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PWE-144 7-year experience of two stage minimally invasive oesophagectomy with intrathoracic anastomosis (mio-2) in a single uk centre
  1. F Noble1,
  2. T Underwood1,
  3. D Sharland2,
  4. J Byrne2,
  5. J Kelly2
  1. 1Cancer Sciences Unit, Faculty of Medicine, University of Southampton
  2. 2Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK

Abstract

Introduction The 2014 report of the National OesopahgoGastric Cancer Audit (NOGCA) identified an increasing number of patients who were treated with minimally invasive (MIO) or hybrid operations (41.5%). Overall complications were similar to open surgery, but a significant increase in anastomotic leak (AL) after MIO was identified (11.7% vs. 6.7%).

Totally minimally invasive oesophagectomy with intrathoracic anastomosis (MIO-2) has been performed at University Hospital Southampton NHS Foundation Trust since 2008 and we present a review of this consecutive series.

Method A prospectively collected database of clinic-pathological and operative variables from consecutive patients undergoing oesophagogastric resection between January 1, 2005 and February 27, 2015 was reviewed. Statistical analysis was performed in SPSS.

Results 147 patients (78% male, 22% female) underwent MIO-2, beginning in June 2008. Patient demographics were: median age 67 years (33–85), median BMI 26 (16–37), ASA 1 6.8%, ASA 2 64.6%, ASA 3 27.9%, ASA 4 0.7%. One patient had surgery for achalasia and 3 for HGD/Tis; the remainder had invasive cancer. 65% of patients had T3 disease on preoperative staging, with 65.3% having evidence of lymph node involvement (N1+).

Median operative duration was 319 min (180–530 min) and median blood loss of 205 ml (0–5000 ml). In 11 (7.5%) cases the thoracic component was converted to open. There were 3 in-patient deaths (2.0%) including one intraoperative mortality. Major complications (Clavien-Dindo 3–4) were observed in 19% of cases with 11 anastomotic leaks (7.5%) and a reoperation rate of 9.6%. An R0 resection was achieved in 81.9% of cases with a median lymph node yield of 21 (2–62). Median length of hospital stay was 11 (6–96) days.

Conclusion MIO-2 can be performed in the UK with acceptable perioperative morbidity, mortality, and oncological efficiency.

Disclosure of interest F. Noble: None Declared, T. Underwood Grant/Research Support from: MRC, D. Sharland: None Declared, J. Byrne: None Declared, J. Kelly: None Declared.

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