Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2013

01-06-2013 | Thoracic Oncology

Assessment and Comparison of Recovery after Open and Minimally Invasive Esophagectomy for Cancer: An Exploratory Study in Two Centers

Authors: R. Parameswaran, MRCS, MD, D. R. Titcomb, FRCS, N. S. Blencowe, MRCS, R. G. Berrisford, FRCS(Th), S. A. Wajed, MChir, FRCS, C. G. Streets, MD, FRCS, A. D. Hollowood, PhD, FRCS, R. Krysztopik, FRCS, C. P. Barham, MD, FRCS, J. M. Blazeby, MD, FRCS

Published in: Annals of Surgical Oncology | Issue 6/2013

Login to get access

Abstract

Background

Minimally invasive esophagectomy (MIE) may lead to early restoration of health-related quality of life, but few prospective comparative studies have been performed. This exploratory study compared recovery between totally minimally invasive esophagectomy (MIE), laparoscopically assisted esophagectomy (LAE) and open surgery (OE).

Methods

A prospective study in 2 specialist centers recruited consecutive patients undergoing OE, LAE, or MIE for high-grade dysplasia or cancer. Patients completed validated questionnaires, the Multi-Dimensional Fatigue Inventory (MFI-20), modified Katz Scale, and modified Lawton and Brody Scale (assessing activities of daily living) before and 6 weeks and 3 and 6 months after surgery.

Results

A total of 97 patients (26 women; median age 64 years) were scheduled for surgery that was abandoned in 11 due to occult low-volume metastatic disease. In the remaining 86 (OE = 19, LAE = 31, and MIE = 36), there were 4 in-hospital deaths (4 %), and 54 postoperative complications (OE = 12, LAE = 19, and MIE = 23). Overall questionnaire compliance was high (77 %) and baseline scores similar in all groups, although clinical differences between groups were observed with earlier tumors and more squamous cell cancers selected for MIE. Following surgery fatigue levels increased dramatically and activity levels reduced in all groups. These gradually recovered to baseline following MIE and LAE within 6 months, but the ability to perform activities of daily living and most parameters of fatigue had not returned to baseline levels in the OE group.

