PMID- 22345284
OWN - NLM
STAT- MEDLINE
DCOM- 20130117
LR  - 20220409
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 42
IP  - 3
DP  - 2012 Sep
TI  - Comparison of perioperative outcomes following open versus minimally invasive 
      Ivor Lewis oesophagectomy at a single, high-volume centre.
PG  - 430-7
LID - 10.1093/ejcts/ezs031 [doi]
AB  - OBJECTIVES: With the increasing popularity of minimally invasive oesophageal 
      resections, equivalence, if not superiority, to open techniques must be 
      demonstrated. Here we compare our open and minimally invasive Ivor Lewis 
      oesophagectomy (MIE) experience. METHODS: A prospective database of all 
      oesophagectomies performed at Massachusetts General Hospital in Boston, MA 
      between November 2007 and January 2011 was analysed. A total of 38 MIE and 76 
      open Ivor Lewis (OIE) oesophagectomies were performed for oesophageal carcinoma. 
      Sixty-day surgical, oncological and postoperative outcomes were examined between 
      the two groups. RESULTS: Groups had similar demographics in terms of age, gender, 
      tumour histology, clinical stage, preoperative comorbidities and neoadjuvant 
      therapy. No difference was found with respect to adequacy of oncological 
      resections. The median number of lymph nodes retrieved (OIE: 21, inter-quartile 
      range (IQR): (16, 27) versus MIE: 19, IQR: (15, 28)), resection margins (OIE: 
      6.6% positive versus MIE: no positive margins) and 60-day mortality (OIE: 2.6% 
      versus MIE: no deaths) were comparable. However, rates of pulmonary complications 
      were significantly lower in the MIE group (OIE: 43.4 versus MIE: 2.6%, P < 
      0.001). Additionally, the median length of ICU and hospital stay, intraoperative 
      blood loss and amount of intravenous fluids infused intraoperatively were also 
      significantly decreased with MIE, while median operative times and the 
      requirement for intraoperative blood transfusion were not significantly different 
      between the two groups. Multivariate logistic regression analysis identified MIE 
      as the only variable associated with a significant reduction in the rate of 
      pulmonary complications in our study, while pre-existing pulmonary comborbidity 
      was associated with an increased risk of pulmonary complications. CONCLUSIONS: 
      Open and MIE appear equivalent with regard to early oncological outcomes. A 
      minimally invasive approach, however, appears to lead to a significant reduction 
      in the rate of postoperative pulmonary complications. Length of ICU and hospital 
      stay, as well as intraoperative blood loss and intravenous fluid requirements are 
      also reduced in the setting of MIE. Long-term survival data will need to be 
      followed closely. A large, multi-centred, randomized, controlled trial is 
      warranted to confirm these results.
FAU - Sihag, Smita
AU  - Sihag S
AD  - Department of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA.
FAU - Wright, Cameron D
AU  - Wright CD
FAU - Wain, John C
AU  - Wain JC
FAU - Gaissert, Henning A
AU  - Gaissert HA
FAU - Lanuti, Michael
AU  - Lanuti M
FAU - Allan, James S
AU  - Allan JS
FAU - Mathisen, Douglas J
AU  - Mathisen DJ
FAU - Morse, Christopher R
AU  - Morse CR
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120215
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Aged
MH  - Boston
MH  - Chi-Square Distribution
MH  - Cohort Studies
MH  - Databases, Factual
MH  - Disease-Free Survival
MH  - Education, Medical, Continuing
MH  - Esophageal Neoplasms/*mortality/pathology/*surgery
MH  - Esophagectomy/adverse effects/*methods
MH  - Female
MH  - Hospital Mortality/trends
MH  - Hospitals, General
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Minimally Invasive Surgical Procedures/adverse effects/methods
MH  - Multivariate Analysis
MH  - Neoplasm Invasiveness/pathology
MH  - Neoplasm Staging
MH  - Operative Time
MH  - Perioperative Care/methods
MH  - Postoperative Complications/*mortality/physiopathology
MH  - Prognosis
MH  - Prospective Studies
MH  - Risk Assessment
MH  - Statistics, Nonparametric
MH  - Survival Analysis
MH  - Treatment Outcome
EDAT- 2012/02/22 06:00
MHDA- 2013/01/18 06:00
CRDT- 2012/02/21 06:00
PHST- 2012/02/21 06:00 [entrez]
PHST- 2012/02/22 06:00 [pubmed]
PHST- 2013/01/18 06:00 [medline]
AID - ezs031 [pii]
AID - 10.1093/ejcts/ezs031 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2012 Sep;42(3):430-7. doi: 10.1093/ejcts/ezs031. Epub 
      2012 Feb 15.