Salvage minimally invasive esophagectomy after definitive chemoradiotherapy for esophageal cancer can improve postoperative complications compared with salvage open esophagectomy
Background Although the advantage of minimally invasive esophagectomy (MIE) over open esophagectomy (OE) in planned esophagectomy is being established, the utility of salvage MIE (S-MIE) remains unclear. We aimed to investigate the feasibility and advantage of S-MIE compared with salvage OE (S-OE)....
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| Veröffentlicht in: | Surgical endoscopy 2022-05, Vol.36 (5), p.3504-3510 |
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| creator | Ishiyama, Koshiro Oguma, Junya Kubo, Kentaro Kanematsu, Kyohei Kurita, Daisuke Daiko, Hiroyuki |
| description | Background
Although the advantage of minimally invasive esophagectomy (MIE) over open esophagectomy (OE) in planned esophagectomy is being established, the utility of salvage MIE (S-MIE) remains unclear. We aimed to investigate the feasibility and advantage of S-MIE compared with salvage OE (S-OE).
Methods
We retrospectively assessed 82 patients who underwent salvage esophagectomy after definitive chemoradiotherapy for thoracic esophageal cancer between January 2007 and April 2020. Perioperative factors and postoperative complications were compared between the S-OE group (
n
= 62) and the S-MIE group (
n
= 20). Logistic regression analysis was performed to analyze the factors associated with postoperative complications.
Results
Regarding the patients’ preoperative characteristics, the S-OE group had a significant number of grade ≥ cT3 patients vs the S-MIE group (69% vs 35%, respectively;
p
= 0.006), whereas ycT rates were comparable. Compared with S-OE, S-MIE had comparable operative time, number of harvested thoracic lymph nodes, and R0 resection, but significantly less estimated blood loss (150 ml and 395 ml, respectively;
p
= 0.003). Regarding postoperative complications, total complications (79% vs 50%;
p
= 0.01) and pneumonia (48.3% vs 20%;
p
= 0.02) rates were significantly lower with S-OE vs S-MIE, respectively. On multivariate analysis, S-MIE was an independent factor associated with postoperative pneumonia (odds ratio: 0.29, 95% confidence interval: 0.06–0.99;
p
= 0.04) and total complications (odds ratio: 0.26, 95% confidence interval: 0.07–0.86;
p
= 0.02).
Conclusion
S-MIE was feasible for salvage esophagectomy, with favorable short-term outcomes vs S-OE regarding postoperative pneumonia and total complications. |
| doi_str_mv | 10.1007/s00464-021-08672-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2581823255</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2581823255</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-289184a9f55c025376dea30a30098fec8493fdc4872caac60628a06c9e8180793</originalsourceid><addsrcrecordid>eNp9kctu1TAQhi0EoofCC7BAltiwCfgSJ_YSVdykSiyAtTU4kx5XSRzsnFPltXhCps2hCBZIlkbj-f6Z0fyMPZfitRSifVOEqJu6EkpWwjatqtYHbCdrrSqlpH3IdsJpUanW1WfsSSnXgngnzWN2pklH_2bHfn6B4QhXyMc4xRGGYeVxOkKJR-RY0rynWljSuHLoF8y8w57A5bYc9jimDF1Myx4zzCvvU74XwcADTIEkFHgc55xIM6eypJnorUMa5yEGStJU7jLI2PGbuOx5Oe1F9PT3Jk_Zox6Ggs9O8Zx9e__u68XH6vLzh08Xby-roFuzVMo6aWtwvTFBKKPbpkPQgp5wtsdga6f7LtS2VQEgNKJRFkQTHFppRev0OXu19aXVfxywLH6MJeAwwITpULwyBCqtjCH05T_odTrkibbzqqGb1w3NJ0ptVMiplIy9nzPdPK9eCn_rqN8c9eSov3PUryR6cWp9-D5idy_5bSEBegMKlaYrzH9m_6ftLyWnsdU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2649146537</pqid></control><display><type>article</type><title>Salvage minimally invasive esophagectomy after definitive chemoradiotherapy for esophageal cancer can improve postoperative complications compared with salvage open esophagectomy</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Ishiyama, Koshiro ; Oguma, Junya ; Kubo, Kentaro ; Kanematsu, Kyohei ; Kurita, Daisuke ; Daiko, Hiroyuki</creator><creatorcontrib>Ishiyama, Koshiro ; Oguma, Junya ; Kubo, Kentaro ; Kanematsu, Kyohei ; Kurita, Daisuke ; Daiko, Hiroyuki</creatorcontrib><description>Background
Although the advantage of minimally invasive esophagectomy (MIE) over open esophagectomy (OE) in planned esophagectomy is being established, the utility of salvage MIE (S-MIE) remains unclear. We aimed to investigate the feasibility and advantage of S-MIE compared with salvage OE (S-OE).
