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. 2022 Jul;93(7):694-701.
doi: 10.1007/s00104-021-01550-2. Epub 2021 Dec 21.

[Change of strategy to minimally invasive esophagectomy-Results at a certified center]

[Article in German]
Felix Merboth  1 , Jasmin Hasanovic  1 , Daniel Stange  1 , Marius Distler  1 , Sandra Kaden  2 , Jürgen Weitz  3 , Thilo Welsch  1
Affiliations

[Change of strategy to minimally invasive esophagectomy-Results at a certified center]

[Article in German]
Felix Merboth et al. Chirurgie (Heidelb). 2022 Jul.

Abstract
in English, German

Background: There are indications that robot-assisted minimally invasive esophagectomy (RAMIE) can reduce the morbidity compared with the conventional operative technique.

Objective: A comparative analysis of a single-center change in strategy of the standard from open esophagectomy to RAMIE with perioperative, enteral, selective bowel decontamination (SBD) was carried out.

Material and methods: Patient and morbidity data after elective RAMIE treated according to the novel standard management between July 2018 and September 2020 were compared retrospectively with an historical control cohort after open esophagectomy between January 2014 and June 2018. A 1:1 propensity score matching (PSM) analysis was performed.

Results: A total of 75 patients could be analyzed in both groups after PSM. Approximately two thirds of the operations were carried out due to an adenocarcinoma and one third due to a squamous cell carcinoma. The median number of resected lymph nodes was 22 and 21, respectively. In the RAMIE group the intrathoracic esophagogastrostomy was performed using a circular stapler with a diameter of ≥28 mm in 97%, whereas a 25 mm stapler was used in 90% in the control group. The operative time was longer (median 490min vs. 339 min, p < 0.001) but in contrast blood loss (median 300ml vs. 500 ml, p < 0.001), anastomotic leaks (8.0% vs. 25.3%, p = 0.004), surgical site infections (4.0% vs. 17.3%, p = 0.008) and pulmonary complication rates (29.3% vs. 44.0%, p = 0.045) as well as the median hospital stay (14 days vs. 20 days, p < 0.001) and 90-day mortality were significantly reduced compared with the open control group (4.0% vs. 13.3%, p = 0.039).

Conclusion: A consistent change of the perioperative management including RAMIE and SBD can lead to a stable reduction of morbidity without compromising oncological radicalness.

Zusammenfassung: HINTERGRUND: Es gibt Hinweise, dass die roboterassistierte minimal-invasive Ösophagektomie (RAMIE) die Morbidität im Vergleich zur konventionellen Operationstechnik verringern kann.

Ziel der arbeit: Es erfolgte eine Vergleichsanalyse eines Single-Center-Strategiewechsels des Standards von offener Ösophagektomie zu RAMIE mit perioperativer, enteraler, selektiver Darmdekontamination (SDD).

Material und methoden: Patienten- und Morbiditätsdaten nach elektiver RAMIE entsprechend dem neuen Standardmanagement zwischen Juli 2018 und September 2020 wurden retrospektiv mit einer historischen Kontrollkohorte nach offener Ösophagektomie zwischen Januar 2014 und Juni 2018 verglichen. Es erfolgte eine 1:1-Propensity-Score-Matching(PSM)-Analyse.

Ergebnisse: Insgesamt 75 Patienten konnten nach PSM in beiden Gruppen analysiert werden. Etwa zwei Drittel der Operationen erfolgte aufgrund eines Adenokarzinoms und ein Drittel bei Plattenepithelkarzinom. Im Median wurden 22 bzw. 21 Lymphknoten reseziert. Die intrathorakale Ösophagogastrostomie erfolgte in der RAMIE-Gruppe in 97 % mit einem Zirkularstapler mit ≥28 mm Durchmesser (offen: 25 mm in 90 % der Fälle). Die Operationszeit war länger (Median 490 vs. 339 min, p < 0,001), hingegen waren der Blutverlust (Median 300 vs. 500 ml, p < 0,001), die Anastomoseninsuffizienz- (8,0 % vs. 25,3 %, p = 0,004), Wundinfektions- (4,0 % vs. 17,3 %, p = 0,008) und pulmonale Komplikationsrate (29,3 % vs. 44,0 %, p = 0,045) sowie die mediane Krankenhausverweildauer (14 vs. 20 Tage, p < 0,001) und die 90-Tage-Mortalität signifikant geringer verglichen mit der offenen Kontrollkohorte (4,0 % vs. 13,3 %, p = 0,039).

Diskussion: Ein konsequenter Wechsel des perioperativen Managements u. a. mit RAMIE und SDD kann zu einer stabilen Reduktion der Morbidität ohne Einschränkungen der onkologischen Radikalität führen.

Keywords: Bowel decontamination; Complication rate; Length of stay; Propensity Score Matching (PSM); Robot-assisted minimally invasive esophagectomy.

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References

    1. Baum P, Diers J, Lichthardt S, et al. Mortality and complications following visceral surgery: a nationwide analysis based on the diagnostic categories used in German hospital invoicing data. Dtsch Arztebl Int. 2019;116:739–746. - PMC - PubMed
    1. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379:1887–1892. doi: 10.1016/S0140-6736(12)60516-9. - DOI - PubMed
    1. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–196. doi: 10.1097/SLA.0b013e3181b13ca2. - DOI - PubMed
    1. Cummings D, Wong J, Palm R, et al. Epidemiology, diagnosis, staging and multimodal therapy of esophageal and gastric tumors. Cancers (Basel) 2021;13(3):582. doi: 10.3390/cancers13030582. - DOI - PMC - PubMed
    1. de Groot EM, Moller T, Kingma BF, et al. Technical details of the hand-sewn and circular-stapled anastomosis in robot-assisted minimally invasive esophagectomy. Dis Esophagus. 2020;33(2):doaa055. doi: 10.1093/dote/doaa055. - DOI - PubMed

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