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James D. Luketich - One of the best experts on this subject based on the ideXlab platform.
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Minimally Invasive Approach to Esophagectomy JSLS
2013Co-Authors: James D. Luketich, Ninh T. Nguyen, Peter F. Ferson, Tracey Weigel, Robert Keenan, Philip SchauerAbstract:Background: Recent advances in laparoscopic and thoracoscopic surgery have made it possible to perform Esophagectomy using minimally invasive techniques. The aim of this report was to present our preliminary experience with minimally invasive Esophagectomy. Methods: We reviewed our experience on eight patients who underwent minimally invasive Esophagectomy using either laparoscopic and/or thoracoscopic techniques from June 1996 to May 1997. Indications for Esophagectomy included stage I carcinoma (5), palliative resection (1), Barrett's with high grade dysplasia (1) and end stage achalasia (1). Results: The average age was 68 years (54-82). The surgical approach to Esophagectomy included laparoscopic transhiatal Esophagectomy with cervical anastomosis (n=4), thoracoscopic and laparoscopic Esophagectomy with cervical anastomosis (n=1), and laparoscopic mobilization with right mini-thoracotomy and intra-thoracic anastomosis (n=3). Conversion to mini-laparotomy was required in two patients (25%) to complete esophageal dissection and facilitate gastric pull-up. The mean operative time was 460 minutes. The mean intensive care stay was 1.9 days (range of 0-7 days) with a mean hospital stay of 13-8 days. Minor complications included atrial fibrillation (n=1), pleural effusion (n=2) and persistent air leak (n=1). Major complications included cervical anastomotic leak (n=1), and delayed gastric emptying requiring pyloroplasty (n=1). There was no perioperative mortality. Conclusions: This preliminary experience suggests that minimally invasive Esophagectomy is safe and feasible in centers with experience in advanced minimally invasive surgical procedures. Further studies are necessary to determine advantages over open Esophagectomy
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Randomized trial comparing minimally invasive Esophagectomy and open Esophagectomy: early perioperative outcomes appear improved with a minimally invasive approach.
Seminars in thoracic and cardiovascular surgery, 2012Co-Authors: Ryan M. Levy, Arjun Pennathur, James D. LuketichAbstract:Esophagectomy is an important curative treatment modality for esophageal cancer, but is a complex operation with associated risks. A minimally invasive approach to Esophagectomy may decrease the risks associated with resection. Recently, an important study was published in the Lancet by Biere and colleagues that reported the results of a randomized study, with the primary endpoint of postoperative pulmonary infection, comparing minimally invasive Esophagectomy versus open Esophagectomy for esophageal cancer. The findings from this trial confirm the data from previous, non-randomized studies and highlight the substantial early postoperative benefits of minimally invasive Esophagectomy.
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Minimally invasive Esophagectomy: state of the art.
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, 2006Co-Authors: Michael S. Kent, Matthew J. Schuchert, Hiran C. Fernando, James D. LuketichAbstract:Open Esophagectomy is associated with significant mortality and morbidity, even in experienced centers. Two of the more frequent complications following Esophagectomy are pneumonia and respiratory failure. Single-institution series have suggested that the incidence of these complications may be decreased with minimally invasive Esophagectomy, with equivalent survival compared to open Esophagectomy. However, this operation is technically challenging. In this review we detail the procedure as performed in our center, and also discuss some recent developments.
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Esophagectomy for Barrett's esophagus: indications, techniques, and outcome.
Current treatment options in gastroenterology, 2006Co-Authors: Ninh T. Nguyen, Kenneth J. Chang, Tarlan Nahidi, Samuel E. Wilson, James D. LuketichAbstract:Barrett’s esophagus describes metaplastic changes from squamous mucosa to specialized columnar epithelium that can progress from low-grade dysplasia to high-grade dysplasia and even invasive carcinoma. The treatment of Barrett’s esophagus with low-grade dysplasia or Barrett’s adenocarcinoma is relatively standardized; however, controversy remains regarding appropriate therapy for Barrett’s esophagus with high-grade dysplasia. Treatment recommendations for high-grade dysplasia vary widely, from periodic endoscopic surveillance to endoscopic ablative therapies and Esophagectomy. Selected studies have shown that a relatively high percentage (41% to 47%) of patients with high-grade dysplasia have occult carcinoma. In these patients, surgery is indicated, as Esophagectomy can be curative for early stage adenocarcinoma in Barrett’s esophagus. A major criticism of Esophagectomy is the significant morbidity and mortality. Minimally invasive Esophagectomy was developed in an effort to reduce the morbidity associated with open Esophagectomy. In minimally invasive Esophagectomy, the abdominal laparotomy is replaced with laparoscopy, and the conventional right thoracotomy is replaced with thoracoscopy to reduce the operative trauma. In experienced centers, minimally invasive Esophagectomy is now an attractive alternative for the treatment of Barrett’s esophagus with high-grade dysplasia.
