dr pradeep jain fortis hospital - thoraco laparoscopic esophagectomy

Thoraco laparoscopic Esophagectomy

Dr Pradeep Jain M.ChDirector GI Surgery Fortis Hospital Shalimar Bagh

Minimally Invasive Esophagectomy

Enthusiasm -- Technical complexity &

Frequency

Lap > open

Cholecystectomy Gatric Bypass Esophagectomy0

5

10

15

20

25

MIE (concerns) Safety Surgery time Blood loss Morbidity and Mortality

Recovery ICU and Hospital Stay Pain

Oncological out come LN yield and Resection margins Survival

Cost

Meta analysis Biere SS, Cuesta MA, van der Peet D, Minimally

invasive versus open esophagectomy for cancer: a systematic review and meta-analysis. Minerva Chir. 2009 Apr;64(2):121-33.

Nagpal K, Ahmed K, Vats A, Yakoub D, James D, Ashrafian H, Darzi A, Moorthy K, Athanasiou T. Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis . Surg Endosc. 2010 Jul;24(7):1621-9.

Sgourakis G, Gockel I, Radtke A, Musholt TJ, Timm S, Rink A, Tsiamis A, Karaliotas C, Lang H   Minimally invasive versus open esophagectomy: meta-analysis of outcomes. ) Dig Dis Sci. 2010 Nov;55(11):3031-40

Randomised Trials

Miguel A. Cuesta,  Surya S. A. Y. Biere, Mark I. van Berge Henegouwen,and Donald L. van der Peet

Randomised trial, Minimally Invasive Oesophagectomy versus open oesophagectomy for patients with resectable oesophageal cancer.

J Thorac Dis. 2012 October; 4(5): 462–46

Open versus laparoscopically-assisted oesophagectomy for cancer: a multicentre randomised controlled phase III trial - the MIRO trial.

Briez N, Piessen G, Bonnetain F, Brigand C, Carrere N, Collet D, Doddoli C, Flamein R, Mabrut JY, Meunier B, Msika S, Perniceni T, Peschaud F, Prudhomme M, Triboulet JP, Mariette C.

BMC Center 2011 Jul 23;11:310 

Our Experience ( retrospective 10 years )

Esophagectomy (89)

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

2

4

6

8

10

12

14

Open MIE

Etiology (MIE 47)

Malignancy Achlasia Cardia Binign Stricture0

5

10

15

20

25

30

35

40

45

MIE

McKeown Ivor Lewis 0

5

10

15

20

25

30

35

40

45

Port Position

Port Position

Thoraco Laparoscopic Esophagectomy

Ivor Lewis Esophagectomy

Operative Time

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

0

100

200

300

400

500

600

700

MIEOPEN

Blood Loss

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

0

200

400

600

800

1000

1200

MIEOPEN

ICU Stay

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

0

2

4

6

8

10

12

MIEOPEN

Hospital Stay

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

0

2

4

6

8

10

12

14

16

MIEOPEN

Lymph Node Yield

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

0

5

10

15

20

25

MIEOPEN

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

0

0.5

1

1.5

2

2.5

3

3.5

MIEOpen

Major complications - bleeding requiring major transfusion - major leak requiring interventions - respiratory complications requiring ventilation - Thoracic duct injury - RLN injury

Mortality5/89 30 day mortality

1/47 MIE (pneumonia with septic shock)

4/42 Traditional ( Gastric conduit leak, Thoracic duct injury, Thoracic anastomosis leak, Pneumonia with sever sepsis )

Summary Minimally invasive technique

very well feasible Immediate outcome better in

MIEProne position with double lung

anesthesia has less respiratory complications

Oncological superiority is yet to be validated in prospective randomised trials

Thank You