Minimally Invasive and Robotic Surgery in the Surgical Treatment of Esophagogastric Junction Cancer

Minimally invasive surgery provides for the treatment of esophagogastric junction tumors under safe conditions, reducing respiratory and abdominal wall complications. Recovery is improved, while maintaining the oncological principles of surgery to obtain an optimal long-term outcome. It is important...

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Published in:	Cirugia española (English ed.) Vol. 97; no. 8; pp. 451 - 458
Main Authors:	Díez del Val, Ismael, Loureiro González, Carlos, Asensio Gallego, José Ignacio, Bettonica Larrañaga, Carla, Leturio Fernández, Saioa, Eizaguirre Letamendia, Emma, Miró Martín, Mónica, García Fernández, Marta María, Martí Gelonch, Laura, Aranda Danso, Humberto, Barrenetxea Asua, Julen, Estremiana García, Fernando, Ortiz Lacorzana, Javier, Farran Teixidó, Leandre
Format:	Journal Article
Language:	English
Published:	Spain Elsevier España, S.L.U 01-10-2019
Subjects:	Anastomosis, Surgical - methods Barrett Esophagus - pathology Cirugía mínimamente invasiva Cirugía robótica Esofagectomía Esophageal Neoplasms - diagnostic imaging Esophageal Neoplasms - pathology Esophageal Neoplasms - surgery Esophagectomy Esophagectomy - methods Esophagogastric junction Esophagogastric Junction - diagnostic imaging Esophagogastric Junction - pathology Esophagogastric Junction - surgery Esophagoscopy Gastrectomy Gastrectomy - methods Gastrectomía Humans Laparoscopy Lymph Node Excision - methods Minimally invasive surgery Neoplasm Invasiveness Positron Emission Tomography Computed Tomography Postoperative Complications - prevention & control Robotic surgery Robotic Surgical Procedures Stomach Neoplasms - pathology Stomach Neoplasms - surgery Unión esofagogástrica Robotic surgery Esofagectomía Minimally invasive surgery Esophagogastric junction Unión esofagogástrica Cirugía mínimamente invasiva Esophagectomy Gastrectomy Cirugía robótica Gastrectomía
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Abstract	Minimally invasive surgery provides for the treatment of esophagogastric junction tumors under safe conditions, reducing respiratory and abdominal wall complications. Recovery is improved, while maintaining the oncological principles of surgery to obtain an optimal long-term outcome. It is important to have a sufficient volume of activity to progress along the learning curve with close expert supervision in order to guarantee R0 resection and adequate lymphadenectomy. Minimal invasiveness ought not become an objective in itself. Should total gastrectomy be performed, the risk of a positive proximal margin makes intraoperative biopsy compulsory, without ruling out a primary open approach. Meanwhile, minimally invasive esophagectomy has been gaining ground. Its main difficulty, the intrathoracic anastomosis, can be safely carried out either with a mechanical side-to-side suture or a robot-assisted manual suture, thanks to the 3-D vision and versatility of the instruments. La cirugía mínimamente invasiva permite el tratamiento de los tumores de la unión esofagogástrica en condiciones de seguridad, reduciendo las complicaciones respiratorias y parietales y mejorando la recuperación postoperatoria, manteniendo además los principios de la cirugía oncológica que permitan obtener unos resultados óptimos de efectividad a largo plazo. Para ello, es necesario un volumen de actividad suficiente y avanzar en la curva de aprendizaje de forma tutelada, para poder garantizar una resección R0 y una linfadenectomía adecuada. La mínima invasión no puede ser un objetivo en sí misma. En caso de gastrectomía total, el riesgo de afectación del margen proximal obliga a verificarlo mediante biopsia intraoperatoria, sin descartar la cirugía abierta de entrada. Por su parte, la esofagectomía mínimamente invasiva se ha ido imponiendo progresivamente. Su principal dificultad, la anastomosis intratorácica, puede realizarse mediante una sutura laterolateral mecánica o manualmente asistida por robot, gracias a la visión tridimensional y a la versatilidad del instrumental.
