The use of a tailored surgical technique for minimally invasive esophagectomy

Objective Uncertainty exists among surgeons as to whether minimally invasive esophagectomy (MIE) is a comparable operation to open esophagectomy (OE). The surgical technique and oncologic dissection should not be degraded when using a minimally invasive approach. Methods We reviewed a single hospita...

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Veröffentlicht in:The Journal of thoracic and cardiovascular surgery 2012-05, Vol.143 (5), p.1125-1129
Hauptverfasser: Javidfar, Jeffrey, MD, Bacchetta, Matthew, MD, Yang, Jonathan A., MD, MPH, Miller, Joanna, BS, D’Ovidio, Frank, MD, PhD, Ginsburg, Mark E., MD, Gorenstein, Lyall A., MD, Bessler, Marc, MD, Sonett, Joshua R., MD
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container_issue 5
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container_title The Journal of thoracic and cardiovascular surgery
container_volume 143
creator Javidfar, Jeffrey, MD
Bacchetta, Matthew, MD
Yang, Jonathan A., MD, MPH
Miller, Joanna, BS
D’Ovidio, Frank, MD, PhD
Ginsburg, Mark E., MD
Gorenstein, Lyall A., MD
Bessler, Marc, MD
Sonett, Joshua R., MD
description Objective Uncertainty exists among surgeons as to whether minimally invasive esophagectomy (MIE) is a comparable operation to open esophagectomy (OE). The surgical technique and oncologic dissection should not be degraded when using a minimally invasive approach. Methods We reviewed a single hospital’s experience with both OE and MIE. From 2000 to 2010, 257 patients underwent esophagectomy by 1 of 3 surgical techniques: transhiatal, Ivor Lewis, or 3-hole. Results Of the 257 patients (median age, 67 years; range, 58–74), 92 underwent MIE. Both groups were comparable in terms of gender, age, comorbidities, surgical technique, and induction chemotherapy and radiotherapy. The overall median follow-up was 29.5 months (range, 9.9–61.5). The MIE group had a significantly shorter operative time (MIE vs OE, 330 vs 365 minutes, P  = .04), length of stay (MIE vs OE, 9 vs 12 days, P  
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The surgical technique and oncologic dissection should not be degraded when using a minimally invasive approach. Methods We reviewed a single hospital’s experience with both OE and MIE. From 2000 to 2010, 257 patients underwent esophagectomy by 1 of 3 surgical techniques: transhiatal, Ivor Lewis, or 3-hole. Results Of the 257 patients (median age, 67 years; range, 58–74), 92 underwent MIE. Both groups were comparable in terms of gender, age, comorbidities, surgical technique, and induction chemotherapy and radiotherapy. The overall median follow-up was 29.5 months (range, 9.9–61.5). The MIE group had a significantly shorter operative time (MIE vs OE, 330 vs 365 minutes, P  = .04), length of stay (MIE vs OE, 9 vs 12 days, P  &lt; .01), intensive care unit admission rate (MIE vs OE, 55% vs 81%, P  &lt; .01), intensive care unit length of stay (MIE vs OE, 1 vs 2 days, P  &lt; .01), and estimated blood loss (MIE vs OE, 100 vs 400 mL, P  &lt; .01). More lymph nodes were harvested in the MIE group than in the OE group (17 vs 11 nodes, P  &lt; .01). There were insignificant differences in 30-day mortality (MIE vs OE, 2.2% vs 3.0%; P  = .93) and overall survival ( P  = .19), as well as in the rates of all complications, except pneumonia (MIE vs OE, 2% vs 13%; P  = .01). Conclusions A thoracic surgeon can safely tailor the MIE to a patient’s anatomy and oncologic demands while maintaining equivalent survival.