Methods
We retrospectively assessed 82 patients who underwent salvage esophagectomy after definitive chemoradiotherapy for thoracic esophageal cancer between January 2007 and April 2020. Perioperative factors and postoperative complications were compared between the S-OE group (
n
= 62) and the S-MIE group (
n
= 20). Logistic regression analysis was performed to analyze the factors associated with postoperative complications.
Results
Regarding the patients’ preoperative characteristics, the S-OE group had a significant number of grade ≥ cT3 patients vs the S-MIE group (69% vs 35%, respectively;
p
= 0.006), whereas ycT rates were comparable. Compared with S-OE, S-MIE had comparable operative time, number of harvested thoracic lymph nodes, and R0 resection, but significantly less estimated blood loss (150 ml and 395 ml, respectively;
p
= 0.003). Regarding postoperative complications, total complications (79% vs 50%;
p
= 0.01) and pneumonia (48.3% vs 20%;
p
= 0.02) rates were significantly lower with S-OE vs S-MIE, respectively. On multivariate analysis, S-MIE was an independent factor associated with postoperative pneumonia (odds ratio: 0.29, 95% confidence interval: 0.06–0.99;
p
= 0.04) and total complications (odds ratio: 0.26, 95% confidence interval: 0.07–0.86;
p
= 0.02).
Conclusion
S-MIE was feasible for salvage esophagectomy, with favorable short-term outcomes vs S-OE regarding postoperative pneumonia and total complications.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-021-08672-y</identifier><identifier>PMID: 34642795</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Body mass index ; Cancer therapies ; Chemoradiotherapy - adverse effects ; Chemotherapy ; Chronic obstructive pulmonary disease ; Confidence intervals ; Endoscopy ; Esophageal cancer ; Esophageal Neoplasms - complications ; Esophageal Neoplasms - surgery ; Esophagectomy - adverse effects ; Gastroenterology ; Gynecology ; Hepatology ; Hospitals ; Humans ; Lymphatic system ; Medical prognosis ; Medicine ; Medicine & Public Health ; Minimally Invasive Surgical Procedures - adverse effects ; Mortality ; Ostomy ; Patients ; Pneumonia ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Complications - surgery ; Postoperative period ; Proctology ; Radiation ; Radiation therapy ; Retrospective Studies ; Surgery ; Surgical outcomes ; Treatment Outcome</subject><ispartof>Surgical endoscopy, 2022-05, Vol.36 (5), p.3504-3510</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021</rights><rights>2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-289184a9f55c025376dea30a30098fec8493fdc4872caac60628a06c9e8180793</citedby><cites>FETCH-LOGICAL-c375t-289184a9f55c025376dea30a30098fec8493fdc4872caac60628a06c9e8180793</cites><orcidid>0000-0002-9562-2966</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-021-08672-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-021-08672-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34642795$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ishiyama, Koshiro</creatorcontrib><creatorcontrib>Oguma, Junya</creatorcontrib><creatorcontrib>Kubo, Kentaro</creatorcontrib><creatorcontrib>Kanematsu, Kyohei</creatorcontrib><creatorcontrib>Kurita, Daisuke</creatorcontrib><creatorcontrib>Daiko, Hiroyuki</creatorcontrib><title>Salvage minimally invasive esophagectomy after definitive chemoradiotherapy for esophageal cancer can improve postoperative complications compared with salvage open esophagectomy</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Although the advantage of minimally invasive esophagectomy (MIE) over open esophagectomy (OE) in planned esophagectomy is being established, the utility of salvage MIE (S-MIE) remains unclear. We aimed to investigate the feasibility and advantage of S-MIE compared with salvage OE (S-OE).
