Journal of Cardio-Thoracic Medicine

Journal of Cardio-Thoracic Medicine

Operative Complications of Minimally Invasive Esophagectomy in Patients with Esophageal Cancer: Analysis of 80 Cases

Document Type : Research Paper

Authors
Ali Esparham 1
Seyed Ziaollah Haghi 2
Nazanin Hazrati 3
Matin Moallem Shahri 3
Reza Bagheri 3
1 Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Cardio-Thoracic Surgery& Transplant Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
10.22038/jctm.2022.67057.1395
Abstract
Introduction: Esophageal cancer (EC) is a common cancer of the digestive system which is one of the most common cancers in our country The primary treatment of EC is surgery. Due to the development of minimally invasive techniques (MIE), in the current study, we have assessed the results of these techniques in patients with EC surgery.
Methods: A total of 80 patients with middle and lower third ECs who had good conditions and were operated with MIE technique (McKeown) from 2014 to 2021, were enrolled in this study. Patients were evaluated based on the following criteria: age, sex, tumor location, pathology, peri-operative complications leading the minimally invasive esophagectomy technique to being converted to an open surgery, and early post-operative complications after surgery and mortality.
Results: A total of 80 patients with EC were enrolled in the study. 85% (n=68) of our patients were male and 15% (n=12) were female with an average age of 58.21±11.39 years old. 43.75% of the patients had a history of neo-adjuvant chemotherapy. Surgery was performed with McKeown technique without complications in 91.25% of the patients. In 8.75% of the patients tracheal injury (n=1), uncontrolled bleeding (n=1), and severe pleural adhesions VATS (n=5) led the surgery plan changing into open surgery. Post-operative complications were observed in 13.75% of patients.
Conclusions: This study suggests using McKeown technique in patients with EC in highly experienced medical centers in order to obtain proper results with low rate of peri- and post-operative complications.
Keywords
Esophageal Cancer
Minimally Invasive Esophagectomy
McKeown
Esophagectomy, Gastrointestinal Cancer
  1. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. European journal of cancer. 2013 Apr 1;49(6):1374-403.
  2. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA: a cancer journal for clinicians. 2011 Mar;61(2):69-90.
  3. Parkin DM, Pisani P, Ferlay J. Global cancer statistics. CA-ATLANTA-. 1999 Jan 1;49:33-64.
  4.  Limburg PJ, Dixon DA. Gastrointestinal Neoplasia, An Issue of Gastroenterology Clinics of North America. Elsevier Health Sciences; 2016 Aug 24.
  5.  Enzinger PC, Mayer RJ. Esophageal cancer. New England Journal of Medicine. 2003 Dec 4;349(23):2241-52.
  6.  Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. New England Journal of Medicine. 2002 Nov 21;347(21):1662-9.
  7.  Morita M, Nakanoko T, Fujinaka Y, Kubo N, Yamashita N, Yoshinaga K, et al. In-hospital mortality after a surgical resection for esophageal cancer: analyses of the associated factors and historical changes. Annals of surgical oncology. 2011 Jun;18(6):1757-65.
  8. Earlam R, Cunha‐Melo JR. Oesophageal squamous cell carcinoma: I. A critical review of surgery. British Journal of Surgery. 1980 Jun;67(6):381-90.
  9. Espinoza-Mercado F, Imai TA, Borgella JD, Sarkissian A, Serna-Gallegos D, Alban RF, et al. Does the approach matter? Comparing survival in robotic, minimally invasive, and open esophagectomies . The Annals of thoracic surgery.2019 Feb 1;107(2):378-85.
  10. Kanekiyo S, Takeda S, Tsutsui M, Nishiyama M, Kitahara M, Shindo Y, et al. Low invasiveness of thoracoscopic esophagectomy in the prone position for esophageal cancer: a propensity score-matched comparison of operative approaches between thoracoscopic and open esophagectomy. Surgical Endoscopy. 2018 Apr;32(4):1945-53.
  11. Coelho FD, Barros DE, Santos FA, Meireles FC, Maia FC, Trovisco RA, et al. Minimally invasive esophagectomy versus open esophagectomy: A systematic review and meta-analysis. European Journal of Surgical Oncology. 2021 Nov 1;47(11):2742-8.
