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Two-phase laparoscopic-assisted oesophago-gastrectomy: a single-unit experience of 111 consecutive cases and outcomes

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Abstract

Background

Minimal access surgery for oesophago-gastric cancer is topical and demanding, and approaches vary significantly. There is little data on the hybrid technique of laparoscopic-assisted two-phase oesophago-gastrectomy (LA2OG). Here we aim to review our experience, which exceeds 10 years, of this technique for oesophageal malignancy.

Methods

From June 1998 to May 2009, 111 patients underwent LA2OG. Patients included 84 men and 27 women with mean age 65 years (range 35–85 years). Retrospective analysis of indications, outcome, staging, complications and survival was performed.

Results

The majority of resections (96%) were performed for gastro-oesophageal junction or distal oesophageal pathology. Indications included adenocarcinoma (84.7%), squamous cell carcinoma (7.2%) and high-grade dysplasia (5.4%). Of patients, 67.6% received neoadjuvant chemotherapy. The median time for the laparoscopic phase was 207 min (range 105–600 min), and 420 min (range 210–780 min) overall. Estimated blood loss was 330 ml (range 100–1,200 ml). Median critical care and post-operative stays were 3 and 14 days, respectively. Over time, the radicality of surgery increased. From 1998 to 2001 median lymph node yield was 5, from 2002 to 2005 it was 12 nodes, and from 2006 to 2009 it was 28 nodes (p < 0.001). The overall complication rate was 38.7%, minor in 24.3%, with anastomotic leak rate of 5.5%. Median survival was 38.5 ± 5.4 months. Thirty-day and in-hospital mortality were 1.8 and 2.7%, respectively.

Conclusions

Two-stage laparoscopic-assisted oesophago-gastrectomy is a safe staged method of developing minimal access surgery for oesophago-gastric cancer. This study provides a useful reference for comparison with other minimally invasive methods.

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References

  1. Enzinger PC, Mayer RJ (2003) Esophageal cancer. N Engl J Med 349:2241–2252

    Article  PubMed  CAS  Google Scholar 

  2. Khushalani NI (2008) Cancer of the esophagus and stomach. Mayo Clin Proc 83:712–722

    Article  PubMed  Google Scholar 

  3. Allum WH, Stenning SP, Bancewicz J, Clark PI, Langley RE (2009) Long-term results of a randomised trial of surgery with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol 27:5062–5067

    Article  PubMed  Google Scholar 

  4. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, Scarffe JH, Lofts FJ, Falk SJ, Iveson TJ, Smith DB, Langley RE, Verma M, Weeden S, Chua YJ, MAGIC Trial Participants (2006) Perioperative chemotherapy versus surgery alone for resectable gastrooesophageal cancer. N Engl J Med 355:11–20

    Article  PubMed  CAS  Google Scholar 

  5. Law S (2010) Esophagectomy without mortality: what can surgeons do? J Gastrointest Surg 14:S101–107

    Article  PubMed  Google Scholar 

  6. Gockel I, Sultanov FS, Domeyer M, Goenner U, Junginger T (2007) Developments in esophageal surgery for adenocarcinoma: a comparison of two decades. BMC Cancer 7:114

    Article  PubMed  CAS  Google Scholar 

  7. Blazeby JM, Farndon JR, Donovan J, Alderson D (2000) A prospective longitudinal study examining the quality of life of patients with esophageal carcinoma. Cancer 88:1781–1787

    Article  PubMed  CAS  Google Scholar 

  8. Cuschieri A, Shimi S, Banting S (1992) Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 37:7–11

    PubMed  CAS  Google Scholar 

  9. Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC (2003) Minimally invasive esophagectomy. Outcomes in 222 patients. Ann Surg 238:486–495

    PubMed  Google Scholar 

  10. Bussières JS (2009) Open or minimally invasive esophagectomy: are the outcomes different? Curr Opin Anaesthesiol 22:56–60

    Article  PubMed  Google Scholar 

  11. Gemmill EH, McCulloch P (2007) Systematic review of minimally invasive resection for gastro-oesophageal cancer. Br J Surg 94:1461–1467

    Article  PubMed  CAS  Google Scholar 

  12. Qureshi I, Nason KS, Luketich JD (2008) Is minimally invasive esophagectomy indicated for cancer? Expert Rev Anticancer Ther 8:1449–1460

    Article  PubMed  Google Scholar 

  13. Smithers BM, Gotley DC, McEwan D, Martin I, Bessell J, Doyle L (2001) Thorascopic mobilisation of the esophagus. A 6 year experience. Surg Endosc 15:176–182

    Article  PubMed  CAS  Google Scholar 

  14. Nguyen NT, Hinojosa MW, Smith BR, Chang KJ, Gray J, Hoyt D (2008) Minimally invasive esophagectomy. Lessons learned from 104 operations. Ann Surg 248:1081–1091

