Universität zu Köln

Bartella, I, Brinkmann, S., Fuchs, H., Leers, J., Schlosser, H. A., Bruns, C. J. and Schroeder, W. . Two-stage hybrid Ivor-Lewis esophagectomy as surgical strategy to reduce postoperative morbidity for high-risk patients. Surg. Endosc.. NEW YORK: SPRINGER. ISSN 1432-2218

Full text not available from this repository.

Abstract

Background Ivor-Lewis esophagectomy (ILE) is the standard surgical care for esophageal cancer patients but postoperative morbidity impairs quality of life and reduces long-term oncological outcome. Two-stage ILE separating the abdominal and thoracic phase into two distinct surgical procedures has proven to enhance microcirculation of the gastric conduit and therefore most likely reduces complications. However, two-stage ILE has not been evaluated systematically in selected groups of patients scheduled for this procedure. This investigation aims to demonstrate the feasibility of two-stage ILE in high-risk patients. Patients and methods In this retrospective analysis of data obtained from a prospective database, a consecutive series of 275 hybrid ILE (hILE) were included. Patients were divided into two groups based on one- or two-stage hILE. Postoperative complications were assessed according to ECCG (Esophageal Complication Consensus Group) criteria and compared using the Clavien-Dindo score. Indication for two-stage esophagectomy was classified as pre- or intraoperative decision. Results 34 out of 275 patients (12.7%) underwent two-stage hILE. Patients of the two-stage group were significantly older. In 21 of 34 patients (61.8%) the decision for a two-stage procedure was made prior to esophagectomy, in 13 (38.2%) patients intraoperatively after completion of the laparoscopic gastric mobilization. The most frequent preoperative reason to select the two-stage procedure was a stenosis of the coeliac trunc and superior mesenteric artery (n = 10). The predominant cause for an intraoperative change of strategy was a laparoscopically diagnosed hepatic fibrosis/cirrhosis (n = 5).Overall morbidity and major' complications (CD > IIIa) were comparable for both groups (11.7% in both groups). The overall anastomotic leak rate was 12.4% and was non-significant lower for the two-stage procedure. Conclusion Two-stage hILE is a feasible concept to individualize the surgical treatment of patients with well-defined clinical risk factors for postoperative morbidity. It can also be applied after completion of the abdominal phase of IL esophagectomy without compromising the patient safety.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bartella, I UNSPECIFIED UNSPECIFIED UNSPECIFIED Brinkmann, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Fuchs, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Leers, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schlosser, H. A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bruns, C. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schroeder, W. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-341097
DOI:	10.1007/s00464-020-07485-9
Journal or Publication Title:	Surg. Endosc.
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1432-2218
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MINIMALLY-INVASIVE-ESOPHAGECTOMY; ANASTOMOTIC LEAKAGE; TRANSTHORACIC ESOPHAGECTOMY; CANCER; CALCIFICATION; COMPLICATIONS; RESECTION; OUTCOMES; IMPACT; MULTICENTER Multiple languages Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/34109