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Current status of minimally invasive Esophagectomy.
Minerva chirurgica, 2004Co-Authors: Ninh T. Nguyen, Kenneth J. Chang, Dmitri V. Gelfand, C. M. Stevens, Sara Chalifoux, Nguyen P, James D. LuketichAbstract:Minimally invasive Esophagectomy is emerging as an option in the management of benign and malignant esophageal diseases. With minimally invasive Esophagectomy, the conventional laparotomy is substituted with laparoscopy and the open thoracotomy with thoracoscopy. This article discusses the surgical techniques and outcomes for a variety of minimally invasive Esophagectomy options.
Akihiko Tsuchida - One of the best experts on this subject based on the ideXlab platform.
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Usefulness of robot-assisted thoracoscopic Esophagectomy.
General thoracic and cardiovascular surgery, 2018Co-Authors: Yoshiaki Osaka, Shingo Tachibana, Yoshihiro Ota, Takeshi Suda, Yosuke Makuuti, Takafumi Watanabe, Kenichi Iwasaki, Kenji Katsumata, Akihiko TsuchidaAbstract:Objectives We started robot-assisted thoracoscopic Esophagectomy using the da Vinci surgical system from June 2010 and operated on 30 cases by December 2013. Herein, we examined the usefulness of robot-assisted thoracoscopic Esophagectomy and compared it with conventional Esophagectomy by right thoracotomy.
H Obertop - One of the best experts on this subject based on the ideXlab platform.
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extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid distal esophagus five year survival of a randomized clinical trial
Annals of Surgery, 2007Co-Authors: Jikke M T Omloo, Jan B F Hulscher, Paul Fockens, Fiebo Ten J W Kate, Herman Van Dekken, H Obertop, Sjoerd M Lagarde, Johannes B Reitsma, Hugo W Tilanus, Jan J B Van LanschotAbstract:OBJECTIVE: To determine whether extended transthoracic Esophagectomy for adenocarcinoma of the mid/distal esophagus improves long-term survival. BACKGROUND: A randomized trial was performed to compare surgical techniques. Complete 5-year survival data are now available. METHODS: A total of 220 patients with adenocarcinoma of the distal esophagus (type I) or gastric cardia involving the distal esophagus (type II) were randomly assigned to limited transhiatal Esophagectomy or to extended transthoracic Esophagectomy with en bloc lymphadenectomy. Patients with peroperatively irresectable/incurable cancer were excluded from this analysis (n = 15). A total of 95 patients underwent transhiatal Esophagectomy and 110 patients underwent transthoracic Esophagectomy. RESULTS: After transhiatal and transthoracic resection, 5-year survival was 34% and 36%, respectively (P = 0.71, per protocol analysis). In a subgroup analysis, based on the location of the primary tumor according to the resection specimen, no overall survival benefit for either surgical approach was seen in 115 patients with a type II tumor (P = 0.81). In 90 patients with a type I tumor, a survival benefit of 14% was seen with the transthoracic approach (51% vs. 37%, P = 0.33). There was evidence that the treatment effect differed depending on the number of positive lymph nodes in the resection specimen (test for interaction P = 0.06). In patients (n = 55) without positive nodes locoregional disease-free survival after transhiatal Esophagectomy was comparable to that after transthoracic Esophagectomy (86% and 89%, respectively). The same was true for patients (n = 46) with more than 8 positive nodes (0% in both groups). Patients (n = 104) with 1 to 8 positive lymph nodes in the resection specimen showed a 5-year locoregional disease-free survival advantage if operated via the transthoracic route (23% vs. 64%, P = 0.02). CONCLUSION: There is no significant overall survival benefit for either approach. However, compared with limited transhiatal resection extended transthoracic Esophagectomy for type I esophageal adenocarcinoma shows an ongoing trend towards better 5-year survival. Moreover, patients with a limited number of positive lymph nodes in the resection specimen seem to benefit from an extended transthoracic Esophagectomy.
