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Neoplasms by Histologic Type

Combined Thoracoscopic and Laparoscopic Esophagectomy

Laparoscopic Esophagectomy

Ninh T Nguyen, MD

Esophagectomy for benign or malignant disease of the esophagus can be performed using a transhiatal technique or Ivor Lewis technique (combined laparotomy with thoracotomy). These procedures can be associated with significant morbidity and mortality \[1\]. Advances in minimally invasive technology and surgical techniques have allowed us to explore the possibility of performing esophagectomy using minimally invasive surgical techniques.

Minimally invasive esophagectomy represents a new alternative to conventional open esophagectomy. It is a technically demanding operation requiring advanced laparoscopic surgical skills, appropriate instrumentation, and thorough knowledge of open esophagectomy. Multiple authors have reported the use of video-assisted thoracoscopy or laparoscopy to facilitate esophagectomy \[2-6\]. Most of these reports have utilized a standard laparotomy in combination with thoracoscopy to perform esophageal mobilization or laparoscopy with a mini-laparotomy to perform esophagectomy. DePaula was the first to report a large series of 48 patients undergoing laparoscopic transhiatal esophagectomy for benign (n=24) and malignant disease (n=24) \[7\]. In 2 patients, conversion to open surgery was required and 2 others required thoracoscopic assistance. Postoperative complications were low in the benign group but higher in the carcinoma group. The 30-day mortality rate was 16% in patients with carcinoma undergoing laparoscopic transhiatal esophagectomy. DePaula concluded that the patients who benefit most from this procedure are those with benign disease. Swanstrom recently reported nine cases of laparoscopic total esophagectomy \[8\]. There were no conversions to laparotomy. One patient required a right thoracoscopy with intrathoracic anastomosis due to poor viability of the gastric tube. The mean operative time was 6.5 hours with a mean hospital stay of 6.4 days. However, the advantages of minimally invasive esophagectomy have not been observed. The aim of this prospective trial is to evaluate the physiologic outcome, clinical outcome, and quality of life after combined thoracoscopic and laparoscopic esophagectomy vs. transhiatal esophagectomy.

RATIONALE:

Open esophagectomy can be associated with significant morbidity. We hypothesize that laparoscopic esophagectomy is associated with reduced morbidity and a faster recovery.

HYPOTHESES:

1. Combined thoracoscopic and laparoscopic esophagectomy can be performed safely.
2. Combined thoracoscopic and laparoscopic esophagectomy is associated with reduced postoperative pain, decrease ICU and hospital stay, and reduced postoperative wound morbidity.
3. Combined thoracoscopic and laparoscopic esophagectomy is associated with similar long term survival as with the open approach for patients with esophageal malignancies.

OBJECTIVES AND SPECIFIC AIMS:

1. To compare short-term outcome such as operative time, operative and in-patient costs, operative complications, length of hospital stay, and postoperative complications between combined thoracoscopic/ laparoscopic esophagectomy and transhiatal esophagectomy.
2. To evaluate physiologic outcomes after minimally invasive esophagectomy vs. transhiatal esophagectomy.
3. To determine the long-term outcome, disease-free survival, survival and quality of life after minimally invasive esophagectomy compared to transhiatal esophagectomy

Combined Thoracoscopic and Laparoscopic Esophagectomy vs. Hand-assisted Transhiatal Esophagectomy: A Prospective Trial.

University of California, Irvine

Digestive System Diseases

Rare Diseases

Esophageal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Head and Neck Neoplasms

Gastrointestinal Diseases

Esophageal Diseases

Esophageal Cancer

Esophagectomy performed for esophageal cancer using the da Vinci robotic surgical system

Esophagectomy performed for esophageal cancer using conventional thoracoscopic and laparoscopic techniques

Removal of the esophagus and its draining lymph nodes using robotic surgical instruments

Robotic esophagectomy

Removal of the esophagus and its draining lymph nodes using conventional thoracoscopic and laparoscopic techniques

Thoracolaparoscopic esophagectomy

Shankar Balasubramanian

Bhushan Chittawadagi, MS, DNB

Chinnusamy Palanivelu, MS, MCh

Shankar Balasubramanian, MS, MRCS

Sandeep Sabnis, MS, DNB

Esophageal cancer is a debilitating condition. The treatment involved is complex requiring a combination of chemotherapy and surgery in most cases. Complete removal of the tumor and the adjacent lymph nodes is of utmost importance in improving the survival. Lymph node yield following surgery helps in proper staging of the disease and is an important prognosticating variable. It is hypothesized that the lymph node yield following robotic esophagectomy is higher than that following thoracolaparoscopic esophagectomy. The study aims to compare the short term oncological outcomes following robotic esophagectomy and thoracolaparoscopic esophagectomy for carcinoma esophagus.

Robotic Versus Thoracolaparoscopic Esophagectomy for Esophageal Cancer

Robotic Versus Thoracolaparoscopic Esophagectomy for Carcinoma Esophagus: a Prospective Comparative Study

The proximal, distal and circumferential surgical margins will be assessed by pathological evaluation for the presence of tumor and will be assigned an "R" category as defined by the College of American Pathologists. R0 would indicate no evidence of residual tumor. Presence of microscopic tumor at margins would be designated as R1 whereas the presence of macroscopically visible tumor at margins would be designated as R2.

Intraoperative and post operative adverse events assessed by Clavien Dindo classification system

Duration of stay in ICU following surgery

Length of stay in hospital following surgery

Time taken to complete the surgical procedure recorded in minutes

Amount of blood lost during and within 24 hours of surgery

Need for conversion of the procedure to open or other alternate technique

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Combined Thoracoscopic and Laparoscopic Esophagectomy vs. Hand-assisted Transhiatal Esophagectomy: A Prospective Trial.	NCT00247936	Adenocarcinoma	Laparoscopic Es...	18 Years -	University of California, Irvine
Robotic Versus Thoracolaparoscopic Esophagectomy for Esophageal Cancer	NCT03727126	Esophageal Canc...	Robotic esophag... Thoracolaparosc...	-	GEM Hospital & Research Center

Spots Global Cancer Trial Database for laparoscopic esophagectomy