Abby White1, Suden Kucukak2, Daniel N Lee2, Emanuele Mazzola3, Yong Zhang4, Scott J Swanson2. 1. Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass. Electronic address: Awhite12@bwh.harvard.edu. 2. Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass. 3. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Mass. 4. Thoracic Surgery Department, Xi'an Jiaotong University Medical College, First Affiliated Hospital, Xi'an, China.
Abstract
OBJECTIVE: Esophagectomy is associated with major morbidity. In this study we sought to assess the learning curve of minimally invasive Ivor Lewis esophagectomy (MIILE) and to evaluate perioperative outcomes, including anastomotic leak and hospital readmission, as a function of graduated surgeon experience. METHODS: Data were extracted from the electronic medical records of patients who underwent MIILE, performed by a single surgeon over an 8-year period (2009-2017). Primary outcomes were 5-year overall survival, postoperative complications, and 90-day readmission rates. Surgeon experience was divided into 4 quartiles, representing graduated experience. Statistical analysis was performed using univariate and multivariate logistic regression, whereas Kaplan-Meier estimators were used to assess survival outcomes. RESULTS: A total of 170 patients underwent MIILE and were analyzed after exclusion criteria were applied. Five-year overall survival was 50.1% (95% confidence interval, 39.7%-63.2%). Mortality at 90 days was 3.9% (95% confidence interval, 0.8%-6.9%). Major complications occurred in 25.3% (n = 43) and 25.9% (n = 44) were readmitted to the hospital within 90 days after surgery. Conversion to open surgery, anastomotic leaks, and readmissions decreased over time. CONCLUSIONS: MIILE can be performed safely and effectively with improving results as the surgeon's experience evolves.
OBJECTIVE: Esophagectomy is associated with major morbidity. In this study we sought to assess the learning curve of minimally invasive Ivor Lewis esophagectomy (MIILE) and to evaluate perioperative outcomes, including anastomotic leak and hospital readmission, as a function of graduated surgeon experience. METHODS: Data were extracted from the electronic medical records of patients who underwent MIILE, performed by a single surgeon over an 8-year period (2009-2017). Primary outcomes were 5-year overall survival, postoperative complications, and 90-day readmission rates. Surgeon experience was divided into 4 quartiles, representing graduated experience. Statistical analysis was performed using univariate and multivariate logistic regression, whereas Kaplan-Meier estimators were used to assess survival outcomes. RESULTS: A total of 170 patients underwent MIILE and were analyzed after exclusion criteria were applied. Five-year overall survival was 50.1% (95% confidence interval, 39.7%-63.2%). Mortality at 90 days was 3.9% (95% confidence interval, 0.8%-6.9%). Major complications occurred in 25.3% (n = 43) and 25.9% (n = 44) were readmitted to the hospital within 90 days after surgery. Conversion to open surgery, anastomotic leaks, and readmissions decreased over time. CONCLUSIONS: MIILE can be performed safely and effectively with improving results as the surgeon's experience evolves.
Authors: Suzanne S Gisbertz; Camiel Rosman; Yassin Eddahchouri; Frans van Workum; Frits J H van den Wildenberg; Mark I van Berge Henegouwen; Fatih Polat; Harry van Goor; Jean-Pierre E N Pierie; Bastiaan R Klarenbeek Journal: Surg Endosc Date: 2021-02-19 Impact factor: 4.584