The original Ivor Lewis two stage esophagectomy revisited in the era of minimally invasive surgery.
Journal
American journal of surgery
ISSN: 1879-1883
Titre abrégé: Am J Surg
Pays: United States
ID NLM: 0370473
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
24
07
2018
revised:
26
11
2018
accepted:
28
11
2018
pubmed:
14
12
2018
medline:
21
11
2019
entrez:
15
12
2018
Statut:
ppublish
Résumé
Esophagectomy has high cardiac and pulmonary complication rates that can reach 43% and 58% respectively. The original Ivor Lewis esophagectomy was a two-stage procedure. We revisited this procedure using a hybrid minimally-invasive approach. Thirty-five consecutive patients with esophageal cancer were operated on over an eight-year period. The first stage used laparoscopic mobilization of the stomach, while the second stage used open thoracotomy. Six patients were aborted due to unresectable disease. Twenty-nine patients were studied. The mean operative times for stage-one and stage-two were 108 ± 18 and 226 ± 63 min respectively. All patients were extubated in the operating room. One (3.4%) patients had cardiac complication and one (3.4%) patient had pulmonary complication. Metachronous hybrid two-stage esophagectomy was associated with a low rate of cardio-pulmonary complications. It may be considered as an alternative to the one-stage esophagectomy, especially in low-volume centers, to decrease these high-risk cardio-pulmonary complications.
Sections du résumé
BACKGROUND
Esophagectomy has high cardiac and pulmonary complication rates that can reach 43% and 58% respectively. The original Ivor Lewis esophagectomy was a two-stage procedure. We revisited this procedure using a hybrid minimally-invasive approach.
METHODS
Thirty-five consecutive patients with esophageal cancer were operated on over an eight-year period. The first stage used laparoscopic mobilization of the stomach, while the second stage used open thoracotomy. Six patients were aborted due to unresectable disease.
RESULTS
Twenty-nine patients were studied. The mean operative times for stage-one and stage-two were 108 ± 18 and 226 ± 63 min respectively. All patients were extubated in the operating room. One (3.4%) patients had cardiac complication and one (3.4%) patient had pulmonary complication.
CONCLUSION
Metachronous hybrid two-stage esophagectomy was associated with a low rate of cardio-pulmonary complications. It may be considered as an alternative to the one-stage esophagectomy, especially in low-volume centers, to decrease these high-risk cardio-pulmonary complications.
Identifiants
pubmed: 30545686
pii: S0002-9610(18)30966-8
doi: 10.1016/j.amjsurg.2018.11.037
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
454-457Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.