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Early outcomes of two‐stage minimally invasive oesophagectomy in an Australian institution
Author(s) -
Johnson Mary A.,
Kariyawasam Sanjeeva,
Epari Krishna,
Ballal Mohammed
Publication year - 2019
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14740
Subject(s) - medicine , surgery , anastomosis , cohort , chyle , hiatal hernia , stage (stratigraphy) , esophagectomy , pneumonia , leak , general surgery , esophageal cancer , complication , reflux , cancer , paleontology , disease , environmental engineering , engineering , biology
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.