Abstract
Intoduction
In an effort to reduce the morbidity and mortality associated with open esophagectomy, a minimally invasive approach to esophagectomy was introduced at the University of Pittsburgh Medical Center (UPMC) in 1996. The objective of this article is to discuss the optimization and refinement of minimally invasive esophagectomy (MIE) techniques over the 15-year experience at UPMC. We also reviewed the literature on technical improvements in MIE.
Method
Literature highlights for MIE and related meta-analyses comparing open esophagectomy and MIE were reviewed. The rationale and outcomes of techniques refinements were discussed in detail.
Results
Most meta-analyses and systematic reviews confirm the feasibility and safety of MIE and suggest similar oncologic outcomes as compared with open esophagectomy. Since 1996, over 1,000 minimally invasive esophagectomies have been performed at UPMC. We have made several refinements to the MIE procedure that we believe significantly improved our surgical outcomes. It included adjustment of width of the gastric conduit, application of omental flap, and conversion from minimally invasive, three-hole esophagectomy to minimally invasive Ivor Lewis esophagectomy.
Conclusion
MIE became a mainstay in the surgical treatment of esophageal cancer at UPMC. The technical improvements detailed above make the UPMC approach to MIE a feasible, safe, and efficient procedure.
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References
Bizekis C, Kent MS, Luketich JD, et al. Initial experience with minimally invasive Ivor Lewis esophagectomy. Ann ThoracSurg. 2006;82(2):4
Pennathur A, Awais O, Luketich JD. Technique of minimally invasive Ivor Lewis esophagectomy. Ann ThoracSurg. 2010;89(6):S2159-62.
Luketich JD, Fernando HC, Christie NA, et al. Outcomes afte rminimally invasive esophagomyotomy. Ann ThoracSurg. 2001;72:1909–1913.
Luketich JD, Schauer PR, Christie NA, et al. Minimally invasive esophagectomy. Ann ThoracSurg. 2000;70:906–912.
Luketich JD, Alvelo-Rivera M, Buenaventura PO, et al. Minimally invasive esophagectomy: outcomesin 222 patients. AnnSurg. 2003;238(4):486-94;
Pennathur A, Luketich JD. Minimally invasive surgical treatment of esophageal carcinoma. Gastrointest Cancer Res. 2008;2(6):295
Kilic A, Schuchert MJ, Pennathur A, et al. Impact of obesity on perioperative outcomes of minimally invasive esophagectomy. Ann ThoracSurg. 2009;87(2):412-5
Pennathur A, Farkas A, Krasinskas AM, et al. Esophagectomy for T1 esophageal cancer: outcomesin 100 patients and implications for endoscopic therapy. AnnThoracSurg. 2009;87(4):1048-54.
Verhage RJ, Hazebroek EJ, Boone J,et al. Minimally invasive surgery compared to open procedures in esophagectomy for cancer: a systematic review of the literature. MinervaChir. 2009;64(2):135-46.
Decker G, Coosemans W, De Leyn P, et al. Minimally invasive esophagectomy for cancer. Eur J CardiothoracSurg. 2009;35(1):13-20.
Biere SS, Cuesta MA, van der Peet DL. Minimally invasive versus open esophagectomy for cancer: a systematic review and meta-analysis. Minerva Chir.2009;64(2):121-33.
Nagpal K, Ahmed K, Vats A, et al. Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc. 2010;24(7):1621-9
Sgourakis G, Gockel I, Radtke A,et al. Minimally invasive versus open esophagectomy: meta-analysis of outcomes. DigDisSci. 2010;55(11):3031-40.
Dantoc MM, Cox MR, Eslick GD. Does minimally invasive esophagectomy (MIE) provide for comparable oncologic outcomes to open techniques? A systematic review. J Gastrointest Surg. 2012 Mar;16(3):486-94.)
Lazzarino AI, Nagpal K, Bottle A, et al. Open versus minimally invasive esophagectomy: trends of utilization and associated outcomes in England. AnnSurg. 2010;252(2):292-8.
Luketich JD, Pennathur A, Catalano PJ et al (2009) Results of a phase II multicenter study of MIE (Eastern Cooperative Oncology Group Study E2202). J Clin Oncol 27:15s (suppl; abstr 4516)
Tsai WS, Levy RM, Luketich JD. Technique of Minimally Invasive Ivor Lewis Esophagectomy. Operative Techniques in Thoracic and Cardiovascular Surgery 2009;14(3):176-92.
