Top

Published in:

01-03-2018 | ORIGINAL ARTICLE

Standardizing procedures improves and homogenizes short-term outcomes after minimally invasive esophagectomy

Authors: Taro Oshikiri, Tetsu Nakamura, Hiroshi Hasegawa, Masashi Yamamoto, Shingo Kanaji, Kimihiro Yamashita, Takeru Matsuda, Yasuo Sumi, Yasuhiro Fujino, Masahiro Tominaga, Satoshi Suzuki, Yoshihiro Kakeji

Published in: Langenbeck's Archives of Surgery | Issue 2/2018

Abstract

Purpose

Esophageal cancer is one of the deadliest cancers worldwide. Esophagectomy with lymphadenectomy is regarded as the only curative option for resectable esophageal cancer, but it is associated with high morbidity and mortality. Multidisciplinary team (MDT) management was recently associated with improved outcomes after surgery for esophageal cancer. The aim of this study was to investigate the effect of standardizing procedures for minimally invasive esophagectomy (MIE) in the MDT setting.

Methods

This was a case-matched control study of 154 patients with esophageal cancer who underwent thoracoscopic esophagectomy in the prone position (TEP) between 2012 and 2016. Surgery was performed by two attending surgeons (surgeons A and B) who began working together in the same MDT in 2015. At that time, the following surgical procedures were standardized between surgeons A and B: mediastinal lymphadenectomy, abdominal procedures, and estimation of the blood supply of the gastric conduit. Short-term outcomes were compared between the following paired groups using propensity scores: surgeon A’s pre- and post-standardization groups, surgeon B’s pre- and post-standardization groups, and surgeon A’s post-standardization group and surgeon B’s post-standardization group.

Results

Concerning surgeon A, the estimated total blood loss in the post-standardization group (142 ± 87 mL) was significantly lower than that in the pre-standardization group (376 ± 215 mL, P = 0.006). The rate of left recurrent laryngeal nerve palsy in the post-standardization group (13%) was significantly lower than that in the pre-standardization group (47%, P = 0.046). Concerning surgeon B, the rate of anastomotic leakage in the post-standardization group (0%) was significantly lower than that in the pre-standardization group (11%, P = 0.039). Comparing the post-standardization groups of surgeons A and B, there were no significant differences in operative outcomes or morbidity.

Conclusions

Standardizing procedures for MIE improved and homogenized surgical short-term outcomes.

Pennathur A, Gibson MK, Jobe BA, Luketich JD (2013) Oesophageal carcinoma. Lancet 381:400–412CrossRefPubMed

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

Sjoquist KM, Burmeister BH, Smithers BM, Zalcberg JR, Simes RJ, Barbour A, Gebski V (2011) Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 12:681–692CrossRefPubMed

Scheepers JJ, Mulder CJ, van der Peet DL, Meijer S, Cuesta MA (2006) Minimally invasive oesophageal resection for distal oesophageal cancer; a review of literature. Scand J Gastroenterol 41:123–134CrossRef

Watson A (1994) Operable esophageal cancer: current results from the West. World J Surg 18:361–366CrossRefPubMed

Stephens MR, Lewis WG, Brewster AE, Lord I, Blackshaw GR, Hodzovic I, Thomas GV, Roberts SA, Crosby TD, Gent C, Allison MC, Shute K (2006) Multidisciplinary team management is associated with improved outcomes after surgery for esophageal cancer. Dis Esophagus 19:164–171CrossRefPubMed

Oshikiri T, Yasuda T, Yamamoto M, Kanaji S, Yamashita K, Matsuda T, Sumi Y, Nakamura T, Fujino Y, Tominaga M, Suzuki S, Kakeji Y (2016) Trainee competence in thoracoscopic esophagectomy in the prone position: evaluation using cumulative sum techniques. Langenbeck's Arch Surg 401:797–804CrossRef

Oshikiri T, Yasuda T, Hasegawa H, Yamamoto M, Kanaji S, Yamashita K, Matsuda T, Sumi Y, Nakamura T, Fujino Y, Tominaga M, Suzuki S, Kakeji Y (2017) Short-term outcomes and one surgeon’s learning curve for thoracoscopic esophagectomy performed with the patient in the prone position. Surg Today 47:313–319CrossRefPubMed

Sobin LH, Gospodarowicz MK, Wittekind C (2010) TNM classification of malignant tumors, 7th edn. Wiley-Blackwell, Oxford

10.