Conclusions

This exploratory prospective nonrandomized study of recovery after different types of surgery for esophageal cancer showed possible small benefits to MIE. A much larger study is needed to confirm these findings.
Literature
1.
2.
Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, et al. Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg. 2003;238:486–94.PubMed
3.
Smithers BM, Gotley DC, Martin I, Thomas JM. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg. 2007;245:232–40.PubMedCrossRef
4.
Nagpal K, Ahmed K, Vats A, Yakoub D, James D, Ashrafian H, et al. Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc. 2010;24:1621–9.CrossRef
5.
Parameswaran R, Blazeby JM, Hughes R, Mitchell K, Berrisford RG, Wajed SA. Health-related quality of life after minimally invasive oesophagectomy. Br J Surg. 2010;97:525–31.PubMedCrossRef
6.
Wang H, Feng M, Tan L, Wang Q. Comparison of the short-term quality of life in patients with esophageal cancer after subtotal esophagectomy via video-assisted thoracoscopic or open surgery. Dis Esophagus. 2010;23:408–14.PubMedCrossRef
7.
Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G; Clinical Outcomes of Surgical Therapy (COST) Study Group. Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA. 2002;287:321–8.PubMedCrossRef
8.
King PM, Blazeby JM, Ewings P, Longman RJ, Kipling RM, Franks PJ, et al. The influence of an Enhanced Recovery Programme on clinical outcomes, costs and quality of life after surgery for colorectal cancer. Colorectal Dis. 2006;8:506–13.PubMedCrossRef
9.
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718–26.PubMedCrossRef
10.
Kleinbeck SV, Eells KR. Monitoring postdischarge ambulatory surgical recovery costs and outcomes. Surg Serv Manage. 1997;3:33–5.
11.
Oberle K, Allen M, Lynkowski P. Follow-up of same day surgery patients. A study of patient concerns. AORN J. 1994;59:1016–5.CrossRef
12.
Zalon ML. Correlates of recovery among older adults after major abdominal surgery. Nurs Res. 2004;53:99–106.PubMedCrossRef
13.
Blazeby JM, Blencowe NS, Titcomb DR, Metcalfe C, Hollowood AD, Barham CP. Demonstration of the IDEAL recommendations for evaluating and reporting surgical innovation in minimally invasive oesophagectomy. Br J Surg. 2011;98:544–51.PubMedCrossRef
14.
Berrisford RG, Wajed SA, Sanders D, Rucklidge MW. Short-term outcomes following total minimally invasive oesophagectomy. Br J Surg. 2008;95:602–10.PubMedCrossRef
15.
Medical Research Council Oesophageal Cancer Working Group. Surgical resection with or without preoperative chemotherapy in oesophageal cancer. Lancet. 2002;359:1727–33.
16.
Medical Research Council. A randomised controlled trial comparing standard chemotherapy followed by resection versus ECX chemotherapy followed by resection in patients with resectable adenocarcinoma of the oesophagus. ISRCTN01852072. 2005.
17.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.PubMedCrossRef
18.
Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc. 1983;31:721–7.PubMed
19.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–86.PubMedCrossRef
20.
Smets EM, Garssen B, Bonke B, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995;39:315–25.PubMedCrossRef
21.
Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379:1887–92.PubMedCrossRef
22.
Briez N, Piessen G, Bonnetain F, Brigand C, Carrere N, Collet D, et al. Open versus laparoscopically-assisted oesophagectomy for cancer: a multicentre randomised controlled phase III trial—the MIRO trial. BMC Cancer. 2011;11:310.PubMedCrossRef
23.
Donovan J, Mills N, Smith M, Brindle L, Jacoby A, Peters T, et al. Improving design and conduct of randomised trials by embedding them in qualitative research: ProtecT (prostate testing for cancer and treatment) study. BMJ. 2002;325:766–70.PubMedCrossRef
24.
Metcalfe C, Blazeby JM, Berrisford R et al. ROMIO: Randomised Oesophagectomy: minimally invasive or open. Sydney: Health Technology Assessment Trial Funded; 2012.
25.
Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002;347:1662–9.PubMedCrossRef
26.
Blencowe NS, Strong S, McNair AG, Brookes ST, Crosby T, Griffin SM, et al. Reporting of short-term clinical outcomes after esophagectomy: a systematic review. Ann Surg. 2012;255:658–66.PubMedCrossRef
27.
Reynolds JV, McLaughlin R, Moore J, Rowley S, Ravi N, Byrne PJ. Prospective evaluation of quality of life in patients with localized oesophageal cancer treated by multimodality therapy or surgery alone. Br J Surg. 2006;93:1084–90.PubMedCrossRef
28.
Blazeby JM, Sanford E, Falk SJ, Alderson D, Donovan JL. Health-related quality of life during neoadjuvant treatment and surgery for localized esophageal carcinoma. Cancer. 2005;103:1791–9.PubMedCrossRef
29.
Bege T, Lelong B, Esterni B, Turrini O, Guiramand J, Francon D, et al. The learning curve for the laparoscopic approach to conservative mesorectal excision for rectal cancer: lessons drawn from a single institution’s experience. Ann Surg. 2010;251:249–53.PubMedCrossRef
30.
Itani KM, Hur K, Kim LT, Anthony T, Berger DH, Reda D, et al. Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. Arch Surg. 2010;145:322–8.PubMedCrossRef
31.
International Union Against Cancer. TNM Classification of Malignant Tumours. In: Sobin LH, Gospodarowicz MK, Wittekind C, editors. West Sussex, UK: Wiley-Blackwell; 2009.
Metadata
Title
Assessment and Comparison of Recovery after Open and Minimally Invasive Esophagectomy for Cancer: An Exploratory Study in Two Centers
Authors
R. Parameswaran, MRCS, MD
D. R. Titcomb, FRCS
N. S. Blencowe, MRCS
R. G. Berrisford, FRCS(Th)
S. A. Wajed, MChir, FRCS
C. G. Streets, MD, FRCS
A. D. Hollowood, PhD, FRCS
R. Krysztopik, FRCS
C. P. Barham, MD, FRCS
J. M. Blazeby, MD, FRCS
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 6/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2848-7

Other articles of this Issue 6/2013

Annals of Surgical Oncology 6/2013 Go to the issue

Healthcare Policy and Outcomes

Longitudinal Changes in Function, Symptom Burden, and Quality of Life in Patients with Early-Stage Lung Cancer

Translational Research and Biomarkers

Effects of Metallothionein-1 Genetic Polymorphism and Cigarette Smoking on the Development of Hepatocellular Carcinoma

Hepatobiliary Tumors

Performance Status Enhances the Selection of Treatment for Patients with Hepatocellular Carcinoma Within the Milan Criteria

Endocrine Tumors

A Systematic Review and Meta-analysis Comparing the Efficacy and Surgical Outcomes of Total Thyroidectomy Between Harmonic Scalpel Versus Ligasure

Neuro-Oncology

Implanted Carmustine Wafers Followed by Concomitant Radiochemotherapy to Treat Newly Diagnosed Malignant Gliomas: Prospective, Observational, Multicenter Study on 92 Cases

Endocrine Tumors

Technical and Oncologic Safety of Robotic Thyroid Surgery