Robert E Merritt1, Peter J Kneuertz2, Desmond M D'Souza2, Kyle A Perry3. 1. Division of Thoracic Surgery, The Ohio State University Wexner Medical Center, N847 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA. robert.merritt@osumc.edu. 2. Division of Thoracic Surgery, The Ohio State University Wexner Medical Center, N847 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA. 3. Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, N847 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA.
Abstract
BACKGROUND: Minimally invasive esophagectomy is associated with significant morbidity, which can substantially influence the hospital length of stay for patients. Anastomotic leak is the most devastating complication. Minimizing major postoperative complications can facilitate adherence to a clinical pathway protocol and can decrease hospital length of stay. METHODS: This is a retrospective study of 130 patients who underwent an elective laparoscopic and thoracoscopic Ivor Lewis esophagectomy for esophageal carcinoma between August 2014 and June 2018. A total of 112 patients (86%) underwent neoadjuvant chemoradiation. All of the 130 patients underwent a laparoscopic gastric devascularization procedure a median of 15 days prior to the esophagectomy. The target discharge date was postoperative day number 8. RESULTS: Thirty patients (23.08%) had postoperative complications. Atrial fibrillation (20 patients) [15.38%] was the most frequent complication. Four patients (3.1%) developed an anastomotic leak. There was one postoperative death (0.77%) in the cohort of patients. The median length of stay was 8 days. The mean length of stay for patients without complications was 8 days ± 1.2 days and 12.4 days ± 7.1 days for patients with one or more complications (p = 0.002). CONCLUSION: The development of postoperative complications after minimally invasive Ivor Lewis esophagectomy significantly increases hospital length of stay. Performing the operation with a specialized tandem surgical team and including preoperative ischemic preconditioning of the stomach minimizes overall and anastomotic complications and facilitates on time hospital discharge as defined by a perioperative clinical pathway protocol.
BACKGROUND: Minimally invasive esophagectomy is associated with significant morbidity, which can substantially influence the hospital length of stay for patients. Anastomotic leak is the most devastating complication. Minimizing major postoperative complications can facilitate adherence to a clinical pathway protocol and can decrease hospital length of stay. METHODS: This is a retrospective study of 130 patients who underwent an elective laparoscopic and thoracoscopic Ivor Lewis esophagectomy for esophageal carcinoma between August 2014 and June 2018. A total of 112 patients (86%) underwent neoadjuvant chemoradiation. All of the 130 patients underwent a laparoscopic gastric devascularization procedure a median of 15 days prior to the esophagectomy. The target discharge date was postoperative day number 8. RESULTS: Thirty patients (23.08%) had postoperative complications. Atrial fibrillation (20 patients) [15.38%] was the most frequent complication. Four patients (3.1%) developed an anastomotic leak. There was one postoperative death (0.77%) in the cohort of patients. The median length of stay was 8 days. The mean length of stay for patients without complications was 8 days ± 1.2 days and 12.4 days ± 7.1 days for patients with one or more complications (p = 0.002). CONCLUSION: The development of postoperative complications after minimally invasive Ivor Lewis esophagectomy significantly increases hospital length of stay. Performing the operation with a specialized tandem surgical team and including preoperative ischemic preconditioning of the stomach minimizes overall and anastomotic complications and facilitates on time hospital discharge as defined by a perioperative clinical pathway protocol.
Authors: James D Luketich; Arjun Pennathur; Omar Awais; Ryan M Levy; Samuel Keeley; Manisha Shende; Neil A Christie; Benny Weksler; Rodney J Landreneau; Ghulam Abbas; Matthew J Schuchert; Katie S Nason Journal: Ann Surg Date: 2012-07 Impact factor: 12.969
Authors: Thomas K Varghese; Douglas E Wood; Farhood Farjah; Brant K Oelschlager; Rebecca G Symons; Kara E MacLeod; David R Flum; Carlos A Pellegrini Journal: Ann Thorac Surg Date: 2011-04 Impact factor: 4.330
Authors: J M Findlay; E Tustian; J Millo; A Klucniks; B Sgromo; R E K Marshall; R S Gillies; M R Middleton; N D Maynard Journal: Dis Esophagus Date: 2014-05-18 Impact factor: 3.429
Authors: Paolo Parise; Carlo Ferrari; Andrea Cossu; Francesco Puccetti; Ugo Elmore; Stefano De Pascale; Leonardo Garutti; Uberto Romario Fumagalli; Mariaclelia Stefania Di Serio; Riccardo Rosati Journal: Ann Surg Date: 2019-07 Impact factor: 12.969
Authors: Robert James Cerfolio; Ayesha S Bryant; Cynthia S Bass; Jeana R Alexander; Alfred A Bartolucci Journal: Chest Date: 2004-10 Impact factor: 9.410
Authors: Nabil P Rizk; Peter B Bach; Deborah Schrag; Manjit S Bains; Alan D Turnbull; Martin Karpeh; Murray F Brennan; Valerie W Rusch Journal: J Am Coll Surg Date: 2004-01 Impact factor: 6.113