Objective:Minimally invasive esophagectomy(MIE)was first implemented in 1992 and various MIEs have been performed subsequently.The modified McKeown MIE that includes thoracoscopic and laparoscopic procedures with left...Objective:Minimally invasive esophagectomy(MIE)was first implemented in 1992 and various MIEs have been performed subsequently.The modified McKeown MIE that includes thoracoscopic and laparoscopic procedures with left neck anastomosis has been implemented in our institution since 2006.We herein report our first 5-year experience in 376 consecutive patients undergone the modified McKeown MIE for esophageal cancer to evaluate perioperative outcomes and survival.Methods:A total of 376 patients underwent a modified McKeown MIE from March 2016 toMarch 2021 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.Patient demographics and perioperative outcomes were collected and assessed,and overall survival and disease-free survival were analyzed.Results:All procedures were completed successfully with no conversions to open surgery.The median operative time was 240 min,and the median blood loss was 100 mL.The median number of harvested lymph nodes was 29,the median number of harvested thoracic lymph nodes was 18,and of harvested abdominal nodes was 10.The 30-day mortality rate was 0.27%and complications occurred in 133(35.4%)patients.The median follow-up period was 19(1-60)months,and 244 patients completed more than 1 year of follow-up.The 1-year overall survival and disease-free survival were 79.5%and 73.8%,respectively.Conclusion:The modified McKeown MIE is safe and feasible for esophageal cancer,offering satisfactory perioperative outcomes and acceptable oncologic survival.展开更多
Background:In China,the esophageal cancer is the most common tumor type,and the main treatment is still surgical treatment.Over the past decade,thoracic laparoscopy combined with esophageal cancer resection and neck a...Background:In China,the esophageal cancer is the most common tumor type,and the main treatment is still surgical treatment.Over the past decade,thoracic laparoscopy combined with esophageal cancer resection and neck anastomosis-McKeown minimally invasive esophagectomy(MIE)has gained interest and known as a minimally invasive surgery for the middle esophageal cancer.However,the safety and operability of McKeown MIE remains to be confirmed clinically.The purpose of this article is to examine the clinical safety and operability of McKeown MIE,and compare the security and outcomes of McKeown MIE and Ivor-Lewis esophagectomy.Materials and methods:The clinical data of 312 patients with middle esophageal cancer in Sir Run Run Shaw Hospital from January 2013 to December 2018 were retrospectively analyzed.Among them,176 patients underwent Ivor-Lewis esophagectomy and 136 patients underwent McKeown MIE.Patients'demographics and perioperative outcomes were comparable between the two groups.Results:There were no significant differences in terms of operative time,postoperative hospital stay,restore fluid diet time,pathology,tumor node metastasis staging between the two groups.In the McKeown MIE group,the intraoperative blood loss was less than that in the Ivor-Lewis group(116.54±80.99 ml vs 152.78±115.35 ml,p=0.001).The total number of lymph nodes and the number of lymph nodes dissection in bilateral recurrent laryngeal nerves were more than those in the Ivor-Lewis group(30.04±14.08 vs 27.51±11.34,p=0.039;5.74±4.27 vs 1.80±2.68,p<0.001).There were no significant differences in the incidence of complications.The overall survival for the McKeown MIE group was higher than the Ivor-Lewis group(p=0.013)and no significant difference was found on disease-free survival.Conclusion:McKeown MIE is safe and operational for middle esophageal cancer,which is consistent with the principle of tumor radicalization.展开更多
Robotic surgery systems,as emerging minimally invasive approaches,have been increasingly applied for the treatment of esophageal cancer because they provide a high-definition three-dimensional surgical view and mechan...Robotic surgery systems,as emerging minimally invasive approaches,have been increasingly applied for the treatment of esophageal cancer because they provide a high-definition three-dimensional surgical view and mechanical rotating arms that surpass the limitations of human hands,greatly enhancing the accuracy and flexibility of surgical methods.Robot-assisted McKeown esophagectomy(RAME),a common type of robotic esophagectomy,has been gradually implemented with the aim of reducing postoperative complications,improving postoperative recovery and achieving better long-term survival.Multiple centers worldwide have reported and summarized their experiences with the RAME,and some have also discussed and analyzed its perioperative effects and survival prognosis compared with those of video-assisted minimally invasive esophagectomy.Compared to traditional surgery,the RAME has significant advantages in terms of lymph node dissection although there seems to be no difference in overall survival or disease-free survival.With the continuous advancement of technology and the development of robotic technology,further development and innovation are expected in the RAME field.This review elaborates on the prospects of the application and advancement of the RAME to provide a useful reference for clinical practice.展开更多
