Early outcomes of two-stage minimally invasive oesophagectomy in an Australian institution

Mary A. Johnson, Sanjeeva Kariyawasam, Krishna Epari, Mohammad Ballal

Research output: Contribution to journalArticle

Abstract

Background: Minimally invasive oesophagectomy (MIO) has a steep learning curve. We report our outcomes of a standardized 25 mm circular-stapled anastomosis using a trans-orally placed anvil (Orvil™). The objective of this study is to report the initial experience of introducing two-stage MIO to an Australian tertiary health service. Methods: We describe our consecutive case series of all MIOs performed from a prospectively maintained database. We assessed the morbidity and mortality of MIO at our institution. We compared our first 30 cases to the second cohort of 32 cases. Results: There were 62 two-stage MIOs performed from 2011 to 2015. The average age was 65 years. Median length of stay was 13 days (5–72 days). Median number of total lymph nodes was 14. Conversion occurred in three patients (5%). Major morbidity was 45%. Delayed gastric emptying 6% (n = 4), pneumonia 6% (n = 4), chyle leak 6% (n = 4), pulmonary embolus 2% (n = 1) and grade II or III anastomotic leak 5% (n = 4). One conduit ischaemia (2%) required reoperation and formation of oesophagostomy. There was one post-operative death within 30 days. There were five post-oesophagectomy hiatal hernias requiring re-operation (8%). There was a significant improvement in operative time (minutes) from the first to second cohort 588 versus 464 (P-value 0.01). Conclusion: The introduction of two-stage MIO to the Australian setting can be safely instituted. Our unit was still within a learning curve after 30 cases.

Original languageEnglish
JournalANZ Journal of Surgery
Early online date17 Aug 2018
DOIs
Publication statusE-pub ahead of print - 17 Aug 2018

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Esophagectomy
Learning Curve
Esophagostomy
Chyle
Morbidity
Anastomotic Leak
Hiatal Hernia
Gastric Emptying
Operative Time
Embolism
Reoperation
Health Services
Length of Stay
Pneumonia
Ischemia
Lymph Nodes
Databases
Lung
Mortality

Cite this

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title = "Early outcomes of two-stage minimally invasive oesophagectomy in an Australian institution",
abstract = "Background: Minimally invasive oesophagectomy (MIO) has a steep learning curve. We report our outcomes of a standardized 25 mm circular-stapled anastomosis using a trans-orally placed anvil (Orvil™). The objective of this study is to report the initial experience of introducing two-stage MIO to an Australian tertiary health service. Methods: We describe our consecutive case series of all MIOs performed from a prospectively maintained database. We assessed the morbidity and mortality of MIO at our institution. We compared our first 30 cases to the second cohort of 32 cases. Results: There were 62 two-stage MIOs performed from 2011 to 2015. The average age was 65 years. Median length of stay was 13 days (5–72 days). Median number of total lymph nodes was 14. Conversion occurred in three patients (5{\%}). Major morbidity was 45{\%}. Delayed gastric emptying 6{\%} (n = 4), pneumonia 6{\%} (n = 4), chyle leak 6{\%} (n = 4), pulmonary embolus 2{\%} (n = 1) and grade II or III anastomotic leak 5{\%} (n = 4). One conduit ischaemia (2{\%}) required reoperation and formation of oesophagostomy. There was one post-operative death within 30 days. There were five post-oesophagectomy hiatal hernias requiring re-operation (8{\%}). There was a significant improvement in operative time (minutes) from the first to second cohort 588 versus 464 (P-value 0.01). Conclusion: The introduction of two-stage MIO to the Australian setting can be safely instituted. Our unit was still within a learning curve after 30 cases.",
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author = "Johnson, {Mary A.} and Sanjeeva Kariyawasam and Krishna Epari and Mohammad Ballal",
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Early outcomes of two-stage minimally invasive oesophagectomy in an Australian institution. / Johnson, Mary A.; Kariyawasam, Sanjeeva; Epari, Krishna; Ballal, Mohammad.

In: ANZ Journal of Surgery, 17.08.2018.

Research output: Contribution to journalArticle

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AU - Kariyawasam, Sanjeeva

AU - Epari, Krishna

AU - Ballal, Mohammad

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