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extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus
The New England Journal of Medicine, 2002Co-Authors: Jan B F Hulscher, Johanna W Van Sandick, Angela G E M De Boer, Bas P L Wijnhoven, Jan G P Tijssen, Paul Fockens, Peep F M Stalmeier, Fiebo Ten J W Kate, Herman Van Dekken, H ObertopAbstract:BACKGROUND: Controversy exists about the best surgical treatment for esophageal carcinoma. METHODS: We randomly assigned 220 patients with adenocarcinoma of the mid-to-distal esophagus or adenocarcinoma of the gastric cardia involving the distal esophagus either to transhiatal Esophagectomy or to transthoracic Esophagectomy with extended en bloc lymphadenectomy. Principal end points were overall survival and disease-free survival. Early morbidity and mortality, the number of quality-adjusted life-years gained, and cost effectiveness were also determined. RESULTS: A total of 106 patients were assigned to undergo transhiatal Esophagectomy, and 114 to undergo transthoracic Esophagectomy. Demographic characteristics and characteristics of the tumor were similar in the two groups. Perioperative morbidity was higher after transthoracic Esophagectomy, but there was no significant difference in in-hospital mortality (P=0.45). After a median follow-up of 4.7 years, 142 patients had died--74 (70 percent) after transhiatal resection and 68 (60 percent) after transthoracic resection (P=0.12). Although the difference in survival was not statistically significant, there was a trend toward a survival benefit with the extended approach at five years: disease-free survival was 27 percent in the transhiatal-Esophagectomy group, as compared with 39 percent in the transthoracic-Esophagectomy group (95 percent confidence interval for the difference, -1 to 24 percent [the negative value indicates better survival with transhiatal resection]), whereas overall survival was 29 percent as compared with 39 percent (95 percent confidence interval for the difference, -3 to 23 percent). CONCLUSIONS: Transhiatal Esophagectomy was associated with lower morbidity than transthoracic Esophagectomy with extended en bloc lymphadenectomy. Although median overall, disease-free, and quality-adjusted survival did not differ statistically between the groups, there was a trend toward improved long-term survival at five years with the extended transthoracic approach.
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extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus
The New England Journal of Medicine, 2002Co-Authors: Jan B F Hulscher, Angela G E M De Boer, Bas P L Wijnhoven, Jan G P Tijssen, Paul Fockens, Peep F M Stalmeier, Fiebo Ten J W Kate, Johanna W Van Sandick, Herman Van Dekken, H ObertopAbstract:Background Controversy exists about the best surgical treatment for esophageal carcinoma. Methods We randomly assigned 220 patients with adenocarcinoma of the mid-to-distal esophagus or adenocarcinoma of the gastric cardia involving the distal esophagus either to transhiatal Esophagectomy or to transthoracic Esophagectomy with extended en bloc lymphadenectomy. Principal end points were overall survival and disease-free survival. Early morbidity and mortality, the number of quality-adjusted life-years gained, and cost effectiveness were also determined. Results A total of 106 patients were assigned to undergo transhiatal Esophagectomy, and 114 to undergo transthoracic Esophagectomy. Demographic characteristics and characteristics of the tumor were similar in the two groups. Perioperative morbidity was higher after transthoracic Esophagectomy, but there was no significant difference in in-hospital mortality (P=0.45). After a median follow-up of 4.7 years, 142 patients had died — 74 (70 percent) after transh...
Ninh T. Nguyen - One of the best experts on this subject based on the ideXlab platform.
