RESUMEN
BACKGROUND: The incidence of esophageal cancer is high in some regions and the surgical treatment requires reference centers, with high volume, to make surgery feasible. AIMS: To evaluate patients undergoing minimally invasive esophagectomy by thoracoscopy in prone position for the treatment of esophageal cancer and to recognize the experience acquired over time in our service after the introduction of this technique. METHODS: From January 2012 to August 2021, all patients who underwent the minimally invasive esophagectomy for esophageal cancer were retrospectively analyzed. In order to assess the factors associated with the predefined outcomes as fistula, pneumonia, and intrahospital death, we performed univariate and multivariate logistic regression analyses, accounting for age as an important factor. RESULTS: Sixty-six patients were studied, with mean age of 59.5 years. The main histological type was squamous cell carcinoma (81.8%). The incidence of postoperative pneumonia and fistula was 38% and 33.3%, respectively. Eight patients died during this period. The patient's age, T and N stages, the year the procedure was performed, and postoperative pneumonia development were factors that influenced postoperative death. There was a 24% reduction in the chance of mortality each year, associated with the learning curve of our service. CONCLUSIONS: The present study presented the importance of the team's experience and the concentration of the treatment of patients with esophageal cancer in reference centers, allowing to significantly improve the postoperative outcomes.
Asunto(s)
Carcinoma de Células Escamosas , Neoplasias Esofágicas , Laparoscopía , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Esofagectomía/métodos , Carcinoma de Células Escamosas/cirugía , Toracoscopía/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos , Complicaciones Posoperatorias/epidemiología , Resultado del TratamientoRESUMEN
ABSTRACT BACKGROUND: The incidence of esophageal cancer is high in some regions and the surgical treatment requires reference centers, with high volume, to make surgery feasible. AIMS: To evaluate patients undergoing minimally invasive esophagectomy by thoracoscopy in prone position for the treatment of esophageal cancer and to recognize the experience acquired over time in our service after the introduction of this technique. METHODS: From January 2012 to August 2021, all patients who underwent the minimally invasive esophagectomy for esophageal cancer were retrospectively analyzed. In order to assess the factors associated with the predefined outcomes as fistula, pneumonia, and intrahospital death, we performed univariate and multivariate logistic regression analyses, accounting for age as an important factor. RESULTS: Sixty-six patients were studied, with mean age of 59.5 years. The main histological type was squamous cell carcinoma (81.8%). The incidence of postoperative pneumonia and fistula was 38% and 33.3%, respectively. Eight patients died during this period. The patient's age, T and N stages, the year the procedure was performed, and postoperative pneumonia development were factors that influenced postoperative death. There was a 24% reduction in the chance of mortality each year, associated with the learning curve of our service. CONCLUSIONS: The present study presented the importance of the team's experience and the concentration of the treatment of patients with esophageal cancer in reference centers, allowing to significantly improve the postoperative outcomes.
RESUMO RACIONAL: A incidência do câncer de esôfago é elevada em algumas regiões e o tratamento cirúrgico requer centros de referência com alto volume para viabilizar a cirurgia. OBJETIVOS: Avaliar os pacientes submetidos à esofagectomia minimamente invasiva, por toracoscopia na posição prona, para o tratamento do câncer de esôfago e conhecer a experiência adquirida ao longo do tempo em nosso serviço após a introdução desta técnica. MÉTODOS: De janeiro de 2012 a agosto de 2021, foram analisados retrospectivamente todos os pacientes submetidos à esofagectomia minimamente invasiva para câncer de esôfago. Para avaliar os fatores associados aos desfechos predefinidos de fístula, pneumonia e óbito intra-hospitalar, realizamos análises de regressão logística univariada e multivariada considerando a idade como fator importante. RESULTADOS: Foram estudados 66 pacientes, com idade média de 59,5 anos. O tipo histológico mais frequente foi carcinoma espinocelular (81,8%). A incidência de pneumonia pós-operatória e fístula foi de 38% e 33,3%, respectivamente. Oito pacientes morreram durante este período. A idade do paciente, os estágios T e N, o ano da realização do procedimento e o desenvolvimento de pneumonia pós-operatória foram fatores que influenciaram o óbito. Houve uma redução de 24% na chance de mortalidade, ano a ano, associada à curva de aprendizado do nosso serviço. CONCLUSÕES: O presente estudo mostrou a importância da experiência da equipe e da concentração do tratamento de pacientes com câncer de esôfago em centros de referência, possibilitando melhorar significativamente o resultado pós-operatório.
