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Safe and efficient 2-step implementation of totally minimally invasive esophagectomy

BACKGROUND: The clinical benefits of totally minimal invasive esophagectomy (TIME) compared to open esophagectomy are documented and include reduced morbidity like pulmonary infections, shorter hospital stay and an increase in short-term quality of life. However, transition to TIME can be associated...

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Autores principales: Lading, Troels, Kjaer, Daniel, Bendixen, Morten, Petersen, Torben Ingemann, Christensen, Thomas Decker, Katballe, Niels
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10636444/
https://www.ncbi.nlm.nih.gov/pubmed/37969264
http://dx.doi.org/10.21037/jtd-23-462
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author Lading, Troels
Kjaer, Daniel
Bendixen, Morten
Petersen, Torben Ingemann
Christensen, Thomas Decker
Katballe, Niels
author_facet Lading, Troels
Kjaer, Daniel
Bendixen, Morten
Petersen, Torben Ingemann
Christensen, Thomas Decker
Katballe, Niels
author_sort Lading, Troels
collection PubMed
description BACKGROUND: The clinical benefits of totally minimal invasive esophagectomy (TIME) compared to open esophagectomy are documented and include reduced morbidity like pulmonary infections, shorter hospital stay and an increase in short-term quality of life. However, transition to TIME can be associated with a learning curve associated increased morbidity. We report our implementation of TIME using a 2-step approach, where the thoracoscopic part was added to the laparoscopic part in carefully selected patients. The hypothesis was that the 2-step implementation provides a safe and efficient implementation without compromising the outcomes for the patients. The aim of this study was to evaluation the implementation of minimal invasive esophagectomy at Aarhus University Hospital, where a 2-step implementation strategy has been used. METHODS: In this retrospective observational cohort study a total of 369 patients with esophagus or gastroesophageal cancers underwent esophagectomy from September 1(st), 2016 to July 31(st), 2021 in a single high-volume tertiary institution. Totally minimally invasive Ivor Lewis esophagectomy was performed by experienced minimal invasive surgeons in 120 of the cases. The study presents the complication rates of the TIME patients in the implementation phase. RESULTS: Anastomotic leakage occurred in 7.5% of the cases and pneumonia occurred in 5.8% of the cases. The lymph node count reached 16 or more in 94.3% of the cases and R0-resection was performed in 98.3% of the cases. Textbook outcome for esophageal cancer surgery was achieved in 45.8% of the patients. CONCLUSIONS: Hybrid minimal invasive esophagectomy can serve as a step towards totally minimally invasive esophagectomy. In our institution, major learning curve associated complications was avoided and a high level of cancer control was achieved by a 2-step implementation strategy in carefully selected patients.
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spelling pubmed-106364442023-11-15 Safe and efficient 2-step implementation of totally minimally invasive esophagectomy Lading, Troels Kjaer, Daniel Bendixen, Morten Petersen, Torben Ingemann Christensen, Thomas Decker Katballe, Niels J Thorac Dis Original Article BACKGROUND: The clinical benefits of totally minimal invasive esophagectomy (TIME) compared to open esophagectomy are documented and include reduced morbidity like pulmonary infections, shorter hospital stay and an increase in short-term quality of life. However, transition to TIME can be associated with a learning curve associated increased morbidity. We report our implementation of TIME using a 2-step approach, where the thoracoscopic part was added to the laparoscopic part in carefully selected patients. The hypothesis was that the 2-step implementation provides a safe and efficient implementation without compromising the outcomes for the patients. The aim of this study was to evaluation the implementation of minimal invasive esophagectomy at Aarhus University Hospital, where a 2-step implementation strategy has been used. METHODS: In this retrospective observational cohort study a total of 369 patients with esophagus or gastroesophageal cancers underwent esophagectomy from September 1(st), 2016 to July 31(st), 2021 in a single high-volume tertiary institution. Totally minimally invasive Ivor Lewis esophagectomy was performed by experienced minimal invasive surgeons in 120 of the cases. The study presents the complication rates of the TIME patients in the implementation phase. RESULTS: Anastomotic leakage occurred in 7.5% of the cases and pneumonia occurred in 5.8% of the cases. The lymph node count reached 16 or more in 94.3% of the cases and R0-resection was performed in 98.3% of the cases. Textbook outcome for esophageal cancer surgery was achieved in 45.8% of the patients. CONCLUSIONS: Hybrid minimal invasive esophagectomy can serve as a step towards totally minimally invasive esophagectomy. In our institution, major learning curve associated complications was avoided and a high level of cancer control was achieved by a 2-step implementation strategy in carefully selected patients. AME Publishing Company 2023-09-04 2023-10-31 /pmc/articles/PMC10636444/ /pubmed/37969264 http://dx.doi.org/10.21037/jtd-23-462 Text en 2023 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Lading, Troels
Kjaer, Daniel
Bendixen, Morten
Petersen, Torben Ingemann
Christensen, Thomas Decker
Katballe, Niels
Safe and efficient 2-step implementation of totally minimally invasive esophagectomy
title Safe and efficient 2-step implementation of totally minimally invasive esophagectomy
title_full Safe and efficient 2-step implementation of totally minimally invasive esophagectomy
title_fullStr Safe and efficient 2-step implementation of totally minimally invasive esophagectomy
title_full_unstemmed Safe and efficient 2-step implementation of totally minimally invasive esophagectomy
title_short Safe and efficient 2-step implementation of totally minimally invasive esophagectomy
title_sort safe and efficient 2-step implementation of totally minimally invasive esophagectomy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10636444/
https://www.ncbi.nlm.nih.gov/pubmed/37969264
http://dx.doi.org/10.21037/jtd-23-462
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