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Minimally Invasive Approach to Esophagectomy JSLS
2013Co-Authors: James D. Luketich, Ninh T. Nguyen, Peter F. Ferson, Tracey Weigel, Robert Keenan, Philip SchauerAbstract:Background: Recent advances in laparoscopic and thoracoscopic surgery have made it possible to perform Esophagectomy using minimally invasive techniques. The aim of this report was to present our preliminary experience with minimally invasive Esophagectomy. Methods: We reviewed our experience on eight patients who underwent minimally invasive Esophagectomy using either laparoscopic and/or thoracoscopic techniques from June 1996 to May 1997. Indications for Esophagectomy included stage I carcinoma (5), palliative resection (1), Barrett's with high grade dysplasia (1) and end stage achalasia (1). Results: The average age was 68 years (54-82). The surgical approach to Esophagectomy included laparoscopic transhiatal Esophagectomy with cervical anastomosis (n=4), thoracoscopic and laparoscopic Esophagectomy with cervical anastomosis (n=1), and laparoscopic mobilization with right mini-thoracotomy and intra-thoracic anastomosis (n=3). Conversion to mini-laparotomy was required in two patients (25%) to complete esophageal dissection and facilitate gastric pull-up. The mean operative time was 460 minutes. The mean intensive care stay was 1.9 days (range of 0-7 days) with a mean hospital stay of 13-8 days. Minor complications included atrial fibrillation (n=1), pleural effusion (n=2) and persistent air leak (n=1). Major complications included cervical anastomotic leak (n=1), and delayed gastric emptying requiring pyloroplasty (n=1). There was no perioperative mortality. Conclusions: This preliminary experience suggests that minimally invasive Esophagectomy is safe and feasible in centers with experience in advanced minimally invasive surgical procedures. Further studies are necessary to determine advantages over open Esophagectomy
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Esophagectomy for Barrett's esophagus: indications, techniques, and outcome.
Current treatment options in gastroenterology, 2006Co-Authors: Ninh T. Nguyen, Kenneth J. Chang, Tarlan Nahidi, Samuel E. Wilson, James D. LuketichAbstract:Barrett’s esophagus describes metaplastic changes from squamous mucosa to specialized columnar epithelium that can progress from low-grade dysplasia to high-grade dysplasia and even invasive carcinoma. The treatment of Barrett’s esophagus with low-grade dysplasia or Barrett’s adenocarcinoma is relatively standardized; however, controversy remains regarding appropriate therapy for Barrett’s esophagus with high-grade dysplasia. Treatment recommendations for high-grade dysplasia vary widely, from periodic endoscopic surveillance to endoscopic ablative therapies and Esophagectomy. Selected studies have shown that a relatively high percentage (41% to 47%) of patients with high-grade dysplasia have occult carcinoma. In these patients, surgery is indicated, as Esophagectomy can be curative for early stage adenocarcinoma in Barrett’s esophagus. A major criticism of Esophagectomy is the significant morbidity and mortality. Minimally invasive Esophagectomy was developed in an effort to reduce the morbidity associated with open Esophagectomy. In minimally invasive Esophagectomy, the abdominal laparotomy is replaced with laparoscopy, and the conventional right thoracotomy is replaced with thoracoscopy to reduce the operative trauma. In experienced centers, minimally invasive Esophagectomy is now an attractive alternative for the treatment of Barrett’s esophagus with high-grade dysplasia.
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Current status of minimally invasive Esophagectomy.
Minerva chirurgica, 2004Co-Authors: Ninh T. Nguyen, Kenneth J. Chang, Dmitri V. Gelfand, C. M. Stevens, Sara Chalifoux, Nguyen P, James D. LuketichAbstract:Minimally invasive Esophagectomy is emerging as an option in the management of benign and malignant esophageal diseases. With minimally invasive Esophagectomy, the conventional laparotomy is substituted with laparoscopy and the open thoracotomy with thoracoscopy. This article discusses the surgical techniques and outcomes for a variety of minimally invasive Esophagectomy options.