Oshikiri T, Yasuda T, Kawasaki K, Harada H, Oyama M, Hasegawa H, Ohara T, Sendo H, Nakamura T, Fujino Y, Tominaga M, Kakeji Y (2016) Hand-assisted laparoscopic surgery (HALS) is associated with less-restrictive ventilatory impairment and less risk for pulmonary complication than open laparotomy in thoracoscopic esophagectomy. Surgery 159:459–466CrossRefPubMed

11.

Oshikiri T, Yasuda T, Harada H, Goto H, Oyama M, Hasegawa H, Ohara T, Sendo H, Nakamura T, Fujino Y, Tominaga M, Kakeji Y (2015) A new method (the “Bascule method”) for lymphadenectomy along the left recurrent laryngeal nerve during prone esophagectomy for esophageal cancer. Surg Endosc 29:2442–2450CrossRefPubMed

12.

Oshikiri T, Nakamura T, Hasegawa H, Yamamoto M, Kanaji S, Yamashita K, Matsuda T, Sumi Y, Suzuki S, Kakeji Y (2017) Reliable surgical techniques for lymphadenectomy along the left recurrent laryngeal nerve during thoracoscopic esophagectomy in the prone position. Ann Surg Oncol 24:1018CrossRefPubMed

13.

Oshikiri T, Nakamura T, Miura Y, Yamamoto M, Kanaji S, Yamashita K, Matsuda T, Sumi Y, Suzuki S, Kakeji Y (2017) A new method (the “Pincers maneuver”) for lymphadenectomy along the right recurrent laryngeal nerve during thoracoscopic esophagectomy in the prone position for esophageal cancer. Surg Endosc 31:1496–1504CrossRefPubMed

14.

Oshikiri T, Nakamura T, Miura Y, Hasegawa H, Yamamoto M, Kanaji S, Yamashita K, Matsuda Y, Matsuda T, Sumi Y, Suzuki S, Kakeji Y (2017) Practical surgical techniques for lymphadenectomy along the right recurrent laryngeal nerve during thoracoscopic esophagectomy in the prone position. Ann Surg Oncol 24:2302CrossRefPubMed

15.

Shimada Y, Okumura T, Nagata T, Sawada S, Matsui K, Hori R, Yoshioka I, Yoshida T, Osada R, Tsukada K (2011) Usefulness of blood supply visualization by indocyanine green fluorescence for reconstruction during esophagectomy. Esophagus 8:259–266CrossRefPubMedPubMedCentral

16.

Murawa D, Hünerbein M, Spychata A, Nowaczyk P, Połom K, Murawa P (2012) Indocyanine green angiography for evaluation of gastric conduit perfusion during esophagectomy—first experience. Acta Chir Belg 112:275–280PubMed

17.

Pacheco PE, Hill SM, Henriques SM, Paulsen JK, Anderson RC (2013) The novel use of intraoperative laser-induced fluorescence of indocyanine green tissue angiography for evaluation of the gastric conduit in esophageal reconstructive surgery. Am J Surg 205:349–353CrossRefPubMed

18.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

19.

Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70:41–55CrossRef

20.

Bertelsen CA, Bols B, Ingeholm P, Jansen JE, Neuenschwander AU, Vilandt J (2011) Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision? Color Dis 13:1123–1129CrossRef

Title: Standardizing procedures improves and homogenizes short-term outcomes after minimally invasive esophagectomy
Authors: Taro Oshikiri
Tetsu Nakamura
Hiroshi Hasegawa
Masashi Yamamoto
Shingo Kanaji
Kimihiro Yamashita
Takeru Matsuda
Yasuo Sumi
Yasuhiro Fujino
Masahiro Tominaga
Satoshi Suzuki
Yoshihiro Kakeji
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 2/2018
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-018-1661-6

ACC 2024 Congress

Springer Medicine

Standardizing procedures improves and homogenizes short-term outcomes after minimally invasive esophagectomy

Abstract

Purpose

Methods

Results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2018

Incidental appendectomy during robotic laparoscopic prostatectomy—safe and worth to perform?

Implication of visceral obesity in patients with esophageal squamous cell carcinoma

Extended pancreatectomy as defined by the ISGPS: useful in selected cases of pancreatic cancer but invaluable in other complex pancreatic tumors

Radiofrequency ablation for locally advanced pancreatic cancer: SMAD4 analysis segregates a responsive subgroup of patients

Outcome of concomitant resection of the replaced right hepatic artery in pancreaticoduodenectomy without reconstruction

Conception of the Lübeck Toolbox curriculum for basic minimally invasive surgery skills