RESUMEN
CONTEXT: Hepatectomy is the treatment of choice for colorectal liver metastases, and several studies have shown good results, with 5-year survival rates ranging from 40% to 57%. Several clinical and pathological predictive factors for survival after liver resection have been studied. Involvement of the hepatic hilum lymph nodes, the incidence of which varies from 2% to 10%, indicates a poor long-term prognosis. RESULTS: Despite variable results, some authors have reported a not-insignificant improvement in survival rate in liver-metastasis patients with hilar lymph node involvement who undergo combined liver resection and lymphadenectomy. Due to the low rates of morbidity and mortality for liver-resection surgery, several specialized centers perform liver resections combined with lymphadenectomies in selected cases. It should be noted that the therapeutic value of systemic lymphadenectomy is not yet entirely understood, and only controlled studies comparing groups with and without lymphadenectomy can fully resolve the issue. CONCLUSION: In any case, hilar lymph node dissection has been shown to be a useful tool for improving the accuracy of extra hepatic disease staging, regardless of its impact on survival.
Asunto(s)
Neoplasias Colorrectales/patología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Neoplasias Colorrectales/cirugía , Supervivencia sin Enfermedad , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , PronósticoRESUMEN
CONTEXT: Hepatectomy is the treatment of choice for colorectal liver metastases, and several studies have shown good results, with 5-year survival rates ranging from 40 percent to 57 percent. Several clinical and pathological predictive factors for survival after liver resection have been studied. Involvement of the hepatic hilum lymph nodes, the incidence of which varies from 2 percent to 10 percent, indicates a poor long-term prognosis. RESULTS: Despite variable results, some authors have reported a not-insignificant improvement in survival rate in liver-metastasis patients with hilar lymph node involvement who undergo combined liver resection and lymphadenectomy. Due to the low rates of morbidity and mortality for liver-resection surgery, several specialized centers perform liver resections combined with lymphadenectomies in selected cases. It should be noted that the therapeutic value of systemic lymphadenectomy is not yet entirely understood, and only controlled studies comparing groups with and without lymphadenectomy can fully resolve the issue. CONCLUSION: In any case, hilar lymph node dissection has been shown to be a useful tool for improving the accuracy of extra hepatic disease staging, regardless of its impact on survival.
CONTEXTO: A hepatectomia é o tratamento de eleição para metástases hepáticas de câncer colorretal e diversos estudos têm demonstrado bons resultados, com índices de sobrevida em 5 anos entre 40 por cento e 57 por cento. Vários fatores clínico-patológicos preditivos de sobrevida após a ressecção hepática têm sido estudados e o envolvimento linfonodal do hilo hepático, que varia entre 2 por cento e 10 por cento, confere a este grupo prognóstico reservado a longo prazo. RESULTADOS: Embora com resultados variáveis, alguns autores têm relatado sobrevida não desprezível em pacientes com metástases hepáticas associada à doença linfonodal hilar submetidos a hepatectomia conjuntamente à linfadenectomia. Muitos centros especializados, embasados nos baixos índices de morbimortalidade da hepatectomia, realizam a ressecção hepática associada à linfadenectomia em casos selecionados. Cumpre ressaltar que o valor terapêutico da linfadenectomia sistemática ainda não é inteiramente conhecido e somente estudos controlados, comparando grupos com e sem linfadenectomia, poderão dirimir estas questões. CONCLUSÃO: De qualquer forma, a dissecção linfonodal hilar demonstrou ser uma ferramenta que torna mais preciso o estadiamento da doença extra-hepática, independente do impacto deste procedimento na sobrevida.