dr pradeep jain fortis hospital - thoraco laparoscopic esophagectomy
DESCRIPTION
Dr Pradeep Jain Fortis Hospital - Thoraco Laparoscopic Esophagectomy. Laparoscopic GI and GI Oncology Surgery, Dr. Pradeep Jain Fortis Hospital Review. He gained so much appreciation for his work and has so many happy patients.TRANSCRIPT
Thoraco laparoscopic Esophagectomy
Dr Pradeep Jain M.ChDirector GI Surgery Fortis Hospital Shalimar Bagh
Minimally Invasive Esophagectomy
Enthusiasm -- Technical complexity &
Frequency
Lap > open
Cholecystectomy Gatric Bypass Esophagectomy0
5
10
15
20
25
MIE (concerns) Safety Surgery time Blood loss Morbidity and Mortality
Recovery ICU and Hospital Stay Pain
Oncological out come LN yield and Resection margins Survival
Cost
Meta analysis Biere SS, Cuesta MA, van der Peet D, Minimally
invasive versus open esophagectomy for cancer: a systematic review and meta-analysis. Minerva Chir. 2009 Apr;64(2):121-33.
Nagpal K, Ahmed K, Vats A, Yakoub D, James D, Ashrafian H, Darzi A, Moorthy K, Athanasiou T. Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis . Surg Endosc. 2010 Jul;24(7):1621-9.
Sgourakis G, Gockel I, Radtke A, Musholt TJ, Timm S, Rink A, Tsiamis A, Karaliotas C, Lang H Minimally invasive versus open esophagectomy: meta-analysis of outcomes. ) Dig Dis Sci. 2010 Nov;55(11):3031-40
Randomised Trials
Miguel A. Cuesta, Surya S. A. Y. Biere, Mark I. van Berge Henegouwen,and Donald L. van der Peet
Randomised trial, Minimally Invasive Oesophagectomy versus open oesophagectomy for patients with resectable oesophageal cancer.
J Thorac Dis. 2012 October; 4(5): 462–46
Open versus laparoscopically-assisted oesophagectomy for cancer: a multicentre randomised controlled phase III trial - the MIRO trial.
Briez N, Piessen G, Bonnetain F, Brigand C, Carrere N, Collet D, Doddoli C, Flamein R, Mabrut JY, Meunier B, Msika S, Perniceni T, Peschaud F, Prudhomme M, Triboulet JP, Mariette C.
BMC Center 2011 Jul 23;11:310
Our Experience ( retrospective 10 years )
Esophagectomy (89)
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140
2
4
6
8
10
12
14
Open MIE
Etiology (MIE 47)
Malignancy Achlasia Cardia Binign Stricture0
5
10
15
20
25
30
35
40
45
MIE
McKeown Ivor Lewis 0
5
10
15
20
25
30
35
40
45
Port Position
Port Position
Thoraco Laparoscopic Esophagectomy
Ivor Lewis Esophagectomy
Operative Time
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
0
100
200
300
400
500
600
700
MIEOPEN
Blood Loss
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
0
200
400
600
800
1000
1200
MIEOPEN
ICU Stay
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
0
2
4
6
8
10
12
MIEOPEN
Hospital Stay
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
0
2
4
6
8
10
12
14
16
MIEOPEN
Lymph Node Yield
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
0
5
10
15
20
25
MIEOPEN
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
0
0.5
1
1.5
2
2.5
3
3.5
MIEOpen
Major complications - bleeding requiring major transfusion - major leak requiring interventions - respiratory complications requiring ventilation - Thoracic duct injury - RLN injury
Mortality5/89 30 day mortality
1/47 MIE (pneumonia with septic shock)
4/42 Traditional ( Gastric conduit leak, Thoracic duct injury, Thoracic anastomosis leak, Pneumonia with sever sepsis )
Summary Minimally invasive technique
very well feasible Immediate outcome better in
MIEProne position with double lung
anesthesia has less respiratory complications
Oncological superiority is yet to be validated in prospective randomised trials
Thank You