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Robot-Assisted Thoracolaparoscopic Esophagectomy: The Netherlands

  • Roy J. J. Verhage
  • Christiaan Kroese
  • Richard van HillegersbergEmail author
Chapter

Abstract

For locally advanced esophageal cancer, radical surgical resection is the mainstay of treatment. Lymph node metastases occur along the entire tract of the esophagus in an early stage. Optimal treatment involves neo-adjuvant chemoradiotherapy followed by a two field thoraco-abdominal en bloc esophagectomy with an extensive mediastinal and truncal lymph node dissection.

Techniques for minimally invasive esophagectomy have been introduced to reduce surgical trauma and morbidity of traditional open esophagectomy. However, conventional endoscopic surgery is limited by 2-dimensional vision, reduced dexterity and limited degrees of freedom. Robotic systems were developed to overcome such limitations, enabling the surgeon to perform complex minimally invasive surgical procedures. Advantages include reduced blood loss and fast postoperative recovery.

This chapter describes the indications and preoperative considerations for robot-assisted thoracolaparoscopic esophagectomy. Furthermore, anesthesiological management is discussed, addressing important intraoperative issues such as single lung ventilation and fluid management.

The three-stage operative procedure is described in detail. The thoracoscopic phase is performed using the robotic DaVinci Si system (Intuitive Surgical Inc., Sunnyvale CA, USA). The laparoscopic phase is performed with conventional laparoscopy. A gastric conduit is created extracorporally and a cervical esophagogastric anastomosis is formed.

Additionally, the clinical care of patients after esophagectomy is discussed with a specific focus on anastomotic leakage and chylous leakage.

Keywords

Esophagectomy Thoracoscopy Single lung ventilation Laparoscopy Gastric conduit Lymph node dissection Thoracic duct Anastomotic leakage Chylous leakage 

