Learning curve of non-tube and early oral feeding after McKeown minimally invasive esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LIU Baoxing ¹ , MA Haibo ¹ ,  LI Yin ^1,2 , QIN Jianjun ^1,2 , ZHANG Ruixiang ¹ , LIU Xianben ¹ , XING Wenqun ¹

1. Department of Thoracic Surgery, The Affiliated Tumor Hospital, Zhengzhou University, Zhengzhou, 450008, P.R.China;
2. Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, 100021, P.R.China;

Corresponding author：

LIU Baoxing, Email: b.x-liu@foxmail.com; LI Yin, Email: liyin825@aliyun.com

Keywords：

Esophageal cancer; minimally invasive esophagectomy (MIE); enhanced recovery after surgery; non-tube and early oral feeding

DOI：

10.7507/1007-4848.201810041

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the learning curve of non-tube and early oral feeding procedure following McKeown minimally invasive esophagectomy (MIE). Methods We analyzed the clinical data of 38 patients (26 males, 12 females, aged 42–79 years) with esophageal cancer who received non-tube and early oral feeding procedure after surgery at the Affiliated Tumor Hospital, Zhengzhou University from November 2017 to August 2018. They suffered upper thoracic esophageal cancer (n=4), middle thoracic esophageal cancer (n=22) or lower thoracic esophageal cancer (n=12). Results McKeown MIE was successfully performed on 38 patients. Oral feeding began 1.7 (1-4) days after surgery in the 38 patients with non-tube. Pneumonia/atelectasis occurred in 5 patients (13.1%), respiratory failure in 1 patient (2.6%), arrhythmia in 3 patients (7.9%), hoarseness in 5 patients (13.1%), anastomotic fistula in 1 patient (2.6%), cervical incision infection in 1 patient (2.6%), pneumomediastinum and infection in 1 patient (2.6%) and gastric emptying disorder in 2 patients (5.2%). No death was observed. After 26 patients with McKeown MIE were treated with enhanced recovery after surgery procedure, the operation time and complications could reach a relatively stable state and entered a plateau phase of learning curve. Conclusion Non-tube and early oral feeding procedure following MIE is technically safe and feasible. It can shorten hospital stay, relieve the discomfort of placement of nasogastric and nutrition tube and may reduce the incidence of complications. The learning curve of non-tube and early oral feeding procedure following MIE is about 26 cases.

Citation： LIU Baoxing, MA Haibo, LI Yin, QIN Jianjun, ZHANG Ruixiang, LIU Xianben, XING Wenqun. Learning curve of non-tube and early oral feeding after McKeown minimally invasive esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(7): 642-647. doi: 10.7507/1007-4848.201810041 Copy

1.	Low DE, Kuppusamy MK, Alderson D, et al. Benchmarking complications associated with esophagectomy. Ann Surg, 2019, 269(2):291-298.
2.	Fransen L, Berkelmans G, Asti E, et al. Fa01.02: The effect of postoperative complications after MIE on long-term Survival: a retrospective, multi-center cohort study. Dis Esophagus, 2018, 31(13): 1.
3.	Cao S, Zhao G, Cui J, et al. Fast-track rehabilitation program and conventional care after esophagectomy: a retrospective controlled cohort study. Support Care Cancer, 2013, 21(3): 707-714.
4.	Shewale JB, Correa AM, Baker CM, et al. Impact of a fast-track esophagectomy protocol on esophageal cancer patient outcomes and hospital charges. Ann Surg, 2015, 261(6): 1114-1123.
5.	Weijs TJ, Berkelmans GH, Nieuwenhuijzen GA, et al. Immediate postoperative oral nutrition following esophagectomy: a multicenter clinical trial. Ann Thorac Surg, 2016, 102(4): 1141-1148.
6.	Sun HB, Li Y, Liu XB, et al. Early oral feeding following McKeown minimally invasive esophagectomy: an open-label, randomized, controlled, noninferiority trial. Ann Surg, 2018, 267(3): 435-442.
7.	刘宝兴, 李印, 秦建军, 等. 胸腹腔镜联合与常规三切口食管次全切除术治疗食管癌的比较研究. 中华胃肠外科杂志, 2012, 15(9): 938-942.
8.	中国医师协会胸外科分会快速康复专家委员会. 食管癌加速康复外科技术应用专家共识(2016版). 中华胸心血管外科杂志, 2016, 32(12): 717-722.
9.	Sun HB, Li Y, Liu XB, et al. Embedded three-layer esophagogastric anastomosis reduces morbidity and improves short-term outcomes after esophagectomy for cancer. Ann Thorac Surg, 2016, 101(3): 1131-1138.
10.	Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
11.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
12.	Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256(1): 95-103.
13.	van Workum F, Slaman AE, van Berge Henegouwen MI, et al. Propensity score-matched analysis comparing minimally invasive Ivor Lewis versus minimally invasive mckeown esophagectomy. Ann Surg, 2018, [Epub ahead of print].
14.	赵格非, 张坤鹏, 高树庚, 等. 食管癌McKeown术后颈部吻合口瘘危险因素分析. 中华肿瘤杂志, 2017, 39(4): 287-292.
15.	Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet, 2012, 379(9829): 1887-1892.
16.	Markar SR, Arya S, Karthikesalingam A, et al. Technical factors that affect anastomotic integrity following esophagectomy: systematic review and meta-analysis. Ann Surg Oncol, 2013, 20(13): 4274-4281.
17.	Jones CE, Watson TJ. Anastomotic leakage following esophagectomy. Thorac Surg Clin, 2015, 25(4): 449-459.
18.	Sato T, Takayama T, So K, et al. Is retention of a nasogastric tube after esophagectomy a risk factor for postoperative respiratory tract infection? J Infect Chemother, 2007, 13(2): 109-113.
19.	刘晟, 仇明, 江道振, 等. 微创手术学习曲线的新概念与临床意义. 中国微创外科杂志, 2008, 8(1): 5-6.
20.	Ninomiya I, Osugi H, Tomizawa N, et al. Learning of thoracoscopic radical esophagectomy: how can the learning curve be made short and flat? Dis Esophagus, 2010, 23(8): 618-626.
21.	Okamura A, Watanabe M, Fukudome I, et al. Surgical team proficiency in minimally invasive esophagectomy is related to case volume and improves patient outcomes. Esophagus, 2018, 15(2): 115-121.
22.	Tapias LF, Morse CR. Minimally invasive Ivor Lewis esophagectomy: description of a learning curve. J Am Coll Surg, 2014, 218(6): 1130-1140.
23.	李印, 孙海波. 食管癌加速康复外科治疗的进展及展望. 中华胸部外科电子杂志, 2017, 4(3): 140-148.

