Comparative Perioperative Outcomes by Esophagectomy Surgical Technique
Kenneth L Meredith, Taylor Maramara, Paige Blinn, Daniel Lee, Jamie Huston, Ravi Shridhar
Gastrointestinal Oncology, Florida State University College Of Medicine/Sarasota Memorial Health Care System, 1950 Arlington Street, Suite 101, Sarasota, FL, 34239, USA. kensurg@hotmail.com. Gastrointestinal Oncology, Florida State University College Of Medicine/Sarasota Memorial Health Care System, 1950 Arlington Street, Suite 101, Sarasota, FL, 34239, USA. Radiation Oncology, University of Central Florida, Orlando, FL, USA.
Introduction: Surgical resection is vital in the curative management of patients with esophageal cancer. However, a myriad of surgical procedures exists based on surgeon preference and training. We report on the perioperative outcomes based on esophagectomy surgical technique.
Methods: A prospectively managed esophagectomy database was queried for patients undergoing esophagectomy from 1996 and 2016. Basic demographics, tumor characteristics, operative details, and post-operative outcomes were recorded and analyzed by comparison of transhiatal vs. Ivor-lewis and minimally invasive (MIE) vs. open procedures.
Results: We identified 856 patients who underwent esophagectomy. Neoadjuvant therapy was administered in 543 patients (63.4%). There were 504 (58.8%) open esophagectomies and 302 (35.2%) MIE. There were 13 (1.5%) mortalities, and this did not differ among techniques (p = 0.6). While there was no difference in overall complications between MIE and open, complications occurred less frequently in patients undergoing RAIL and MIE IVL compared to other techniques (p = 0.003). Pulmonary complications also occurred less frequently in RAIL and MIE IVL (p < 0.001). Anastomotic leaks were less common in patients who underwent IVL compared to trans-hiatal approaches (p = 0.03). MIE patients were more likely to receive neoadjuvant therapy (p = 0.001), have lower blood loss (p < 0.001), have longer operations (p < 0.001), and higher lymph node harvests (p < 0.001) compared to open patients.
Conclusion: Minimally invasive and robotic Ivor Lewis techniques demonstrated substantial benefits in post-operative complications. Oncologic outcomes similarly favor MIE IVL and RAIL.
For more information or to refer a patient, call Gastrointestinal Oncology Nurse Navigators Erica Corcoran, MSN, RN, OCN, AOCNS, ONN-CG, at 407-303-5981, or Wyntir Purtha, BSN, RN, OCN, at 407-303-5959.