257. UPDATE OF THE INTRODUCTION OF MINIMALLY INVASIVE TRANSCERVICAL ESOPHAGECTOMY (MICE), CLINICAL OUTCOMES OF THE LEARNING CURVE COHORT
Bastiaan Klarenbeek, Richard Vercoulen, Linde Veenendaal, Atsushi Shiozaki, Hitoshi Fujiwara, Camiel Rosman- Gastroenterology
- General Medicine
Abstract
Background
Surgical resection remains the cornerstone of curative treatment for patients with esophageal cancer. Transthoracic minimally invasive esophagectomies have reduced the occurrence of pulmonary complications, however it is still associated with significant morbidity. The Minimally Invasive transCervical Esophagectomy (MICE) is a novel surgical technique. To date this technique is not routinely performed in Western esophageal cancer patients. We aim to assess the safety and efficacy of the MICE procedure in Dutch patients with esophageal carcinoma. An update of the clinical outcomes of the learning curve cohort.
Methods
The MICE is a recently developed surgical technique in Japan. The procedure combines a laparoscopic transhiatal and single-port transcervical mediastinal dissection and aims to ensure a radical oncological resection with a reduction of pulmonary complications because a thoracotomy/scopy is avoided. Potential drawbacks may be an increased incidence of recurrent laryngeal nerve paresis (RLNP) and learning associated morbidity. A prospective pilot study was performed including consecutive patients undergoing MICE for esophageal cancer.
Results
Results will be updated up to August 2023, probably around 70 cases. A total of 50 patients were included in this study in Januari 2023 (male/female ratio 16:4, median age 71 years (IQR 52–85). Median operation time and blood loss was 350 minutes (IQR 326–360) and 100 mL (IQR 50–175). Conversion occurred in five patients (12%). Anastomotic leakage occurred in four patients (10%, 3 ECCG grade 1 and 1 ECCG grade 3). Pneumonia, pleural effusion and chyle leakage occurred in two (5%), five 12%) and two (5%) patients. Recurrent laryngeal nerve paralysis was seen in 22 patients (55%), at least 16 (73%) of which were only temporary. Median length-of-stay was 9 days (IQR 7–10).
Conclusion
MICE is a novel minimally invasive surgical technique which seems safe and effective to perform in Dutch patients with esophageal carcinoma. As expected, a higher incidence of RLNP was seen, but often only temporarily. Long-term safety and effectiveness will be prospectively evaluated in a larger population.