Comparative Perioperative Outcomes by Esophagectomy Surgical Technique
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.
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.
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.
Minimally invasive and robotic Ivor Lewis techniques demonstrated substantial benefits in post-operative complications. Oncologic outcomes similarly favor MIE IVL and RAIL.
KeywordsEsophagectomy Robotic esophagectomy Transhiatal Ivor Lewis Mckeown (three-field)
1. Kenneth Meredith: Concept and design, data analysis and interpretation, manuscript writing and final approval.
2. Taylor Maramara: manuscript writing, and final approval.
3. Paige Blinn: manuscript writing, and final approval.
4. Daniel Lee: concept and design, data analysis, manuscript writing, and final approval.
5. Jamie Huston: Collection and assembly of data and final approval.
6. Ravi Shridhar: Concept and design, data analysis and interpretation, manuscript writing, and final approval.
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