Dr Pradeep Jain Fortis Hospital - Thoraco Laparoscopic Esophagectomy

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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.

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Dr Pradeep Jain Fortis Hospital - Thoraco Laparoscopic Esophagectomy

  1. 1. Thoraco laparoscopic Esophagectomy Dr Pradeep Jain M.Ch Director GI Surgery Fortis Hospital Shalimar Bagh
  2. 2. Minimally Invasive Esophagectomy  Enthusiasm -- Technical complexity & Frequency
  3. 3. Lap > open 0 5 10 15 20 25 Cholecystectomy Gatric Bypass Esophagectomy
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. Our Experience ( retrospective 10 years )
  8. 8. Esophagectomy (89) 0 2 4 6 8 10 12 14 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Open MIE
  9. 9. Etiology (MIE 47) 0 5 10 15 20 25 30 35 40 45 Malignancy Achlasia Cardia Binign Stricture
  10. 10. MIE 0 5 10 15 20 25 30 35 40 45 McKeown Ivor Lewis
  11. 11. Port Position
  12. 12. Port Position
  13. 13. Thoraco Laparoscopic Esophagectomy
  14. 14. Ivor Lewis Esophagectomy
  15. 15. Operative Time 0 100 200 300 400 500 600 700 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 MIE OPEN
  16. 16. Blood Loss 0 200 400 600 800 1000 1200 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 MIE OPEN
  17. 17. ICU Stay 0 2 4 6 8 10 12 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 MIE OPEN
  18. 18. Hospital Stay 0 2 4 6 8 10 12 14 16 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 MIE OPEN
  19. 19. Lymph NodeYield 0 5 10 15 20 25 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 MIE OPEN
  20. 20. 0 0.5 1 1.5 2 2.5 3 3.5 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 MIE Open Major complications - bleeding requiring major transfusion - major leak requiring interventions - respiratory complications requiring ventilation - Thoracic duct injury - RLN injury
  21. 21. Mortality  5/89 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 )
  22. 22. Summary  Minimally invasive technique very well feasible  Immediate outcome better in MIE  Prone position with double lung anesthesia has less respiratory complications  Oncological superiority is yet to be validated in prospective randomised trials
  23. 23. ThankYou

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