Effects of hybrid minimally invasive oesophagectomy on major postoperative pulmonary complications

Authors

  • N. Briez,

    1. Departments of Digestive and Oncological Surgery, University Hospital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, France
    2. Departments of Medical Section, Université Lille Nord de France
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  • G. Piessen,

    1. Departments of Digestive and Oncological Surgery, University Hospital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, France
    2. Departments of Medical Section, Université Lille Nord de France
    3. Institut National de la Santé et de la Recherche Médicale, UMR837, Jean-Pierre Aubert Research Centre, Lille Cedex, France
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  • F. Torres,

    1. Departments of Digestive and Oncological Surgery, University Hospital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, France
    2. Departments of Medical Section, Université Lille Nord de France
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  • G. Lebuffe,

    1. Departments of Anaesthesiology, University Hospital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, France
    2. Departments of Medical Section, Université Lille Nord de France
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  • J.-P. Triboulet,

    1. Departments of Digestive and Oncological Surgery, University Hospital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, France
    2. Departments of Medical Section, Université Lille Nord de France
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  • C. Mariette

    Corresponding author
    1. Departments of Digestive and Oncological Surgery, University Hospital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, France
    2. Departments of Medical Section, Université Lille Nord de France
    3. Institut National de la Santé et de la Recherche Médicale, UMR837, Jean-Pierre Aubert Research Centre, Lille Cedex, France
    • Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Place de Verdun, 59037 Lille Cedex, France.
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  • Presented in part to the Annual Meeting of the American Society of Clinical Oncology, Chicago, Illinois, USA, June 2010; published in abstract form as J Clin Oncol 2010; 28(Suppl): 15s

Abstract

Background:

Morbidity after oesophageal cancer surgery remains high, mainly due to major postoperative pulmonary complications (MPPCs). The aim of this study was to test the hypothesis that hybrid minimally invasive oesophagectomy (HMIO) decreases the 30-day MPPC rate without compromising oncological outcomes.

Methods:

Consecutive patients undergoing curative oesophagectomy for cancer by laparoscopic gastric mobilization and open thoracotomy (HMIO) between January 2004 and December 2009 were matched to randomly selected patients undergoing a totally open approach during the same study interval. Matching variables were age, sex, cancer stage, location of the primary tumour, histological subtype, American Society of Anesthesiologists grade, malnutrition, neoadjuvant chemoradiation and epidural analgesia.

Results:

MPPCs at 30 days were significantly less frequent after HMIO compared with open surgery (15·7 versus 42·9 per cent; P < 0·001). Postoperative in-hospital mortality and overall morbidity rates were 4·3 and 47·5 per cent respectively, again significantly lower in the HMIO group: 1·4 versus 7·1 per cent (P = 0·018) and 35·7 versus 59·3 per cent (P < 0·001). In multivariable analysis, HMIO, adenocarcinoma subtype, epidural analgesia and surgery after 2006 were independent protective factors against MPPCs, and HMIO was independently protective against acute respiratory distress syndrome (ARDS). Lymph node yields and survival were similar in the two groups.

Conclusion:

HMIO for oesophageal cancer, using laparoscopic gastric mobilization and open right thoracotomy, offered a substantial and independent protective effect against MPPCs, including ARDS, without compromising oncological outcomes. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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