Levy RM, Wizorek J, Shende M, et al. Laparoscopic and thoracoscopic esophagectomy. Advances in surgery 2010;44:101-16.
Goldsmith HS, Kiely AA, Randall HT. Protection of intrathoracic esophageal anastomoses by omentum. Surgery 1968;63:464–466.
Ghazi BH, Carlson GW, LoskenA. Use of the greater omentum for reconstruction of infected sternotomy wounds: a prognostic indicator. Ann Plast Surg. 2008;60(2):169-73
Kawahara N, Tomita K, Murakami H, et al. Total en bloc spondylectomy and a greater omentum pedicle flap for a large bone and soft tissue defect: solitary lumbar metastasis from renal cell carcinoma. J Orthop Sci. 2009; 14(6):830-6.
Goldsmith HS, Griffith AL, Kupferman A, et al. Lipid angiogenic factor from omentum. JAMA. 1984; 252(15):2034-6.
Zhang QX, Magovern CJ, Mack CA, et al. Vascular endothelial growth factor is the major angiogenic factor in omentum: mechanism of the omentum-mediated angiogenesis. J SurgRes 1997;67:147–154
Karaoglanoglu N, Turyilmaz A, ErogluA. Use of pedicled omentum and endostaplers in esophagogastric anastomosis. Ann ThoracSurg. 2007;83(6): 2259-60.
Bhat MA, Dar MA, Lone GN, et al. Use of pedicled omentum in esophagogastric anastomosis for prevention of anastomotic leak. Ann ThoracSurg 2006; 82(5):1857-62.
Zhang K, Yang YH. Use of pedicled omentum in oesophagogastric anastomosis: An analysis of 100 cases. Ann R CollSurg Eng 1987;69:209–11.)
Dai JG, Zhang ZY, Min JX, et al. Wrapping of the omental pedicle flap around esophagogastric anastomosis after esophagectomy for esophageal cancer. Surgery. 2011;149(3):404-10.
Orringer MB, Marshall B, Chang AC. Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg. 2007;246(3):363-72
Watson DI, Davies N, Jamieson GG. Totally endoscopic Ivor Lewis esophagectomy. Surg Endosc. 1999;13(3):293-7.
Nguyen NT, Follette DM, Lemoine PH, et al. Minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg 2001; 72(2):593-6.
Nguyen NT, Hinojosa MW, Smith BR, Chang KJ, Gray J, Hoyt D. Minimally invasive esophagectomy: lessons learned from 104 operations. Ann Surg. 2008;248(6):1081-91.
Rizk NP. Ishwaran H, Rice TW, et al. Optimum lymphadenectomy for esophageal cancer. Ann Surg. 2010; 251(1):46-50.
Luketich JD, Pennathur A, Awais O, Keeley S, Shende M, Christie N, Weksler B, Landreneau RJ, Abbas G, Schuchert MJ, Nason KS. Outcomes After Minimally Invasive Esophagectomy: Review of 1000 patients. Ann Surg 2012 Jun 4. [Epub ahead of print]
Levy RM, Luketich JD. Minimally invasive intrathoracic esophagogastric anastomosis. Semin ThoracCardiovasc Surg. 2010; 22(3):256-8.
Clark J, Sodergren MH, Purkayastha S, et al. The role of robotic assisted laparoscopy for oesophagogastric oncological resection; an appraisal of the literature. Dis Esophagus. 2011;24(4):240-50
Biere SS, Maas KW, Bonavina L, Garcia JR, van Berge Henegouwen MI, Rosman C, Sosef MN, de Lange ES, Bonjer HJ, Cuesta MA, van der Peet DL. Traditional invasive vs. minimally invasive esophagectomy: a multi-center, randomized trial (TIME-trial). BMC Surg. 2011;11:2.
Acknowledgments
This work is supported, in part, by Pujiang Talent Grant, UICC fellowship ICR/11/033, a Young Investigator Grant from Shanghai Municipal Health Bureau, Zhuo Shi grant from Fudan University, Ministry of Education returned scientific research foundation (to J. Z). We thank Shannon Wyszomierski for her editorial assistance.
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Jie Zhang and Rui Wang contributed equally to this work.
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Zhang, J., Wang, R., Liu, S. et al. Refinement of Minimally Invasive Esophagectomy Techniques After 15 Years of Experience. J Gastrointest Surg 16, 1768–1774 (2012). https://doi.org/10.1007/s11605-012-1950-2
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DOI: https://doi.org/10.1007/s11605-012-1950-2