  12. Barbour AP, Mc Cormack OM, Baker PJ, Hirst J, Krause L, Brosda S, et al. Long-term health-related quality of life following esophagectomy: a nonrandomized comparison of thoracoscopically assisted and open surgery. Annals of Surgery. 2017 Jun 1;265(6):1158-65.
  13. Yibulayin W, Abulizi S, Lv H, Sun W. Minimally invasive oesophagectomy versus open esophagectomy for resectable esophageal cancer: a meta-analysis. World journal of surgical oncology. 2016 Dec;14(1):1-7.
  14. Guo W, Ma X, Yang S, Zhu X, Qin W, Xiang J, et al. Combined thoracoscopic-laparoscopic esophagectomy versus open esophagectomy: a meta-analysis of outcomes. Surgical endoscopy. 2016 Sep;30(9):3873-81.
  15. Nagpal K, Ahmed K, Vats A, Yakoub D, James D, Ashrafian H, et al. Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surgical endoscopy. 2010 Jul;24(7):1621-9.
  16. Tanaka Y, Sato Y, Suetsugu T, Mase J, Takaha R, Okumura N, et al. How to maintain nutritional status after esophagectomy via the Tanaka method. Journal of Cancer Metastasis and Treatment. 2021 Oct 21;7:59.
  17. Tachimori Y, Ozawa S, Numasaki H, Ishihara R, Matsubara H, Muro K, et al. Comprehensive registry of esophageal cancer in Japan, 2012. Esophagus. 2019 Jul;16(3):221-45.
  18. Zhang Y. Epidemiology of esophageal cancer. World journal of gastroenterology: WJG. 2013 Sep 9;19(34):5598.
  19. Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, et al. Minimally invasive esophagectomy: outcomes in 222 patients. Annals of surgery. 2003 Oct;238(4):486.
  20. Giugliano DN, Berger AC, Rosato EL, Palazzo F. Total minimally invasive esophagectomy for esophageal cancer: approaches and outcomes. Langenbeck's archives of surgery. 2016 Sep;401(6):747-56.
  21. Chowdappa R, Dharanikota A, Arjunan R, Althaf S, Premalata CS, Ranganath N. Operative Outcomes of Minimally Invasive Esophagectomy versus Open Esophagectomy for Resectable Esophageal Cancer. South Asian Journal of Cancer. 2021 Dec;10(04):230-5.
  22. Biere SS, Cuesta MA, Van Der Peet DL. Minimally invasive versus open esophagectomy for cancer: a systematic review and meta-analysis. Minerva chirurgica. 2009 Apr 1;64(2):121-33.
  23. Walther B, Johansson J, Johnsson F, Von Holstein CS, Zilling T. Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstruction: a prospective randomized trial comparing sutured neck anastomosis with stapled intrathoracic anastomosis. Annals of surgery. 2003 Dec 1;238(6):803-14.
  24. Markar SR, Arya S, Karthikesalingam A, Hanna GB. Technical factors that affect anastomotic integrity following esophagectomy: systematic review and meta-analysis. Annals of surgical oncology. 2013 Dec;20(13):4274-81.
  25. 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. The Lancet. 2012 May 19;379(9829):1887-92.
  26. Xie J, Zhang L, Liu Z, Lu CL, Xu GH, Guo M, et al. Advantages of McKeown minimally invasive oesophagectomy for the treatment of oesophageal cancer: propensity score matching analysis of 169 cases. World Journal of Surgical Oncology. 2022 Dec;20(1):1-9.
  27. Smithers BM, Gotley DC, Martin I, Thomas JM. Comparison of the outcomes between open and minimally invasive esophagectomy. Annals of surgery. 2007 Feb;245(2):232.
  28. van Workum F, Klarenbeek BR, Baranov N, Rovers MM, Rosman C. Totally minimally invasive esophagectomy versus hybrid minimally invasive esophagectomy: systematic review and meta-analysis. Diseases of the Esophagus. 2020 Aug;33(8):doaa021.
  29. Zhou C, Ma G, Li X, Li J, Yan Y, Liu P, et al. Is minimally invasive esophagectomy effective for preventing anastomotic leakages after esophagectomy for cancer? A systematic review and meta-analysis. World journal of surgical oncology. 2015 Dec;13(1):1-0.
  30. van Hagen P, Hulshof MC, Van Lanschot JJ, Steyerberg EW, Henegouwen MV, Wijnhoven BP, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. New England Journal of Medicine. 2012 May 31;366(22):2074-84.
Journal of Cardio-Thoracic Medicine
Volume 10, Issue 3
Summer 2022
Pages 1004-1009