Methods
We retrospectively assessed 82 patients who underwent salvage esophagectomy after definitive chemoradiotherapy for thoracic esophageal cancer between January 2007 and April 2020. Perioperative factors and postoperative complications were compared between the S-OE group (
n
= 62) and the S-MIE group (
n
= 20). Logistic regression analysis was performed to analyze the factors associated with postoperative complications.
Results
Regarding the patients’ preoperative characteristics, the S-OE group had a significant number of grade ≥ cT3 patients vs the S-MIE group (69% vs 35%, respectively;
p
= 0.006), whereas ycT rates were comparable. Compared with S-OE, S-MIE had comparable operative time, number of harvested thoracic lymph nodes, and R0 resection, but significantly less estimated blood loss (150 ml and 395 ml, respectively;
p
= 0.003). Regarding postoperative complications, total complications (79% vs 50%;
p
= 0.01) and pneumonia (48.3% vs 20%;
p
= 0.02) rates were significantly lower with S-OE vs S-MIE, respectively. On multivariate analysis, S-MIE was an independent factor associated with postoperative pneumonia (odds ratio: 0.29, 95% confidence interval: 0.06–0.99;
p
= 0.04) and total complications (odds ratio: 0.26, 95% confidence interval: 0.07–0.86;
p
= 0.02).
Conclusion
S-MIE was feasible for salvage esophagectomy, with favorable short-term outcomes vs S-OE regarding postoperative pneumonia and total complications.</description><subject>Abdominal Surgery</subject><subject>Body mass index</subject><subject>Cancer therapies</subject><subject>Chemoradiotherapy - adverse effects</subject><subject>Chemotherapy</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Confidence intervals</subject><subject>Endoscopy</subject><subject>Esophageal cancer</subject><subject>Esophageal Neoplasms - complications</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophagectomy - adverse effects</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Lymphatic system</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minimally Invasive Surgical Procedures - adverse effects</subject><subject>Mortality</subject><subject>Ostomy</subject><subject>Patients</subject><subject>Pneumonia</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - surgery</subject><subject>Postoperative period</subject><subject>Proctology</subject><subject>Radiation</subject><subject>Radiation therapy</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kctu1TAQhi0EoofCC7BAltiwCfgSJ_YSVdykSiyAtTU4kx5XSRzsnFPltXhCps2hCBZIlkbj-f6Z0fyMPZfitRSifVOEqJu6EkpWwjatqtYHbCdrrSqlpH3IdsJpUanW1WfsSSnXgngnzWN2pklH_2bHfn6B4QhXyMc4xRGGYeVxOkKJR-RY0rynWljSuHLoF8y8w57A5bYc9jimDF1Myx4zzCvvU74XwcADTIEkFHgc55xIM6eypJnorUMa5yEGStJU7jLI2PGbuOx5Oe1F9PT3Jk_Zox6Ggs9O8Zx9e__u68XH6vLzh08Xby-roFuzVMo6aWtwvTFBKKPbpkPQgp5wtsdga6f7LtS2VQEgNKJRFkQTHFppRev0OXu19aXVfxywLH6MJeAwwITpULwyBCqtjCH05T_odTrkibbzqqGb1w3NJ0ptVMiplIy9nzPdPK9eCn_rqN8c9eSov3PUryR6cWp9-D5idy_5bSEBegMKlaYrzH9m_6ftLyWnsdU</recordid><startdate>20220501</startdate><enddate>20220501</enddate><creator>Ishiyama, Koshiro</creator><creator>Oguma, Junya</creator><creator>Kubo, Kentaro</creator><creator>Kanematsu, Kyohei</creator><creator>Kurita, Daisuke</creator><creator>Daiko, Hiroyuki</creator><general>Springer US</general><general>Springer Nature B.V</general><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>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9562-2966</orcidid></search><sort><creationdate>20220501</creationdate><title>Salvage minimally invasive esophagectomy after definitive chemoradiotherapy for esophageal cancer can improve postoperative complications compared with salvage open esophagectomy</title><author>Ishiyama, Koshiro ; Oguma, Junya ; Kubo, Kentaro ; Kanematsu, Kyohei ; Kurita, Daisuke ; Daiko, Hiroyuki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-289184a9f55c025376dea30a30098fec8493fdc4872caac60628a06c9e8180793</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Abdominal Surgery</topic><topic>Body mass index</topic><topic>Cancer therapies</topic><topic>Chemoradiotherapy - adverse effects</topic><topic>Chemotherapy</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Confidence intervals</topic><topic>Endoscopy</topic><topic>Esophageal cancer</topic><topic>Esophageal Neoplasms - complications</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophagectomy - adverse effects</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Lymphatic