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thoracoscopic and laparoscopic Esophagectomy for benign and malignant disease lessons learned from 46 consecutive procedures
Journal of The American College of Surgeons, 2003Co-Authors: Ninh T. Nguyen, David M. Follette, Peter F. Roberts, Ryan Rivers, Bruce M. WolfeAbstract:Abstract Background Transhiatal and transthoracic Esophagectomy are common approaches for esophageal resection. The literature is limited regarding the combined thoracoscopic and laparoscopic approach to Esophagectomy. The aim of this study was to evaluate the outcomes of combined thoracoscopic and laparoscopic Esophagectomy for the treatment of benign and malignant esophageal disease. Study design We performed a retrospective chart review of 46 consecutive minimally invasive esophagectomies performed between August 1998 and September 2002. Indications for Esophagectomy were carcinoma (n = 38), Barrett's esophagus with high-grade dysplasia (n = 3), and recalcitrant stricture (n = 5). Of 38 patients with carcinoma 23 (61%) had neoadjuvant therapy. The main outcome measures were operative time, blood loss, length of intensive care unit and hospital stay, conversion rate, morbidity, mortality, pathology, disease recurrence, and survival. Results Approaches to Esophagectomy were thoracoscopic and laparoscopic Esophagectomy (n = 41), thoracoscopic and laparoscopic Ivor Lewis resection (n = 3), abdominal only laparoscopic esophagogastrectomy (n = 1), and hand-assisted laparoscopic transhiatal Esophagectomy (n = 1). Minimally invasive Esophagectomy was successfully completed in 45 (97.8%) of 46 patients. The mean operative time was 350 ± 75 minutes and the mean blood loss was 279 ± 184 mL. The median length of intensive care unit stay was 2 days and median length of stay was 8 days. Major complications occurred in 17.4% of patients and minor complications occurred in 10.8%. Late complications were seen in 26.1% of patients. The overall mortality was 4.3%. Among the 38 patients who underwent Esophagectomy for cancer the 3-year survival was 57%. In a mean followup of 26 months there was no trocar site or neck wound recurrences. Conclusions A thoracoscopic and laparoscopic approach to Esophagectomy is technically feasible and safe for the treatment of benign and malignant esophageal disease. With a mean followup of 26 months thoracoscopic and laparoscopic Esophagectomy appears to be an oncologically acceptable surgical approach for the treatment of esophageal cancer.
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Comparison of minimally invasive Esophagectomy with transthoracic and transhiatal Esophagectomy.
Archives of surgery (Chicago Ill. : 1960), 2000Co-Authors: Ninh T. Nguyen, David M. Follette, Bruce M. Wolfe, Philip D. Schneider, Peter F. Roberts, James E. GoodnightAbstract:Hypothesis Minimally invasive Esophagectomy can be performed as safely as conventional Esophagectomy and has distinct perioperative outcome advantages. Design A retrospective comparison of 3 methods of Esophagectomy: minimally invasive, transthoracic, and blunt transhiatal. Setting University medical center. Patients Eighteen consecutive patients underwent combined thoracoscopic and laparoscopic Esophagectomy from October 9, 1998, through January 19, 2000. These patients were compared with 16 patients who underwent transthoracic Esophagectomy and 20 patients who underwent blunt transhiatal Esophagectomy from June 1, 1993, through August 5, 1998. Main Outcome Measures Operative time, amount of blood loss, number of operative transfusions, length of intensive care and hospital stays, complications, and mortality. Results Patients who had minimally invasive Esophagectomy had shorter operative times, less blood loss, fewer transfusions, and shortened intensive care unit and hospital courses than patients who underwent transthoracic or blunt transhiatal Esophagectomy. There was no significant difference in the incidence of anastomotic leak or respiratory complications among the 3 groups. Conclusion Minimally invasive Esophagectomy is safe and provides clinical advantages compared with transthoracic and blunt transhiatal Esophagectomy.
Toni Lerut - One of the best experts on this subject based on the ideXlab platform.
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Combined thoracoscopic-laparoscopic Esophagectomy versus open Esophagectomy: a meta-analysis of outcomes.
Surgical endoscopy, 2015Co-Authors: Wei Guo, Su Yang, Xiaoli Zhu, Wei Qin, Jiaqing Xiang, Toni LerutAbstract:Objectives At present there is controversy regarding the optimal surgical method for esophageal cancer. Specifically, whether combined thoracoscopic-laparoscopic Esophagectomy is superior to open Esophagectomy with respect to the surgical wound, perioperative morbidities and mortality, and the overall survival rate is of great concern. This article aimed to compare thoracoscopic-laparoscopic Esophagectomy versus open Esophagectomy on the perioperative morbidities and long-term survival.