1. Low DE, Kuppusamy MK, Alderson D, et al. Benchmarking complications associated with esophagectomy. Ann Surg, 2019, 269(2):291-298.
2. Fransen L, Berkelmans G, Asti E, et al. Fa01.02: The effect of postoperative complications after MIE on long-term Survival: a retrospective, multi-center cohort study. Dis Esophagus, 2018, 31(13): 1.
3. Cao S, Zhao G, Cui J, et al. Fast-track rehabilitation program and conventional care after esophagectomy: a retrospective controlled cohort study. Support Care Cancer, 2013, 21(3): 707-714.
4. Shewale JB, Correa AM, Baker CM, et al. Impact of a fast-track esophagectomy protocol on esophageal cancer patient outcomes and hospital charges. Ann Surg, 2015, 261(6): 1114-1123.
5. Weijs TJ, Berkelmans GH, Nieuwenhuijzen GA, et al. Immediate postoperative oral nutrition following esophagectomy: a multicenter clinical trial. Ann Thorac Surg, 2016, 102(4): 1141-1148.
6. Sun HB, Li Y, Liu XB, et al. Early oral feeding following McKeown minimally invasive esophagectomy: an open-label, randomized, controlled, noninferiority trial. Ann Surg, 2018, 267(3): 435-442.
7. 刘宝兴, 李印, 秦建军, 等. 胸腹腔镜联合与常规三切口食管次全切除术治疗食管癌的比较研究. 中华胃肠外科杂志, 2012, 15(9): 938-942.
8. 中国医师协会胸外科分会快速康复专家委员会. 食管癌加速康复外科技术应用专家共识(2016版). 中华胸心血管外科杂志, 2016, 32(12): 717-722.
9. Sun HB, Li Y, Liu XB, et al. Embedded three-layer esophagogastric anastomosis reduces morbidity and improves short-term outcomes after esophagectomy for cancer. Ann Thorac Surg, 2016, 101(3): 1131-1138.
10. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
11. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
12. Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256(1): 95-103.
13. van Workum F, Slaman AE, van Berge Henegouwen MI, et al. Propensity score-matched analysis comparing minimally invasive Ivor Lewis versus minimally invasive mckeown esophagectomy. Ann Surg, 2018, [Epub ahead of print].
14. 赵格非, 张坤鹏, 高树庚, 等. 食管癌McKeown术后颈部吻合口瘘危险因素分析. 中华肿瘤杂志, 2017, 39(4): 287-292.
15. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet, 2012, 379(9829): 1887-1892.
16. Markar SR, Arya S, Karthikesalingam A, et al. Technical factors that affect anastomotic integrity following esophagectomy: systematic review and meta-analysis. Ann Surg Oncol, 2013, 20(13): 4274-4281.
17. Jones CE, Watson TJ. Anastomotic leakage following esophagectomy. Thorac Surg Clin, 2015, 25(4): 449-459.
18. Sato T, Takayama T, So K, et al. Is retention of a nasogastric tube after esophagectomy a risk factor for postoperative respiratory tract infection? J Infect Chemother, 2007, 13(2): 109-113.
19. 刘晟, 仇明, 江道振, 等. 微创手术学习曲线的新概念与临床意义. 中国微创外科杂志, 2008, 8(1): 5-6.
20. Ninomiya I, Osugi H, Tomizawa N, et al. Learning of thoracoscopic radical esophagectomy: how can the learning curve be made short and flat? Dis Esophagus, 2010, 23(8): 618-626.
21. Okamura A, Watanabe M, Fukudome I, et al. Surgical team proficiency in minimally invasive esophagectomy is related to case volume and improves patient outcomes. Esophagus, 2018, 15(2): 115-121.
22. Tapias LF, Morse CR. Minimally invasive Ivor Lewis esophagectomy: description of a learning curve. J Am Coll Surg, 2014, 218(6): 1130-1140.
23. 李印, 孙海波. 食管癌加速康复外科治疗的进展及展望. 中华胸部外科电子杂志, 2017, 4(3): 140-148.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Learning curve of non-tube and early oral feeding after McKeown minimally invasive esophagectomy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content