Francisco E Berrospi, MD, Ramiro M Fernández, MD, Eloy F Ruiz, MD, Ivan K Chávez, MD. National Cancer Institute – Peru
Introduction: Surgical resection remains the mainstay treatment for neoplasms of the hypopharynx, esophagus and esophago-gastric junction, although there are many options for reconstruction, in the last decades minimally-invasive surgery (MIS) has gained acceptance. The aim of this study is to present our clinical outcomes in different neoplasms of the foregut and the changes observed in the last 12 years with MIS.
Methods and Procedures: A retrospective study of the patients who had MIS reconstruction with the remnant stomach was performed. Clinical (age, sex, year of surgery, open or MIS, type of reconstruction, type of anastomosis, operative time), pathologic (primary neoplasm, histologic type) and postoperative course data (days of hospitalization, complications according to Dindo-Clavien Classification, anastomotic leak, mortality) were considered for analysis.
Results: Between February 2006 and April 2017 a total of 84 patients had esophagectomy, of them 42 were male and 42 female (1:1), mean age was 60.13 years (SD ±11.9), 59 patients (72%) had MIS. The type of reconstruction was predominantly with a “pull-up” technique (n=43, 51.2%) followed by the Kirschner-Akiyama procedure (n=25, 29.8%), stapled gastroplasty was performed in 12 patients. All the anastomosis were performed at the level of the neck and only one of the patients had a stapled anastomosis, mean operative time was 374min (SD ±92min) including resection of the specimen. Primary neoplasms were predominantly hypopharynx (n=34, 40.5%), distal esophagus (n=21, 25%), cervical esophagus (n=12, 14.3%) and thoracic esophagus (n=11, 13.1%). Histologic types were mainly squamous cell carcinoma (n=63, 77.4%) and adenocarcinoma (n=12, 14.3%). Mean of hospitalization days was 14.76 (SD ±9.374). No complications were observed in 38 patients and major complications (Dindo-Clavien ≥IIIb) were found in 18 patients. Anastomotic leak was present in 6 patients (7.1%) and perioperative mortality (30 days) was 2.4%. Progressive shift to laparoscopic surgery was evidenced through the years (2006-2009: 35.29%, 2010-2013:70.27% and 2014-2017:96.43%; p=0.000) and reduction in major complications (p=0,021) was observed. Anastomotic leaks (p=0,545) and perioperative mortality (p=0.373) did not show significant differences in the present study.
Conclusions: Results in our center show that major complications decrease with time after application of minimally-invasive surgery and no differences in anastomotic leaks and mortality were seen. Current data has lead us to abandon open total esophagectomy as a first-choice procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88366
Program Number: P392
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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