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2012.01.071</identifier><identifier>PMID: 22500593</identifier><identifier>CODEN: JTCSAQ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adenocarcinoma - mortality ; Adenocarcinoma - pathology ; Adenocarcinoma - surgery ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Carcinoma, Squamous Cell - mortality ; Carcinoma, Squamous Cell - pathology ; Carcinoma, Squamous Cell - surgery ; Cardiology. Vascular system ; Cardiothoracic Surgery ; Chi-Square Distribution ; Esophageal Neoplasms - mortality ; Esophageal Neoplasms - pathology ; Esophageal Neoplasms - surgery ; Esophagectomy - adverse effects ; Esophagectomy - methods ; Esophagectomy - mortality ; Female ; Humans ; Kaplan-Meier Estimate ; Lymph Node Excision ; Male ; Medical sciences ; Middle Aged ; Minimally Invasive Surgical Procedures ; New York City ; Pneumology ; Postoperative Complications - etiology ; Retrospective Studies ; Stomach, duodenum, intestine, rectum, anus ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Time Factors ; Treatment Outcome</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2012-05, Vol.143 (5), p.1125-1129</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2012 The American Association for Thoracic Surgery</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c489t-cff1208674bab054e7218ffbb9269f7d3ec2b88bbb843b501c7153f38e3c45163</citedby><cites>FETCH-LOGICAL-c489t-cff1208674bab054e7218ffbb9269f7d3ec2b88bbb843b501c7153f38e3c45163</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2012.01.071$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>315,782,786,3554,27933,27934,46004</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=25878092$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22500593$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Javidfar, Jeffrey, MD</creatorcontrib><creatorcontrib>Bacchetta, Matthew, MD</creatorcontrib><creatorcontrib>Yang, Jonathan A., MD, MPH</creatorcontrib><creatorcontrib>Miller, Joanna, BS</creatorcontrib><creatorcontrib>D’Ovidio, Frank, MD, PhD</creatorcontrib><creatorcontrib>Ginsburg, Mark E., MD</creatorcontrib><creatorcontrib>Gorenstein, Lyall A., MD</creatorcontrib><creatorcontrib>Bessler, Marc, MD</creatorcontrib><creatorcontrib>Sonett, Joshua R., MD</creatorcontrib><title>The use of a tailored surgical technique for minimally invasive esophagectomy</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objective Uncertainty exists among surgeons as to whether minimally invasive esophagectomy (MIE) is a comparable operation to open esophagectomy (OE). The surgical technique and oncologic dissection should not be degraded when using a minimally invasive approach. Methods We reviewed a single hospital’s experience with both OE and MIE. From 2000 to 2010, 257 patients underwent esophagectomy by 1 of 3 surgical techniques: transhiatal, Ivor Lewis, or 3-hole. Results Of the 257 patients (median age, 67 years; range, 58–74), 92 underwent MIE. Both groups were comparable in terms of gender, age, comorbidities, surgical technique, and induction chemotherapy and radiotherapy. The overall median follow-up was 29.5 months (range, 9.9–61.5). The MIE group had a significantly shorter operative time (MIE vs OE, 330 vs 365 minutes, P  = .04), length of stay (MIE vs OE, 9 vs 12 days, P  &lt; .01), intensive care unit admission rate (MIE vs OE, 55% vs 81%, P  &lt; .01), intensive care unit length of stay (MIE vs OE, 1 vs 2 days, P  &lt; .01), and estimated blood loss (MIE vs OE, 100 vs 400 mL, P  &lt; .01). More lymph nodes were harvested in the MIE group than in the OE group (17 vs 11 nodes, P  &lt; .01). There were insignificant differences in 30-day mortality (MIE vs OE, 2.2% vs 3.0%; P  = .93) and overall survival ( P  = .19), as well as in the rates of all complications, except pneumonia (MIE vs OE, 2% vs 13%; P  = .01). Conclusions A thoracic surgeon can safely tailor the MIE to a patient’s anatomy and oncologic demands while maintaining equivalent survival.