system</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Minimally Invasive Surgical Procedures - adverse effects</topic><topic>Mortality</topic><topic>Ostomy</topic><topic>Patients</topic><topic>Pneumonia</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - surgery</topic><topic>Postoperative period</topic><topic>Proctology</topic><topic>Radiation</topic><topic>Radiation therapy</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ishiyama, Koshiro</creatorcontrib><creatorcontrib>Oguma, Junya</creatorcontrib><creatorcontrib>Kubo, Kentaro</creatorcontrib><creatorcontrib>Kanematsu, Kyohei</creatorcontrib><creatorcontrib>Kurita, Daisuke</creatorcontrib><creatorcontrib>Daiko, Hiroyuki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ishiyama, Koshiro</au><au>Oguma, Junya</au><au>Kubo, Kentaro</au><au>Kanematsu, Kyohei</au><au>Kurita, Daisuke</au><au>Daiko, Hiroyuki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Salvage minimally invasive esophagectomy after definitive chemoradiotherapy for esophageal cancer can improve postoperative complications compared with salvage open esophagectomy</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2022-05-01</date><risdate>2022</risdate><volume>36</volume><issue>5</issue><spage>3504</spage><epage>3510</epage><pages>3504-3510</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Although the advantage of minimally invasive esophagectomy (MIE) over open esophagectomy (OE) in planned esophagectomy is being established, the utility of salvage MIE (S-MIE) remains unclear. We aimed to investigate the feasibility and advantage of S-MIE compared with salvage OE (S-OE).
Methods
We retrospectively assessed 82 patients who underwent salvage esophagectomy after definitive chemoradiotherapy for thoracic esophageal cancer between January 2007 and April 2020. Perioperative factors and postoperative complications were compared between the S-OE group (
n
= 62) and the S-MIE group (
n
= 20). Logistic regression analysis was performed to analyze the factors associated with postoperative complications.
Results
Regarding the patients’ preoperative characteristics, the S-OE group had a significant number of grade ≥ cT3 patients vs the S-MIE group (69% vs 35%, respectively;
p
= 0.006), whereas ycT rates were comparable. Compared with S-OE, S-MIE had comparable operative time, number of harvested thoracic lymph nodes, and R0 resection, but significantly less estimated blood loss (150 ml and 395 ml, respectively;
p
= 0.003). Regarding postoperative complications, total complications (79% vs 50%;
p
= 0.01) and pneumonia (48.3% vs 20%;
p
= 0.02) rates were significantly lower with S-OE vs S-MIE, respectively. On multivariate analysis, S-MIE was an independent factor associated with postoperative pneumonia (odds ratio: 0.29, 95% confidence interval: 0.06–0.99;
p
= 0.04) and total complications (odds ratio: 0.26, 95% confidence interval: 0.07–0.86;
p
= 0.02).
Conclusion
S-MIE was feasible for salvage esophagectomy, with favorable short-term outcomes vs S-OE regarding postoperative pneumonia and total complications.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>34642795</pmid><doi>10.1007/s00464-021-08672-y</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-9562-2966</orcidid></addata></record> |
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| ispartof | Surgical endoscopy, 2022-05, Vol.36 (5), p.3504-3510 |
| issn | 0930-2794 1432-2218 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Abdominal Surgery Body mass index Cancer therapies Chemoradiotherapy - adverse effects Chemotherapy Chronic obstructive pulmonary disease Confidence intervals Endoscopy Esophageal cancer Esophageal Neoplasms - complications Esophageal Neoplasms - surgery Esophagectomy - adverse effects Gastroenterology Gynecology Hepatology Hospitals Humans Lymphatic system Medical prognosis Medicine Medicine & Public Health Minimally Invasive Surgical Procedures - adverse effects Mortality Ostomy Patients Pneumonia Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - surgery Postoperative period Proctology Radiation Radiation therapy Retrospective Studies Surgery Surgical outcomes Treatment Outcome |
| title | Salvage minimally invasive esophagectomy after definitive chemoradiotherapy for esophageal cancer can improve postoperative complications compared with salvage open esophagectomy |
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