文摘Objective:Minimally invasive esophagectomy(MIE)was first implemented in 1992 and various MIEs have been performed subsequently.The modified McKeown MIE that includes thoracoscopic and laparoscopic procedures with left neck anastomosis has been implemented in our institution since 2006.We herein report our first 5-year experience in 376 consecutive patients undergone the modified McKeown MIE for esophageal cancer to evaluate perioperative outcomes and survival.Methods:A total of 376 patients underwent a modified McKeown MIE from March 2016 toMarch 2021 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.Patient demographics and perioperative outcomes were collected and assessed,and overall survival and disease-free survival were analyzed.Results:All procedures were completed successfully with no conversions to open surgery.The median operative time was 240 min,and the median blood loss was 100 mL.The median number of harvested lymph nodes was 29,the median number of harvested thoracic lymph nodes was 18,and of harvested abdominal nodes was 10.The 30-day mortality rate was 0.27%and complications occurred in 133(35.4%)patients.The median follow-up period was 19(1-60)months,and 244 patients completed more than 1 year of follow-up.The 1-year overall survival and disease-free survival were 79.5%and 73.8%,respectively.Conclusion:The modified McKeown MIE is safe and feasible for esophageal cancer,offering satisfactory perioperative outcomes and acceptable oncologic survival.
文摘Background:In China,the esophageal cancer is the most common tumor type,and the main treatment is still surgical treatment.Over the past decade,thoracic laparoscopy combined with esophageal cancer resection and neck anastomosis-McKeown minimally invasive esophagectomy(MIE)has gained interest and known as a minimally invasive surgery for the middle esophageal cancer.However,the safety and operability of McKeown MIE remains to be confirmed clinically.The purpose of this article is to examine the clinical safety and operability of McKeown MIE,and compare the security and outcomes of McKeown MIE and Ivor-Lewis esophagectomy.Materials and methods:The clinical data of 312 patients with middle esophageal cancer in Sir Run Run Shaw Hospital from January 2013 to December 2018 were retrospectively analyzed.Among them,176 patients underwent Ivor-Lewis esophagectomy and 136 patients underwent McKeown MIE.Patients'demographics and perioperative outcomes were comparable between the two groups.Results:There were no significant differences in terms of operative time,postoperative hospital stay,restore fluid diet time,pathology,tumor node metastasis staging between the two groups.In the McKeown MIE group,the intraoperative blood loss was less than that in the Ivor-Lewis group(116.54±80.99 ml vs 152.78±115.35 ml,p=0.001).The total number of lymph nodes and the number of lymph nodes dissection in bilateral recurrent laryngeal nerves were more than those in the Ivor-Lewis group(30.04±14.08 vs 27.51±11.34,p=0.039;5.74±4.27 vs 1.80±2.68,p<0.001).There were no significant differences in the incidence of complications.The overall survival for the McKeown MIE group was higher than the Ivor-Lewis group(p=0.013)and no significant difference was found on disease-free survival.Conclusion:McKeown MIE is safe and operational for middle esophageal cancer,which is consistent with the principle of tumor radicalization.
文摘Robotic surgery systems,as emerging minimally invasive approaches,have been increasingly applied for the treatment of esophageal cancer because they provide a high-definition three-dimensional surgical view and mechanical rotating arms that surpass the limitations of human hands,greatly enhancing the accuracy and flexibility of surgical methods.Robot-assisted McKeown esophagectomy(RAME),a common type of robotic esophagectomy,has been gradually implemented with the aim of reducing postoperative complications,improving postoperative recovery and achieving better long-term survival.Multiple centers worldwide have reported and summarized their experiences with the RAME,and some have also discussed and analyzed its perioperative effects and survival prognosis compared with those of video-assisted minimally invasive esophagectomy.Compared to traditional surgery,the RAME has significant advantages in terms of lymph node dissection although there seems to be no difference in overall survival or disease-free survival.With the continuous advancement of technology and the development of robotic technology,further development and innovation are expected in the RAME field.This review elaborates on the prospects of the application and advancement of the RAME to provide a useful reference for clinical practice.
