Morbidity and mortality in minimally invasive esophagectomy: where do we stand
Keywords:Esophagectomy, Minimally invasive, Morbidity, Mortality
Background: The objective of the study was to study morbidity and mortality patterns in patients with carcinoma oesophagus who underwent minimally invasive esophagectomy (MIE) in a tertiary centre for oncology in South India.
Methods: This was a retrospective observational study of 20 patients with carcinoma esophagus who underwent minimally invasive esophagectomy in center for oncology, Government Royapettah Hospital. Medical records of all these patients treated from September 2016 to August 2019 were collected from medical records department and details regarding the type of lesion, site of the lesion, preoperative chemoradiotherapy, type of surgery performed and post-operative complications were analyzed.
Results: Out of 20 patients who underwent minimally invasive esophagectomy 13 were female and 7 were male. Among these 18 had squamous cell carcinoma, 2 had adenocarcinoma. Thirteen patients had lesion in middle third oesophagus and 7 patients had lesion in lower third oesophagus. Nineteen patients underwent surgery after chemoradiation and one patient underwent upfront surgery. Twelve patients underwent thoracolaparoscopic esophagectomy and 8 patients underwent trans hiatal esophagectomy. Perioperative complications were seen in 8 patients of whom pulmonary complications seen in 6 were most common. Anastomotic leaks occurred in 4 patients of which 2 patients were reoperated. One patient died within 30 days of surgery. Voice change and ECG abnormalities occurred in 2 patients each.
Conclusions: Minimally invasive esophagectomy is safe and associated with comparable morbidity. Though the initial learning curve is steep, it helps in faster recovery of the patient. Also, the peri-operative outcome tends to improve with experience.
Samarasam I. Esophageal cancer in India: Current status and future perspectives. Int J Adv Med Health Res. 2017;4(1):5.
Lerut T, Coosemans W, De Leyn P, Van Raemdonck D, Nafteux P, Moons J. Optimizing treatment of carcinoma of the oesophagus and gastroesophageal junction. Surg Clin North Am. 2001;10:863-84.
Vrouenraets BC, van Lanschot JJB. Extent of surgical resection for oesophageal and gastroesophageal junction adenocarcinomas. Surg Oncol Clin N Am. 2006;15:781-91.
Hulscher JBF, van Sandick JW, de Boer AG, Wijnhoven BPL, Tijssen JGP, Fockens P, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002;347:1662-9.
Cushieri A, Shimi S, Banting S. Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb. 1992;37:7-11.
Kim T, Hochwald SN, Sarosi GA, Caban AM, Rossidis G, Ben-David K. Review of minimally invasive esophagectomy and current controversies. Gastroenterol Res Pract. 2012;2012:683213.
Luketich JD, Nguyen NT, Weigel T, Ferson P, Keenan R, Schauer P. Minimally invasive approach to esophagectomy. J Soc Laparoendosc Surg. 1998;2:243-7.
D’Journo XB, Thomas PA. Current management of esophageal cancer. J Thorac Dis. 2014;6(2):S253-64.
Mamidanna R, Bottle A, Aylin P, Faiz O, Hanna GB. Short-term outcomes following open versus minimally invasive esophagectomy for cancer in England: A population-based national study. Ann Surg. 2012;255:197-203.
Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: A multicentre, open-label, randomised controlled trial. Lancet. 2012;379:1887-92.
Briez N, Piessen G, Bonnetain F, Brigand C, Carrere N, Collet D, et al. Open versus laparoscopically-assisted oesophagectomy for cancer: A multicentre randomised controlled phase III trial-the MIRO trial. BMC Cancer. 2011;11:310.
Schoppmann SF, Prager G, Langer FB, Riegler FM, Kabon B, Fleischmann E, et al. Open versus minimally invasive esophagectomy: A single-center case controlled study. Surg Endosc. 2010;24:3044-53.
Wang W, Zhou Y, Feng J, Mei Y. Oncological and surgical outcomes of minimally invasive versus open esophagectomy for esophageal squamous cell carcinoma: A matched-pair comparative study. Int J Clin Exp Med. 2015;8:15983-90.
Bailey L, Khan O, Willows E, Somers S, Mercer S, Toh S. Open and laparoscopically assisted oesophagectomy: A prospective comparative study. Eur J Cardiothorac Surg. 2013;43:268-73.
Kauppi J, Räsänen J, Sihvo E, Huuhtanen R, Nelskylä K, Salo J. Open versus minimally invasive esophagectomy: Clinical outcomes for locally advanced esophageal adenocarcinoma. Surg Endosc. 2015;29:2614-9.
Decker G, Coosemans W, De Leyn P, Decaluwé H, Nafteux P, Van Raemdonck D, et al. Minimally invasive esophagectomy for cancer. Eur J Cardio-thorac Surg. 2009;35(1):13-21.
Khan M, Ashraf MI, Syed AA, Khattak S, Urooj N, Muzaffar A. Morbidity analysis in minimally invasive esophagectomy for oesophageal cancer versus conventional over the last 10 years, a single institution experience. J Min Access Surg. 2017;13(3):192.
Braghetto MI, Cardemil HG, Mandiola BC, Masia LG, Gattini SF. Impact of minimally invasive surgery in the treatment of esophageal cancer. Arquivos brasileiros de cirurgia digestiva: ABCD= Brazilian Arch Digest Surg. 2014;27(4):237-42.
Chen L, Liu X, Wang R, Wang Y, Zhang T, Gao D, et al. Minimally invasive esophagectomy for esophageal cancer according to the location of the tumor: Experience of 251 patients. Ann Med Surg. 2017;17:54-60.
Nguyen NT, Schauer PR, Luketich JD. Combined laparoscopic and thoracoscopic approach to esophagectomy. J Am Coll Surg. 1999;188:328-32.
Fabian T, Martin J, Katigbak M, McKelvey AA, Federico JA. Thoracoscopic esophageal mobilization during minimally invasive esophagectomy: a head-to head comparison of prone versus decubitus positions. Surg Endosc. 2008;22:2485-91.
Zingg U, McQuinn A, DiValentino D, Esterman AJ, Bessell JR, Thompson SK, et al. Minimally invasive versus open esophagectomy for patients with esophageal cancer. Ann Thorac Surg. 2009;87:911-9.
Parameswaren R, Veeramootoo D, Krishnadas R, Cooper M, Berrisford R, Wajed S. Comparative experience of open and minimally invasive esophagogastric resection. World J Surg. 2009;33:1868-75
Gao Y, Wang Y, Chen L, Zhao Y. Comparison of open three-field and minimally-invasive esophagectomy for esophageal cancer. Intract Cardiovasc Thorac Surg. 2011;12:366-9.
Sundaram A, Geronimo JC, Willer BL, Hoshino M, Torgersen Z, Juhasz A, et al. Survival and quality of life after minimally invasive esophagectomy: a single-surgeon experience. Surg Endosc. 2012;26:168-76.
Bakhos CT, Fabian T, Oyasiji TO, Gautam S, Gangadharan SP, Kent MS, et al. Impact of the surgical technique on pulmonary morbidity after esophagectomy. Ann Thorac Surg. 2012;93:221-7.