References

  1. 1.
    Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 2006;24:2137–50.CrossRefGoogle Scholar
  2. 2.
    Stoner GD, Gupta A. Etiology and chemoprevention of esophageal squamous cell carcinoma. Carcinogenesis. 2001;22:1737–46.CrossRefGoogle Scholar
  3. 3.
    Marsman WA, Tytgat GN, ten Kate FJ, van Lanschot JJ. Differences and similarities of adenocarcinomas of the esophagus and esophagogastric junction. J Surg Oncol. 2005;92:160–8.CrossRefGoogle Scholar
  4. 4.
    Holmes RS, Vaughan TL. Epidemiology and pathogenesis of esophageal cancer. Semin Radiat Oncol. 2007;17:2–9.CrossRefGoogle Scholar
  5. 5.
    Mariette C, Piessen G, Triboulet JP. Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities. Lancet Oncol. 2007;8:545–53.CrossRefGoogle Scholar
  6. 6.
    Hulscher JB, Tijssen JG, Obertop H, van Lanschot JJ. Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thorac Surg. 2001;72:306–13.CrossRefGoogle Scholar
  7. 7.
    Orringer MB, Marshall B, Chang AC, Lee J, Pickens A, Lau CL. Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg. 2007;246:363–72.CrossRefGoogle Scholar
  8. 8.
    Espat NJ, Jacobsen G, Horgan S, Donahue P. Minimally invasive treatment of esophageal cancer: laparoscopic staging to robotic esophagectomy. Cancer J. 2005;11:10–7.CrossRefGoogle Scholar
  9. 9.
    Boone J, Schipper ME, Moojen WA, Borel Rinkes IH, Cromheecke GJ, van Hillegersberg R. Robot-assisted thoracoscopic oesophagectomy for cancer. Br J Surg. 2009;96:878–86.CrossRefGoogle Scholar
  10. 10.
    Omloo JM, Lagarde SM, Hulscher JB, Reitsma JB, Fockens P, van Dekken H, ten Kate FJ, Obertop H, Tilanus HW, van Lanschot JJ. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg. 2007;246:992–1000.CrossRefGoogle Scholar
  11. 11.
    Rizzetto C, DeMeester SR, Hagen JA, Peyre CG, Lipham JC, DeMeester TR. En bloc esophagectomy reduces local recurrence and improves survival compared with transhiatal resection after neoadjuvant therapy for esophageal adenocarcinoma. J Thorac Cardiovasc Surg. 2008;135:1228–36.CrossRefGoogle Scholar
  12. 12.
    Stark SP, Romberg MS, Pierce GE, Hermreck AS, Jewell WR, Moran JF, Cherian G, Delcore R, Thomas JH. Transhiatal versus transthoracic esophagectomy for adenocarcinoma of the distal esophagus and cardia. Am J Surg. 1996;172:478–81.CrossRefGoogle Scholar
  13. 13.
    Rentz J, Bull D, Harpole D, Bailey S, Neumayer L, Pappas T, Krasnicka B, Henderson W, Daley J, Khuri S. Transthoracic versus transhiatal esophagectomy: a prospective study of 945 patients. J Thorac Cardiovasc Surg. 2003;125:1114–20.CrossRefGoogle Scholar
  14. 14.
    Colvin H, Dunning J, Khan OA. Transthoracic versus transhiatal esophagectomy for distal esophageal cancer: which is superior? Interact Cardiovasc Thorac Surg. 2011;12:265–9.CrossRefGoogle Scholar
  15. 15.
    Luketich JD, velo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC. Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg. 2003;238:486–94.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Gemmill EH, McCulloch P. Systematic review of minimally invasive resection for gastro-oesophageal cancer. Br J Surg. 2007;94:1461–7.CrossRefGoogle Scholar
  17. 17.
    Verhage RJ, Hazebroek EJ, Boone J, van Hillegersberg R. Minimally invasive surgery compared to open procedures in esophagectomy for cancer: a systematic review of the literature. Minerva Chir. 2009;64:135–46.PubMedGoogle Scholar
  18. 18.
    Ruurda JP, van Vroonhoven TJ, Broeders IA. Robot-assisted surgical systems: a new era in laparoscopic surgery. Ann R Coll Surg Engl. 2002;84:223–6.CrossRefGoogle Scholar
  19. 19.
    Camarillo DB, Krummel TM, Salisbury JK. Robotic technology in surgery: past, present, and future. Am J Surg. 2004;188:2S–15S.CrossRefGoogle Scholar
  20. 20.
    van Hillegersberg R, Boone J, Draaisma WA, Broeders IA, Giezeman MJ, Borel Rinkes IH. First experience with robot-assisted thoracoscopic esophagolymphadenectomy for esophageal cancer. Surg Endosc. 2006;20:1435–9.CrossRefGoogle Scholar
  21. 21.
    Kernstine KH, DeArmond DT, Karimi M, Van Natta TL, Campos JH, Yoder MR, Everett JE. The robotic, 2-stage, 3-field esophagolymphadenectomy. J Thorac Cardiovasc Surg. 2004;127:1847–9.CrossRefGoogle Scholar
  22. 22.
    Wittekind C, Greene FL, Hutter RVP, Klimpfinger M, Sobin LH. TNM atlas. Illustrated guide to the TNM/pTNM classification of malignant tumors. 2004.Google Scholar
  23. 23.
    Cense HA, Lagarde SM, de JK, Omloo JM, Busch OR, Henny C, van Lanschot JJ. Association of no epidural analgesia with postoperative morbidity and mortality after transthoracic esophageal cancer resection. J Am Coll Surg. 2006;202:395–400.CrossRefGoogle Scholar
  24. 24.
    Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA, Wu CL. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA. 2003;290:2455–63.CrossRefGoogle Scholar
  25. 25.
    Michelet P, Roch A, D’Journo XB, Blayac D, Barrau K, Papazian L, Thomas P, Auffray JP. Effect of thoracic epidural analgesia on gastric blood flow after oesophagectomy. Acta Anaesthesiol Scand. 2007;51:587–94.CrossRefGoogle Scholar
  26. 26.
    American Society of Anesthesiologists. Standards for basic anestheticmonitoring. http://www.asahq.org/For-Healthcare-Professionals/Standards-Guidelines-and-Statements.aspx. Accessed July 2011.
  27. 27.
    Sato N, Koeda K, Ikeda K, Kimura Y, Aoki K, Iwaya T, Akiyama Y, Ishida K, Saito K, Endo S. Randomized study of the benefits of preoperative corticosteroid administration on the postoperative morbidity and cytokine response in patients undergoing surgery for esophageal cancer. Ann Surg. 2002;236:184–90.CrossRefGoogle Scholar
  28. 28.
    Pennefather SH, Russell GN. Placement of double lumen tubes: time to shed light on an old problem. Br J Anaesth. 2000;84:308–10.CrossRefGoogle Scholar
  29. 29.
    Patane PS, Sell BA, Mahla ME. Awake fiberoptic endobronchial intubation. J Cardiothorac Anesth. 1990;4:229–31.CrossRefGoogle Scholar
  30. 30.
    Gothard J. Lung injury after thoracic surgery and one-lung ventilation. Curr Opin Anaesthesiol. 2006;19:5–10.CrossRefGoogle Scholar
  31. 31.
    Renner J, Gruenewald M, Quaden R, Hanss R, Meybohm P, Steinfath M, Scholz J, Bein B. Influence of increased intra-abdominal pressure on fluid responsiveness predicted by pulse pressure variation and stroke volume variation in a porcine model. Crit Care Med. 2009;37:650–8.CrossRefGoogle Scholar
  32. 32.
    Chandrashekar MV, Irving M, Wayman J, Raimes SA, Linsley A. Immediate extubation and epidural analgesia allow safe management in a high-dependency unit after two-stage oesophagectomy. Results of eight years of experience in a specialized upper gastrointestinal unit in a district general hospital. Br J Anaesth. 2003;90:474–9.CrossRefGoogle Scholar
  33. 33.
    Boone J, Borel Rinkes IH, van Hillegersberg R. Gastric conduit staple line after esophagectomy: to oversew or not? J Thorac Cardiovasc Surg. 2006;132:1491–2.CrossRefGoogle Scholar
  34. 34.
    Ajani J, Bekaii-Saab T, D’Amico TA, Fuchs C, Gibson MK, Goldberg M, Hayman JA, Ilson DH, Javle M, Kelley S, Kurtz RC, Locker GY, Meropol NJ, Minsky BD, Orringer MB, Osarogiagbon RU, Posey JA, Roth J, Sasson AR, Swisher SG, Wood DE, Yen Y. Esophageal cancer clinical practice guidelines. J Natl Compr Canc Netw. 2006;4:328–47.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Roy J. J. Verhage
    • 1
  • Christiaan Kroese
    • 2
  • Richard van Hillegersberg
    • 1
    Email author
  1. 1.Department of Surgical OncologyUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.Department of Anesthesiology, Intensive Care and Emergency SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands

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