Esofaguectomía «tubeless»: menos es más / “Tubeless” esophagectomy: Less is more

La cirugía del cáncer de esófago es un procedimiento complejo con tasas de morbimortalidad elevadas, por lo que para obtener resultados adecuados se precisa de centros experimentados, un completo soporte multidisciplinar y vías clínicas adecuadas. Se describe la experiencia inicial y la técnica de la esofaguectomía «tubeless» en la que tras realizar una resección esofágica y linfadenectomía mediastínica extendida, al final del procedimiento no son colocados drenajes ni sondas de ningún tipo, con el fin de disminuir la agresividad del mismo, mejorar el bienestar postoperatorio y acelerar la recuperación funcional del paciente. (AU)

The esophageal cancer surgery is a complex procedure with elevated rates of both morbidity and mortality, which is why, in order to achieve adequate results, it should be performed in high volume centers, where complete multidisciplinary support is available and recent clinical guidelines are applied. We describe the initial experience and the technique of “tubeless” esophagectomy where esophageal resection and mediastinal lymphadenectomy are performed and no drains nor tubes of any kind are placed, with the aim to decrease the level of surgical aggression, enhance the postoperative comfort and accelerate the patient́s recovery. (AU)

"Tubeless" esophagectomy: Less is more.

The esophageal cancer surgery is a complex procedure with elevated rates of both morbidity and mortality, which is why, in order to achieve adequate results, it should be performed in high volume centers, where complete multidisciplinary support is available and recent clinical guidelines are applied. We describe the initial experience and the technique of "tubeless" esophagectomy where esophageal resection and mediastinal lymphadenectomy are performed and no drains nor tubes of any kind are placed, with the aim to decrease the level of surgical aggression, enhance the postoperative comfort and accelerate the patient́s recovery.

Resultados de una encuesta nacional sobre el manejo terapéutico del cáncer de esófago / Results of a National Survey about Therapeutic Management in Esophageal Cancer

En la actualidad existen numerosos puntos de controversia en el manejo perioperatorio y quirúrgico de los pacientes con cáncer de esófago. El objetivo de este trabajo es describir las posibles diferencias en el tratamiento coadyuvante y quirúrgico de estos pacientes entre los hospitales de nuestro país mediante un estudio descriptivo de las encuestas respondidas entre febrero y abril de 2020. Se evaluaron las características de cada centro, el número de procedimientos, el manejo del adenocarcinoma de tercio distal y del carcinoma escamoso de tercio medio, el tipo de anastomosis, el empleo de sonda nasogástrica y drenajes y el seguimiento de una vía clínica. La mediana de esofaguectomías anuales por centro es de 10, realizando solamente el 7,1% más de 20. En el adenocarcinoma distal el 62,5% emplea quimiorradioterapia preoperatoria, un abordaje abdominal y transtorácico (57,1%) y una linfadenectomía infracarinal (51,8%) o extendida (41,1%). En el carcinoma escamoso de tercio medio el 89,3% emplea quimiorradioterapia preoperatoria, una cirugía en 3 campos (73,2%) y una linfadenectomía mediastínica ampliada (52%). La anastomosis intratorácica se realiza de forma mecánica en el 77,8% y la cervical preferentemente de forma manual (71,4%). Los drenajes pleurales y abdominales son colocados habitualmente por el 77,6 y el 48,2%, respectivamente, mientras que la sonda nasogástrica es empleada normalmente por el 57,1%. El 57,1% siguen una vía clínica y el 28,6% un protocolo de recuperación intensificada específico. Por tanto, en el manejo del cáncer de esófago, existen claras diferencias entre los hospitales de nuestro país con relación al tratamiento coadyuvante, abordaje quirúrgico, tipo de linfadenectomía y anastomosis practicadas. (AU)

There are numerous controversial aspects in the perioperative and surgical management of patients with esophageal cancer. The aim of this study is to evaluate the differences between the hospitals of our country in the adjuvant and surgical treatment of these patients. We conducted a descriptive study of 56 surveys answered from February to April 2020, evaluating hospital characteristics, number of procedures, management of distal adenocarcinoma and squamous cell carcinoma of the middle third of the esophagus, type of anastomosis, use of nasogastric tube and drains, and clinical follow-up. The median number of annual esophagectomies per hospital was 10, and only 7.1% performed more than 20. In distal adenocarcinoma, 62.5% use preoperative chemoradiotherapy, an abdominal and transthoracic approach (57.1%), and an infracarinal lymphadenectomy (51.8%) or extended to right paratracheal lymph nodes (41.1%). In squamous cell carcinoma of the middle third of the esophagus, 89.3% use preoperative chemoradiotherapy, surgery in three fields (73.2%) and extended mediastinal lymphadenectomy (52%). Intrathoracic anastomosis is performed mechanically in 77.8% and cervical anastomosis preferably manually (71.4%). Pleural and abdominal drains are usually placed by 77.6% and 48.2%, respectively, while the nasogastric tube is normally used by 57.1%. A clinical pathway is followed by 57.1%, and 28.6% use a specific enhanced recovery after surgery protocol. Thus, in the management of esophageal cancer, there are some clear differences between hospitals in our country regarding adjuvant treatment, surgical approach, type of lymphadenectomy and anastomosis performed. (AU)

Results of a National Survey about Therapeutic Management in Esophageal Cancer. / Resultados de una encuesta nacional sobre el manejo terapéutico del cáncer de esófago.

There are numerous controversial aspects in the perioperative and surgical management of patients with esophageal cancer. The aim of this study is to evaluate the differences between the hospitals of our country in the adjuvant and surgical treatment of these patients. We conducted a descriptive study of 56 surveys answered from February to April 2020, evaluating hospital characteristics, number of procedures, management of distal adenocarcinoma and squamous cell carcinoma of the middle third of the esophagus, type of anastomosis, use of nasogastric tube and drains, and clinical follow-up. The median number of annual esophagectomies per hospital was 10, and only 7.1% performed more than 20. In distal adenocarcinoma, 62.5% use preoperative chemoradiotherapy, an abdominal and transthoracic approach (57.1%), and an infracarinal lymphadenectomy (51.8%) or extended to right paratracheal lymph nodes (41.1%). In squamous cell carcinoma of the middle third of the esophagus, 89.3% use preoperative chemoradiotherapy, surgery in three fields (73.2%) and extended mediastinal lymphadenectomy (52%). Intrathoracic anastomosis is performed mechanically in 77.8% and cervical anastomosis preferably manually (71.4%). Pleural and abdominal drains are usually placed by 77.6% and 48.2%, respectively, while the nasogastric tube is normally used by 57.1%. A clinical pathway is followed by 57.1%, and 28.6% use a specific enhanced recovery after surgery protocol. Thus, in the management of esophageal cancer, there are some clear differences between hospitals in our country regarding adjuvant treatment, surgical approach, type of lymphadenectomy and anastomosis performed.