</description><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Carcinoma, Squamous Cell - mortality</subject><subject>Carcinoma, Squamous Cell - pathology</subject><subject>Carcinoma, Squamous Cell - surgery</subject><subject>Cardiology. Vascular system</subject><subject>Cardiothoracic Surgery</subject><subject>Chi-Square Distribution</subject><subject>Esophageal Neoplasms - mortality</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophagectomy - adverse effects</subject><subject>Esophagectomy - methods</subject><subject>Esophagectomy - mortality</subject><subject>Female</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Lymph Node Excision</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Minimally Invasive Surgical Procedures</subject><subject>New York City</subject><subject>Pneumology</subject><subject>Postoperative Complications - etiology</subject><subject>Retrospective Studies</subject><subject>Stomach, duodenum, intestine, rectum, anus</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUGL1DAUx4so7uzqJxAkF8FL60vStOlBQRZXhRUPruAtJOnLTmrbjEk7MN_ejDMqePGUy--f997vXxTPKFQUaPNqqIbF7lPFgLIKaAUtfVBsKHRt2Ujx7WGxAWCsFIzxi-IypQEAWqDd4-KCMQEgOr4pPt1tkawJSXBEk0X7MUTsSVrjvbd6JAva7ex_rEhciGTys5_0OB6In_c6-T0STGG31fdolzAdnhSPnB4TPj2_V8XXm3d31x_K28_vP16_vS1tLbultM5RBrJpa6MNiBpbRqVzxnSs6Vzbc7TMSGmMkTU3AqhtqeCOS-S2FrThV8XL07-7GPJuaVGTTxbHUc8Y1qQo5DsF62rIKD-hNoaUIjq1i_mGeMiQOnpUg_rlUR09KqAqe8yp5-cBq5mw_5P5LS4DL86ATtmTi3q2Pv3lhGwldCxzr08cZh17j1El63G22PuYnak--P8s8uafvB1zCXnkdzxgGsIa52xaUZVyRn05Vn5sPPsF2oLgPwEHVqbI</recordid><startdate>20120501</startdate><enddate>20120501</enddate><creator>Javidfar, Jeffrey, MD</creator><creator>Bacchetta, Matthew, MD</creator><creator>Yang, Jonathan A., MD, MPH</creator><creator>Miller, Joanna, BS</creator><creator>D’Ovidio, Frank, MD, PhD</creator><creator>Ginsburg, Mark E., MD</creator><creator>Gorenstein, Lyall A., MD</creator><creator>Bessler, Marc, MD</creator><creator>Sonett, Joshua R., MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120501</creationdate><title>The use of a tailored surgical technique for minimally invasive esophagectomy</title><author>Javidfar, Jeffrey, MD ; Bacchetta, Matthew, MD ; Yang, Jonathan A., MD, MPH ; Miller, Joanna, BS ; D’Ovidio, Frank, MD, PhD ; Ginsburg, Mark E., MD ; Gorenstein, Lyall A., MD ; Bessler, Marc, MD ; Sonett, Joshua R., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c489t-cff1208674bab054e7218ffbb9269f7d3ec2b88bbb843b501c7153f38e3c45163</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - surgery</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Carcinoma, Squamous Cell - mortality</topic><topic>Carcinoma, Squamous Cell - pathology</topic><topic>Carcinoma, Squamous Cell - surgery</topic><topic>Cardiology. Vascular system</topic><topic>Cardiothoracic Surgery</topic><topic>Chi-Square Distribution</topic><topic>Esophageal Neoplasms - mortality</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophagectomy - adverse effects</topic><topic>Esophagectomy - methods</topic><topic>Esophagectomy - mortality</topic><topic>Female</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Lymph Node Excision</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Minimally Invasive Surgical Procedures</topic><topic>New York City</topic><topic>Pneumology</topic><topic>Postoperative Complications - etiology</topic><topic>Retrospective Studies</topic><topic>Stomach, duodenum, intestine, rectum, anus</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Javidfar, Jeffrey, MD</creatorcontrib><creatorcontrib>Bacchetta, Matthew, MD</creatorcontrib><creatorcontrib>Yang, Jonathan