Thoracic: Esophageal CancerMinimally invasive surgery is associated with decreased postoperative complications after esophagectomy
Graphical abstract
Section snippets
Ethical Oversight
The Colorado Multiple Institutional Review Board determined this study exempt from review because it used publicly available deidentified data.
Patient Population and Data
This was a retrospective review of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2007 to 2018. The ACS-NSQIP database includes audited, systematically sampled data on patients who underwent surgery, reporting preoperative, intraoperative, and 30-day postoperative data from
Results
We identified 13,587 patients undergoing esophagectomies within the ACS-NSQIP database. Of those, we excluded 130 (1.0%) for undergoing emergency operations, having preoperative sepsis, or requiring a ventilator preoperatively, leaving a total of 13,457 patients (99.0%) for inclusion. Figure 1 shows the visual abstract. There were 11,202 (83.2%) OEs and 2255 (16.8%) MIEs. There were 7611 (56.6%) ILEs, 3348 (24.9%) THEs, and 2498 (18.6%) MKEs. Table 1 shows the demographic information of the
Discussion
We performed a comprehensive analysis of esophagectomy comparing open and minimally invasive approaches of the 3 most common surgical techniques. Patients who underwent MIE had a shorter length of stay and lower risk-adjusted rates of several postoperative complications than patients who underwent OE. Among the esophagectomy techniques, ILE had the lowest rate of complications, followed by THE and then MKE. Among the individual techniques, MIS was associated with lower complications rates for
Conclusions
Patients undergoing MIE have lower rates of adjusted postoperative complications than those undergoing OE. This remained true on subgroup analysis comparing MIE with OE for each of the 3 common surgical techniques evaluated. Given the differences in complication profiles among the 3 techniques when comparing MIE with OE, the benefit of a MIS approach likely stems from a minimally invasive transthoracic approach. Although the rates of most complications were lowest in ILE and highest in MKE, the
References (34)
- et al.
The “best operation” for esophageal cancer?
Ann Thorac Surg
(2010) - et al.
En bloc esophagectomy reduces local recurrence and improves survival compared with transhiatal resection after neoadjuvant therapy for esophageal adenocarcinoma
J Thorac Cardiovasc Surg
(2008) - et al.
A 10-year ACS-NSQIP analysis of trends in esophagectomy practices
J Surg Res
(2020) - et al.
A prospective randomized comparison of transhiatal and transthoracic resection for lower-third esophageal carcinoma
Am J Surg
(1997) - et al.
Minimally invasive esophagectomy versus open esophagectomy: a systematic review and meta-analysis
Eur J Surg Oncol
(2021) - et al.
Outcomes with open and minimally invasive Ivor Lewis esophagectomy after neoadjuvant therapy
Ann Thorac Surg
(2016) - et al.
Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial
Lancet
(2012) - et al.
Minimally invasive esophagectomy provides equivalent survival to open esophagectomy: an analysis of the National Cancer Database
Semin Thorac Cardiovasc Surg
(2017) - et al.
Transhiatal vs transthoracic esophagectomy: a NSQIP analysis of postoperative outcomes and risk factors for morbidity
J Gastrointest Surg
(2017) - et al.
Failure to rescue from surgical complications after trans-thoracic and trans-hiatal esophageal resection: an ACS-NSQIP Study
J Gastrointest Surg
(2021)
Comparative outcomes of transthoracic versus transhiatal esophagectomy
Surgery
The effect of volume on esophageal cancer resections: what constitutes acceptable resection volumes for centers of excellence?
J Thorac Cardiovasc Surg
Ivor Lewis vs McKeown esophagectomy: analysis of operative outcomes from the ACS NSQIP database
Gen Thorac Cardiovasc Surg
Short-term outcomes after esophagectomy at 164 American College of Surgeons National Surgical Quality Improvement Program hospitals: effect of operative approach and hospital-level variation
Arch Surg
Intrathoracic vs cervical anastomosis after totally or hybrid minimally invasive esophagectomy for esophageal cancer: a randomized clinical trial
JAMA Surg
Esophagectomies with thoracic incisions carry increased pulmonary morbidity
JAMA Surg
Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus
N Engl J Med
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This work was supported by an internal grant from the Department of Surgery, University of Colorado School of Medicine. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Drs Dyas and Meguid had full data access to all of the data in the study and take full responsibility for its integrity and the accuracy of analysis. The ACS-NSQIP and participating hospitals are the source of these data; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
The Colorado Multiple Institutional Review Board determined this study exempt from review because it used publicly available deidentified data.