AbstractList	Minimally invasive surgery provides for the treatment of esophagogastric junction tumors under safe conditions, reducing respiratory and abdominal wall complications. Recovery is improved, while maintaining the oncological principles of surgery to obtain an optimal long-term outcome. It is important to have a sufficient volume of activity to progress along the learning curve with close expert supervision in order to guarantee R0 resection and adequate lymphadenectomy. Minimal invasiveness ought not become an objective in itself. Should total gastrectomy be performed, the risk of a positive proximal margin makes intraoperative biopsy compulsory, without ruling out a primary open approach. Meanwhile, minimally invasive esophagectomy has been gaining ground. Its main difficulty, the intrathoracic anastomosis, can be safely carried out either with a mechanical side-to-side suture or a robot-assisted manual suture, thanks to the 3-D vision and versatility of the instruments. Minimally invasive surgery provides for the treatment of esophagogastric junction tumors under safe conditions, reducing respiratory and abdominal wall complications. Recovery is improved, while maintaining the oncological principles of surgery to obtain an optimal long-term outcome. It is important to have a sufficient volume of activity to progress along the learning curve with close expert supervision in order to guarantee R0 resection and adequate lymphadenectomy. Minimal invasiveness ought not become an objective in itself. Should total gastrectomy be performed, the risk of a positive proximal margin makes intraoperative biopsy compulsory, without ruling out a primary open approach. Meanwhile, minimally invasive esophagectomy has been gaining ground. Its main difficulty, the intrathoracic anastomosis, can be safely carried out either with a mechanical side-to-side suture or a robot-assisted manual suture, thanks to the 3-D vision and versatility of the instruments. La cirugía mínimamente invasiva permite el tratamiento de los tumores de la unión esofagogástrica en condiciones de seguridad, reduciendo las complicaciones respiratorias y parietales y mejorando la recuperación postoperatoria, manteniendo además los principios de la cirugía oncológica que permitan obtener unos resultados óptimos de efectividad a largo plazo. Para ello, es necesario un volumen de actividad suficiente y avanzar en la curva de aprendizaje de forma tutelada, para poder garantizar una resección R0 y una linfadenectomía adecuada. La mínima invasión no puede ser un objetivo en sí misma. En caso de gastrectomía total, el riesgo de afectación del margen proximal obliga a verificarlo mediante biopsia intraoperatoria, sin descartar la cirugía abierta de entrada. Por su parte, la esofagectomía mínimamente invasiva se ha ido imponiendo progresivamente. Su principal dificultad, la anastomosis intratorácica, puede realizarse mediante una sutura laterolateral mecánica o manualmente asistida por robot, gracias a la visión tridimensional y a la versatilidad del instrumental.
Author	Díez del Val, Ismael Miró Martín, Mónica Barrenetxea Asua, Julen Asensio Gallego, José Ignacio Martí Gelonch, Laura Aranda Danso, Humberto Estremiana García, Fernando Loureiro González, Carlos Eizaguirre Letamendia, Emma Farran Teixidó, Leandre Leturio Fernández, Saioa García Fernández, Marta María Bettonica Larrañaga, Carla Ortiz Lacorzana, Javier
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Keywords	Robotic surgery Esofagectomía Minimally invasive surgery Esophagogastric junction Unión esofagogástrica Cirugía mínimamente invasiva Esophagectomy Gastrectomy Cirugía robótica Gastrectomía
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SubjectTerms	Anastomosis, Surgical - methods Barrett Esophagus - pathology Cirugía mínimamente invasiva Cirugía robótica Esofagectomía Esophageal Neoplasms - diagnostic imaging Esophageal Neoplasms - pathology Esophageal Neoplasms - surgery Esophagectomy Esophagectomy - methods Esophagogastric junction Esophagogastric Junction - diagnostic imaging Esophagogastric Junction - pathology Esophagogastric Junction - surgery Esophagoscopy Gastrectomy Gastrectomy - methods Gastrectomía Humans Laparoscopy Lymph Node Excision - methods Minimally invasive surgery Neoplasm Invasiveness Positron Emission Tomography Computed Tomography Postoperative Complications - prevention & control Robotic surgery Robotic Surgical Procedures Stomach Neoplasms - pathology Stomach Neoplasms - surgery Unión esofagogástrica
Title	Minimally Invasive and Robotic Surgery in the Surgical Treatment of Esophagogastric Junction Cancer
URI	https://dx.doi.org/10.1016/j.cireng.2019.09.005 https://www.ncbi.nlm.nih.gov/pubmed/31047649
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