A., MD, MPH</creatorcontrib><creatorcontrib>Miller, Joanna, BS</creatorcontrib><creatorcontrib>D’Ovidio, Frank, MD, PhD</creatorcontrib><creatorcontrib>Ginsburg, Mark E., MD</creatorcontrib><creatorcontrib>Gorenstein, Lyall A., MD</creatorcontrib><creatorcontrib>Bessler, Marc, MD</creatorcontrib><creatorcontrib>Sonett, Joshua R., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Javidfar, Jeffrey, MD</au><au>Bacchetta, Matthew, MD</au><au>Yang, Jonathan A., MD, MPH</au><au>Miller, Joanna, BS</au><au>D’Ovidio, Frank, MD, PhD</au><au>Ginsburg, Mark E., MD</au><au>Gorenstein, Lyall A., MD</au><au>Bessler, Marc, MD</au><au>Sonett, Joshua R., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The use of a tailored surgical technique for minimally invasive esophagectomy</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2012-05-01</date><risdate>2012</risdate><volume>143</volume><issue>5</issue><spage>1125</spage><epage>1129</epage><pages>1125-1129</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><coden>JTCSAQ</coden><abstract>Objective Uncertainty exists among surgeons as to whether minimally invasive esophagectomy (MIE) is a comparable operation to open esophagectomy (OE). The surgical technique and oncologic dissection should not be degraded when using a minimally invasive approach. Methods We reviewed a single hospital’s experience with both OE and MIE. From 2000 to 2010, 257 patients underwent esophagectomy by 1 of 3 surgical techniques: transhiatal, Ivor Lewis, or 3-hole. Results Of the 257 patients (median age, 67 years; range, 58–74), 92 underwent MIE. Both groups were comparable in terms of gender, age, comorbidities, surgical technique, and induction chemotherapy and radiotherapy. The overall median follow-up was 29.5 months (range, 9.9–61.5). The MIE group had a significantly shorter operative time (MIE vs OE, 330 vs 365 minutes, P  = .04), length of stay (MIE vs OE, 9 vs 12 days, P  &lt; .01), intensive care unit admission rate (MIE vs OE, 55% vs 81%, P  &lt; .01), intensive care unit length of stay (MIE vs OE, 1 vs 2 days, P  &lt; .01), and estimated blood loss (MIE vs OE, 100 vs 400 mL, P  &lt; .01). More lymph nodes were harvested in the MIE group than in the OE group (17 vs 11 nodes, P  &lt; .01). There were insignificant differences in 30-day mortality (MIE vs OE, 2.2% vs 3.0%; P  = .93) and overall survival ( P  = .19), as well as in the rates of all complications, except pneumonia (MIE vs OE, 2% vs 13%; P  = .01). Conclusions A thoracic surgeon can safely tailor the MIE to a patient’s anatomy and oncologic demands while maintaining equivalent survival.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>22500593</pmid><doi>10.1016/j.jtcvs.2012.01.071</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record>
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subjects Adenocarcinoma - mortality
Adenocarcinoma - pathology
Adenocarcinoma - surgery
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Carcinoma, Squamous Cell - mortality
Carcinoma, Squamous Cell - pathology
Carcinoma, Squamous Cell - surgery
Cardiology. Vascular system
Cardiothoracic Surgery
Chi-Square Distribution
Esophageal Neoplasms - mortality
Esophageal Neoplasms - pathology
Esophageal Neoplasms - surgery
Esophagectomy - adverse effects
Esophagectomy - methods
Esophagectomy - mortality
Female
Humans
Kaplan-Meier Estimate
Lymph Node Excision
Male
Medical sciences
Middle Aged
Minimally Invasive Surgical Procedures
New York City
Pneumology
Postoperative Complications - etiology
Retrospective Studies
Stomach, duodenum, intestine, rectum, anus
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Time Factors
Treatment Outcome
title The use of a tailored surgical technique for minimally invasive esophagectomy
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