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Standardizing procedures improves and homogenizes short-term outcomes after minimally invasive esophagectomy

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Abstract

Purpose

Esophageal cancer is one of the deadliest cancers worldwide. Esophagectomy with lymphadenectomy is regarded as the only curative option for resectable esophageal cancer, but it is associated with high morbidity and mortality. Multidisciplinary team (MDT) management was recently associated with improved outcomes after surgery for esophageal cancer. The aim of this study was to investigate the effect of standardizing procedures for minimally invasive esophagectomy (MIE) in the MDT setting.

Methods

This was a case-matched control study of 154 patients with esophageal cancer who underwent thoracoscopic esophagectomy in the prone position (TEP) between 2012 and 2016. Surgery was performed by two attending surgeons (surgeons A and B) who began working together in the same MDT in 2015. At that time, the following surgical procedures were standardized between surgeons A and B: mediastinal lymphadenectomy, abdominal procedures, and estimation of the blood supply of the gastric conduit. Short-term outcomes were compared between the following paired groups using propensity scores: surgeon A’s pre- and post-standardization groups, surgeon B’s pre- and post-standardization groups, and surgeon A’s post-standardization group and surgeon B’s post-standardization group.

Results

Concerning surgeon A, the estimated total blood loss in the post-standardization group (142 ± 87 mL) was significantly lower than that in the pre-standardization group (376 ± 215 mL, P = 0.006). The rate of left recurrent laryngeal nerve palsy in the post-standardization group (13%) was significantly lower than that in the pre-standardization group (47%, P = 0.046). Concerning surgeon B, the rate of anastomotic leakage in the post-standardization group (0%) was significantly lower than that in the pre-standardization group (11%, P = 0.039). Comparing the post-standardization groups of surgeons A and B, there were no significant differences in operative outcomes or morbidity.

Conclusions

Standardizing procedures for MIE improved and homogenized surgical short-term outcomes.

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Taro Oshikiri, Tetsu Nakamura, Hiroshi Hasegawa, Masashi Yamamoto, Shingo Kanaji, Kimihiro Yamashita, Takeru Matsuda, Yasuo Sumi, Satoshi Suzuki & Yoshihiro Kakeji

  2. Department of Gastroenterological Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan

    Yasuhiro Fujino & Masahiro Tominaga

Authors
  1. Taro Oshikiri
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  2. Tetsu Nakamura
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  3. Hiroshi Hasegawa
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  4. Masashi Yamamoto
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  5. Shingo Kanaji
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  6. Kimihiro Yamashita
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  7. Takeru Matsuda
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  8. Yasuo Sumi
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  9. Yasuhiro Fujino
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  10. Masahiro Tominaga
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  11. Satoshi Suzuki
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  12. Yoshihiro Kakeji
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Corresponding author

Correspondence to Taro Oshikiri.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Oshikiri, T., Nakamura, T., Hasegawa, H. et al. Standardizing procedures improves and homogenizes short-term outcomes after minimally invasive esophagectomy. Langenbecks Arch Surg 403, 221–234 (2018). https://doi.org/10.1007/s00423-018-1661-6

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  • DOI: https://doi.org/10.1007/s00423-018-1661-6

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