M M K Veenstra1,2, B M Smithers1,3,4, E Visser3,5, D Edholm3,6, S Brosda7, J M Thomas3,4, D C Gotley1,3, I G Thomson1,3, B P L Wijnhoven2, A P Barbour1,3,7. 1. Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia. 2. Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands. 3. Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia. 4. Mater Research Institute, Mater Health Services, Brisbane, Queensland, Australia. 5. Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands. 6. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. 7. Diamantina Institute, Translational Research Institute, The University of Queensland, Queensland, Australia.
Abstract
BACKGROUND: Minimally invasive oesophagectomy (MIO) is reported to produce fewer respiratory complications than open oesophagectomy. This study assessed differences in postoperative complications between MIO and hybrid MIO (HMIO) employing thoracoscopy and laparotomy, along with the influence of co-morbidities on postoperative outcomes. METHODS: Patients with oesophageal cancer undergoing three-stage MIO or three-stage HMIO between 1999 and 2018 were identified from a prospectively developed database, which included patient demographics, co-morbidities, preoperative therapies, and cancer stage. The primary outcome was postoperative complications in the two groups. Secondary outcomes included duration of operation, blood transfusion requirement, duration of hospital stay, and overall survival. RESULTS: There were 828 patients, of whom 722 had HMIO and 106 MIO, without significant baseline differences. Median duration of operation was longer for MIO (325 versus 289 min; P < 0.001), but with less blood loss (median 250 versus 300 ml; P < 0.001) and a shorter hospital stay (median 12 versus 13 days; P = 0.006). Respiratory complications were not associated with operative approach (31.1 versus 35.2 per cent for MIO and HMIO respectively; P = 0.426). Anastomotic leak rates (10.4 versus 10.2 per cent) and 90-day mortality (1.0 versus 1.7 per cent) did not differ. Cardiac co-morbidity was associated with more medical and surgical complications. Overall survival was associated with AJCC stage and co-morbidities, but not operative approach. CONCLUSION: MIO had a small benefit in terms of blood loss and hospital stay, but not in operating time. Oncological outcomes were similar in the two groups. Postoperative complications were associated with pre-existing cardiorespiratory co-morbidities rather than operative approach.
BACKGROUND: Minimally invasive oesophagectomy (MIO) is reported to produce fewer respiratory complications than open oesophagectomy. This study assessed differences in postoperative complications between MIO and hybrid MIO (HMIO) employing thoracoscopy and laparotomy, along with the influence of co-morbidities on postoperative outcomes. METHODS: Patients with oesophageal cancer undergoing three-stage MIO or three-stage HMIO between 1999 and 2018 were identified from a prospectively developed database, which included patient demographics, co-morbidities, preoperative therapies, and cancer stage. The primary outcome was postoperative complications in the two groups. Secondary outcomes included duration of operation, blood transfusion requirement, duration of hospital stay, and overall survival. RESULTS: There were 828 patients, of whom 722 had HMIO and 106 MIO, without significant baseline differences. Median duration of operation was longer for MIO (325 versus 289 min; P < 0.001), but with less blood loss (median 250 versus 300 ml; P < 0.001) and a shorter hospital stay (median 12 versus 13 days; P = 0.006). Respiratory complications were not associated with operative approach (31.1 versus 35.2 per cent for MIO and HMIO respectively; P = 0.426). Anastomotic leak rates (10.4 versus 10.2 per cent) and 90-day mortality (1.0 versus 1.7 per cent) did not differ. Cardiac co-morbidity was associated with more medical and surgical complications. Overall survival was associated with AJCC stage and co-morbidities, but not operative approach. CONCLUSION: MIO had a small benefit in terms of blood loss and hospital stay, but not in operating time. Oncological outcomes were similar in the two groups. Postoperative complications were associated with pre-existing cardiorespiratory co-morbidities rather than operative approach.
Authors: Maarten F J Seesing; Suzanne S Gisbertz; Lucas Goense; Richard van Hillegersberg; Hidde M Kroon; Sjoerd M Lagarde; Jelle P Ruurda; Annelijn E Slaman; Mark I van Berge Henegouwen; Bas P L Wijnhoven Journal: Ann Surg Date: 2017-11 Impact factor: 12.969
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Authors: A P Barbour; E T Walpole; G T Mai; E H Barnes; D I Watson; S P Ackland; J M Martin; M Burge; R Finch; C S Karapetis; J Shannon; L M Nott; S Varma; G Marx; G L Falk; V Gebski; M Oostendorp; K Wilson; J Thomas; G Lampe; J R Zalcberg; J Simes; B M Smithers Journal: Ann Oncol Date: 2019-12-23 Impact factor: 32.976