Safe Transition from Open to Total Minimally Invasive Esophagectomy for Cancer Utilizing Process Management Methodology.

Bjelovic, Milos; Gunjic, Dragan; Babic, Tamara; Veselinovic, Milan; Djukanovic, Marija; Potkonjak, Dario; Milosavljevic, Vladimir

Bjelovic, Milos; Gunjic, Dragan; Babic, Tamara; Veselinovic, Milan; Djukanovic, Marija; Potkonjak, Dario; Milosavljevic, Vladimir.

Afiliación

Bjelovic M; Euromedic General Hospital, Bulevar umetnosti 29, 11070 Belgrade, Serbia.
Gunjic D; School of Medicine Foca, University East Sarajevo, Studentska 5, 73300 Foca, Bosnia and Herzegovina.
Babic T; Euromedic General Hospital, Bulevar umetnosti 29, 11070 Belgrade, Serbia.
Veselinovic M; Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, Dr Koste Todorovica Street 6, 11000 Belgrade, Serbia.
Djukanovic M; Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, Dr Koste Todorovica Street 6, 11000 Belgrade, Serbia.
Potkonjak D; School of Medicine, University of Belgrade, Dr Subotica Street 8, 11000 Belgrade, Serbia.
Milosavljevic V; Department of Anesthesiology and Resuscitation, Hospital for Digestive Surgery, Clinical Center of Serbia, Dr Koste Todorovica Street 6, 11000 Belgrade, Serbia.

J Clin Med ; 13(15)2024 Jul 26.

Article en En | MEDLINE | ID: mdl-39124631

ABSTRACT

ABSTRACT

Background:

The global shift from open esophagectomy (OE) to minimally invasive esophagectomy (MIE) for treating esophageal cancer is well-established. Recent data indicate that transitioning from hybrid minimally invasive esophagectomy (hMIE) to total minimally invasive esophagectomy (tMIE) can be challenging due to concerns about higher leakage rates and lower lymph node counts, especially at the beginning of the learning curve. This study aimed to demonstrate that a safe transition from OE to tMIE for cancer is possible using process management methodology.

Methods:

A step-change approach was adopted in process management planning, with hMIE serving as an intermediate step between OE and tMIE. This single-center, case-control study included 150 patients who underwent the Ivor Lewis procedure with curative intent for esophageal cancer. Among these patients, 50 underwent OE, 50 hMIE (laparoscopic procedure followed by conventional right thoracotomy), and 50 tMIE (laparoscopic and thoracoscopic approach). A preceptored training scheme was implemented during execution, and treatment results were monitored and controlled to ensure a safe transition.

Results:

During the transition, the tMIE group was not worse than the hMIE and OE groups regarding operation duration (p = 0.135), overall postoperative complications (p = 0.020), anastomotic leakage rates (p = 0.773), 30-day mortality (p = 1.0), and oncological outcomes (based on R status (p = 0.628) and 2-year survival (p = 0.967)). Additionally, the tMIE group showed superior results in terms of major postoperative pulmonary complications (p = 0.004) and ICU stay duration (p < 0.001).

Conclusions:

Utilizing managerial methodology and practice in surgery, as a bridge between interdisciplinary and transdisciplinary approaches, demonstrated that transitioning from OE to tMIE, with hMIE as an intermediate step, is safe and feasible without compromising outcomes.

Palabras clave

esophageal cancer; minimally invasive esophagectomy; process management; surgery

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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Clin Med Año: 2024 Tipo del documento: Article Pais de publicación: Suiza