Comparative Perioperative Outcomes by Esophagectomy Surgical Technique
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ORIGINAL ARTICLE
Comparative Perioperative Outcomes by Esophagectomy Surgical Technique Kenneth L. Meredith 1
&
Taylor Maramara 1 & Paige Blinn 1 & Daniel Lee 1 & Jamie Huston 1 & Ravi Shridhar 2
Received: 18 December 2018 / Accepted: 10 May 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract 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. Keywords Esophagectomy . Robotic esophagectomy . Transhiatal . Ivor Lewis . Mckeown (three-field)
Introduction Esophageal cancer is a common gastrointestinal malignant tumor with continued increase in incidence worldwide.1–5 Classically, esophageal cancer has shown a poor prognosis, even with variety of traditional and novel modalities of treatments.4,6 Surgical resection remains pivotal in the management of patients with esophageal cancer. In 2018, it is
* Kenneth L. Meredith [email protected]; [email protected] 1
Gastrointestinal Oncology, Florida State University College Of Medicine/Sarasota Memorial Health Care System, 1950 Arlington Street, Suite 101, Sarasota, FL 34239, USA
2
Radiation Oncology, University of Central Florida, Orlando, FL, USA
estimated that there will be 17,290 new cases of esophageal cancer and 15,850 deaths in the USA.2 The 5-year survival rate between is estimated at 18% despite improvements in multi-modality care over the last several decades.5,7 Primary treatment for esophageal cancer employs a combination of
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