagectomy. Diseases of the Esophagus, 26 (3), 263-271. (doi:10.1111/j.1442-2050.2012.01356.x).

Record type: Article

Abstract

The majority of esophagectomies in Western parts of the world are performed by a transthoracic approach reflecting the prevalence of adenocarcinoma of the lower esophagus or esophagogastric junction. Minimally invasive esophagectomy (MIE) has been reported in a variety of formats, but there are no series that directly compare totally minimally invasive thoracolaparoscopic 2 stage esophagectomy (MIE-2) with open Ivor Lewis (IVL). A prospective single-center cohort study of patients undergoing elective MIE-2 or IVL between January 2005 and November 2010 was performed. Short-term clinicopathologic outcomes were recorded using validated systems. One hundred and six patients (median age 66, range 36–85, 88 M : 18 F) underwent two-stage esophagectomy (53 MIE-2 and 53 IVL). Patient demographics (age, sex, body mass index, American Society of Anesthesiologists grade, tumor characteristics, neoadjuvant chemotherapy, and TNM stage) were comparable between the two groups. Outcomes for MIE-2 and IVL were comparable for anastomotic leak rates (5 [9%] vs. 2 [4%], P= 0.241), resection margin clearance (R0) (43 [81%] vs. 38 [72%], P= 0.253), median lymph node yield (19 vs. 18, P= 0.584), and median length of stay (12 [range 7–91] vs. 12 [range 7–101] days), respectively. Blood loss was significantly less for MIE-2 compared with IVL (median 300 [range 0–1250] mL vs. 400 [range 0–3000] mL, respectively, P= 0.021). MIE-2 in this series of selected patients supports its efficacy, when performed by an experienced minimally invasive surgical team. A well-designed multicenter trial addressing clinical effectiveness is now required.

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Published date: April 2013
Organisations: Cancer Sciences

Identifiers

Local EPrints ID: 350711
URI: http://eprints.soton.ac.uk/id/eprint/350711
ISSN: 1120-8694
PURE UUID: 10de94b0-3e47-410d-a14c-0ed7a3273086
ORCID for T.J. Underwood: ORCID iD orcid.org/0000-0001-9455-2188

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Date deposited: 28 Mar 2013 15:36
Last modified: 15 Mar 2024 03:17

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Contributors

Author: F. Noble
Author: J.J. Kelly
Author: I.S. Bailey
Author: J.P. Byrne
Author: T.J. Underwood ORCID iD

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