    Article  PubMed  Google Scholar 

  15. Sobin LH, Wittekind C (eds) (2002) International Union Against Cancer (UICC): TNM classification of malignant tumours, 6th edn. Wiley, New York

    Google Scholar 

  16. Bonavina L, Bona D, Binyom PR, Peracchia A (2004) A laparoscopy-assisted surgical approach to esophageal carcinoma. J Surg Res 117:52–57

    Article  PubMed  Google Scholar 

  17. Godiris-Petit G, Munoz-Bongrand N, Honigman I, Cattan P, Sarfati E (2006) Minimally invasive esophagectomy for cancer: prospective evaluation of laparoscopic gastric mobilisation. World J Surg 30:1434–1440

    Article  PubMed  Google Scholar 

  18. Hamouda AH, Forshaw MJ, Tsigritis K, Jones GE, Noorani AS, Rohatgi A, Botha AJ (2010) Perioperative outcomes after transition from convention to minimally invasive Ivor-Lewis esophagectomy in a specialized centre. Surg Endosc 24:865–869

    Article  PubMed  Google Scholar 

  19. Hölscher AH, Schneider PM, Gutschow C, Schröder W (2007) Laparoscopic ischemic preconditioning of the stomach for esophageal replacement. Ann Surg 245:241–246

    Article  PubMed  Google Scholar 

  20. Martin DJ, Bessell JR, Chew A, Watson DI (2005) Thoracoscopic and laparoscopic esophagectomy: initial experience and outcomes. Surg Endosc 19:1597–1601

    Article  PubMed  CAS  Google Scholar 

  21. Decker G, Coosemans W, De Leyn P, Decaluwe H, Nafteux P, Van Raemdonck D, Lerut T (2009) Minimally invasive esophagectomy for cancer. Eur J Cardiothor Surg 35:13–21

    Article  Google Scholar 

  22. Worrell S, Mumtaz S, Tsuboi K, Lee TH, Mittal SK (2010) Anastomotic complications associated with stapled versus hand-sewn anstomosis. J Surg Res 161:9–12

    Article  PubMed  Google Scholar 

  23. Sutchiffe RP, Forshaw MJ, Tandon R, Rohatgi A, Strauss DC, Botha AJ, Mason RC (2008) Anastomotic strictures and delayed gastric emptying after esophagectomy: incidence, risk factors and management. Dis Esophagus 21:712–717

    Article  Google Scholar 

  24. Biere SS, Cuesta MA, van der Peet DL (2009) Minimally invasive versus open esophagectomy for cancer: a systemic review and metaanalysis. Minerva Chir 64:121–133

    PubMed  CAS  Google Scholar 

  25. Smithers BM, Gotley DC, Martin I, Thomas JM (2007) Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg 245:232–240

    Article  PubMed  Google Scholar 

  26. Palanivelu C, Prakash A, Senthilkumar R, Senthilnathan P, Parthasarathi R, Rajan PS, Venkatachlam S (2006) Minimally invasive esophagectomy: thoracoscopic mobilisation of the esophagus and mediastinal lymphadenectomy in prone position—experience of 130 patients. J Am Coll Surg 203:7–16

    Article  PubMed  Google Scholar 

  27. National Oesophago-Gastric Cancer Audit (2009) An audit of the care received by people with Oesophago-Gastric Cancer in England and Wales. Second Annual Report. http://www.ic.nhs.uk/services/national-clinical-audit-support-programme-ncasp/audit-reports/oesophago-gastric-cancer. Accessed 2 June 2011

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Acknowledgments

The authors acknowledge the contribution of Mr KK Singh, who performed a number of the resections included in this study.

Disclosures

Authors Baker, Bailey, Singh, Soon and Preston have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. The Regional Oesophago-Gastric Unit & Minimal Access Therapy Training Unit, The Royal Surrey County Hospital, Guildford, Surrey, GU2 7XX, UK

    Cara R. Baker, Michael E. Bailey, Yuen Soon, Sukhpal Singh & Shaun R. Preston

Authors
  1. Cara R. Baker
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  2. Michael E. Bailey
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  3. Yuen Soon
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  4. Sukhpal Singh
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  5. Shaun R. Preston
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Corresponding author

Correspondence to Shaun R. Preston.

Additional information

Previous communication

Presented in part at the European Association of Endoscopic Surgeons (EAES), Prague, 18th June 2009. Laparoscopic Assisted 2 Phase Oesophago-Gastrectomy—Over 10 Years Experience. SR Preston, SS Singh, KK Singh, Y Soon & ME Bailey. Surgical Endoscopy 24(S1), S139, Abstract P493; 2010.

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Baker, C.R., Bailey, M.E., Soon, Y. et al. Two-phase laparoscopic-assisted oesophago-gastrectomy: a single-unit experience of 111 consecutive cases and outcomes. Surg Endosc 25, 3658–3667 (2011). https://doi.org/10.1007/s00464-011-1774-2

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  • DOI: https://doi.org/10.1007/s00464-011-1774-2

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