Minimally invasive surgery is associated with decreased postoperative complications after esophagectomy
Although some studies have compared esophagectomy outcomes by technique or approach, there is opportunity to strengthen our knowledge surrounding these outcomes. We aimed to perform a comprehensive comparison of esophagectomy postoperative complications. We retrospectively reviewed the American Coll...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2023-07, Vol.166 (1), p.268-278 |
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| container_title | The Journal of thoracic and cardiovascular surgery |
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| creator | Dyas, Adam R. Stuart, Christina M. Bronsert, Michael R. Schulick, Richard D. McCarter, Martin D. Meguid, Robert A. |
| description | Although some studies have compared esophagectomy outcomes by technique or approach, there is opportunity to strengthen our knowledge surrounding these outcomes. We aimed to perform a comprehensive comparison of esophagectomy postoperative complications.
We retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program database (2007-2018). Esophagectomies were identified using Current Procedural Terminology codes and grouped by operative technique (Ivor Lewis, transhiatal, McKeown) and surgical approach (minimally invasive vs open esophagectomy). Twelve postoperative complications were compared. Significant complications underwent risk adjustment using multivariate logistic regression.
Analysis was performed on 13,457 esophagectomies: 11,202 (83.2%) open and 2255 (16.8%) minimally invasive. There were 7611 (56.6%) Ivor Lewis, 3348 (24.9%) transhiatal, and 2498 (18.6%) McKeown procedures. There were significant differences among the surgical techniques in 6 of 12 risk-adjusted complications. When comparing the outcomes of minimally invasive techniques, there were only significant differences in 2 of 12 complications: overall morbidity (minimally invasive Ivor Lewis 30.5%, minimally invasive transhiatal 43.4%, minimally invasive McKeown 40.3%, P = .0009) and infections (minimally invasive Ivor Lewis 15.4%, minimally invasive transhiatal 26.0%, minimally invasive McKeown 25.3%, P = .0003). Patients who underwent minimally invasive surgery were less likely to have overall morbidity (odds ratio, 0.68; 95% confidence interval, 0.62-0.75), respiratory complications (odds ratio, 0.77; 95% confidence interval, 0.68-0.87), urinary tract infection (odds ratio, 0.61; 95% confidence interval, 0.43-0.88), renal complications (odds ratio, 0.52; 95% confidence interval, 0.34-0.81), bleeding complications (odds ratio, 0.36; 95% confidence interval, 0.30-0.43), and nonhome discharge (odds ratio, 0.54; 95% confidence interval, 0.45-0.64), and had shorter length of stay (9.7 vs 13.2 days, P |
| doi_str_mv | 10.1016/j.jtcvs.2022.11.026 |
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We retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program database (2007-2018). Esophagectomies were identified using Current Procedural Terminology codes and grouped by operative technique (Ivor Lewis, transhiatal, McKeown) and surgical approach (minimally invasive vs open esophagectomy). Twelve postoperative complications were compared. Significant complications underwent risk adjustment using multivariate logistic regression.
Analysis was performed on 13,457 esophagectomies: 11,202 (83.2%) open and 2255 (16.8%) minimally invasive. There were 7611 (56.6%) Ivor Lewis, 3348 (24.9%) transhiatal, and 2498 (18.6%) McKeown procedures. There were significant differences among the surgical techniques in 6 of 12 risk-adjusted complications. When comparing the outcomes of minimally invasive techniques, there were only significant differences in 2 of 12 complications: overall morbidity (minimally invasive Ivor Lewis 30.5%, minimally invasive transhiatal 43.4%, minimally invasive McKeown 40.3%, P = .0009) and infections (minimally invasive Ivor Lewis 15.4%, minimally invasive transhiatal 26.0%, minimally invasive McKeown 25.3%, P = .0003). Patients who underwent minimally invasive surgery were less likely to have overall morbidity (odds ratio, 0.68; 95% confidence interval, 0.62-0.75), respiratory complications (odds ratio, 0.77; 95% confidence interval, 0.68-0.87), urinary tract infection (odds ratio, 0.61; 95% confidence interval, 0.43-0.88), renal complications (odds ratio, 0.52; 95% confidence interval, 0.34-0.81), bleeding complications (odds ratio, 0.36; 95% confidence interval, 0.30-0.43), and nonhome discharge (odds ratio, 0.54; 95% confidence interval, 0.45-0.64), and had shorter length of stay (9.7 vs 13.2 days, P < .0001).
Patients undergoing minimally invasive esophagectomy have lower rates of postoperative complications regardless of esophagectomy techniques. The minimally invasive approach was associated with reduced complication variance among 3 common esophagectomy techniques.
[Display omitted]</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2022.11.026</identifier><identifier>PMID: 36577613</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>ACS-NSQIP ; esophagectomy ; MIE ; minimally invasive ; robotic surgery</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2023-07, Vol.166 (1), p.268-278</ispartof><rights>2022 The American Association for Thoracic Surgery</rights><rights>Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-ccc82da4b34a474c5defc70a840ab597e78c092810f84914191aef4a20c79ec93</citedby><cites>FETCH-LOGICAL-c359t-ccc82da4b34a474c5defc70a840ab597e78c092810f84914191aef4a20c79ec93</cites><orcidid>0000-0002-2136-8010</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2022.11.026$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3549,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36577613$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dyas, Adam R.</creatorcontrib><creatorcontrib>Stuart, Christina M.</creatorcontrib><creatorcontrib>Bronsert, Michael R.</creatorcontrib><creatorcontrib>Schulick, Richard D.</creatorcontrib><creatorcontrib>McCarter, Martin D.</creatorcontrib><creatorcontrib>Meguid, Robert A.</creatorcontrib><title>Minimally invasive surgery is associated with decreased postoperative complications after esophagectomy</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Although some studies have compared esophagectomy outcomes by technique or approach, there is opportunity to strengthen our knowledge surrounding these outcomes. We aimed to perform a comprehensive comparison of esophagectomy postoperative complications.
We retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program database (2007-2018). Esophagectomies were identified using Current Procedural Terminology codes and grouped by operative technique (Ivor Lewis, transhiatal, McKeown) and surgical approach (minimally invasive vs open esophagectomy). Twelve postoperative complications were compared. Significant complications underwent risk adjustment using multivariate logistic regression.
Analysis was performed on 13,457 esophagectomies: 11,202 (83.2%) open and 2255 (16.8%) minimally invasive. There were 7611 (56.6%) Ivor Lewis, 3348 (24.9%) transhiatal, and 2498 (18.6%) McKeown procedures. There were significant differences among the surgical techniques in 6 of 12 risk-adjusted complications. When comparing the outcomes of minimally invasive techniques, there were only significant differences in 2 of 12 complications: overall morbidity (minimally invasive Ivor Lewis 30.5%, minimally invasive transhiatal 43.4%, minimally invasive McKeown 40.3%, P = .0009) and infections (minimally invasive Ivor Lewis 15.4%, minimally invasive transhiatal 26.0%, minimally invasive McKeown 25.3%, P = .0003). Patients who underwent minimally invasive surgery were less likely to have overall morbidity (odds ratio, 0.68; 95% confidence interval, 0.62-0.75), respiratory complications (odds ratio, 0.77; 95% confidence interval, 0.68-0.87), urinary tract infection (odds ratio, 0.61; 95% confidence interval, 0.43-0.88), renal complications (odds ratio, 0.52; 95% confidence interval, 0.34-0.81), bleeding complications (odds ratio, 0.36; 95% confidence interval, 0.30-0.43), and nonhome discharge (odds ratio, 0.54; 95% confidence interval, 0.45-0.64), and had shorter length of stay (9.7 vs 13.2 days, P < .0001).
Patients undergoing minimally invasive esophagectomy have lower rates of postoperative complications regardless of esophagectomy techniques. The minimally invasive approach was associated with reduced complication variance among 3 common esophagectomy techniques.
[Display omitted]</description><subject>ACS-NSQIP</subject><subject>esophagectomy</subject><subject>MIE</subject><subject>minimally invasive</subject><subject>robotic surgery</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kE9v2zAMxYVhxZp2-wQDBh93sSvJf2QddiiCtiuQopcW2E1QaDpVYFueqGTIt6-ydD3uRJB8jw_8MfZV8EJw0Vxti22EPRWSS1kIUXDZfGALwbXKm7b-9ZEteNrktZTlObsg2nLOFRf6Ezsvm1qpRpQLtnlwkxvtMBwyN-0tuT1mtAsbDGlAmSXy4GzELvvj4kvWIQS0lNrZU_QzBhuPFvDjPDhIjZ-Sq48YMiQ_v9gNQvTj4TM76-1A-OWtXrLn25un5c989Xh3v7xe5VDWOuYA0MrOVuuyspWqoO6wB8VtW3G7rrVC1QLXshW8bystKqGFxb6ykoPSCLq8ZN9Pd-fgf--QohkdAQ6DndDvyEhVa9koqdskLU9SCJ4oYG_mkFCEgxHcHAmbrflL2BwJGyFMIpxc394CdusRu3fPP6RJ8OMkwPTm3mEwBA4nwM6FxMJ03v034BXzIpD7</recordid><startdate>202307</startdate><enddate>202307</enddate><creator>Dyas, Adam R.</creator><creator>Stuart, Christina M.</creator><creator>Bronsert, Michael R.</creator><creator>Schulick, Richard D.</creator><creator>McCarter, Martin D.</creator><creator>Meguid, Robert A.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2136-8010</orcidid></search><sort><creationdate>202307</creationdate><title>Minimally invasive surgery is associated with decreased postoperative complications after esophagectomy</title><author>Dyas, Adam R. ; Stuart, Christina M. ; Bronsert, Michael R. ; Schulick, Richard D. ; McCarter, Martin D. ; Meguid, Robert A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-ccc82da4b34a474c5defc70a840ab597e78c092810f84914191aef4a20c79ec93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>ACS-NSQIP</topic><topic>esophagectomy</topic><topic>MIE</topic><topic>minimally invasive</topic><topic>robotic surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dyas, Adam R.</creatorcontrib><creatorcontrib>Stuart, Christina M.</creatorcontrib><creatorcontrib>Bronsert, Michael R.</creatorcontrib><creatorcontrib>Schulick, Richard D.</creatorcontrib><creatorcontrib>McCarter, Martin D.</creatorcontrib><creatorcontrib>Meguid, Robert A.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dyas, Adam R.</au><au>Stuart, Christina M.</au><au>Bronsert, Michael R.</au><au>Schulick, Richard D.</au><au>McCarter, Martin D.</au><au>Meguid, Robert A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Minimally invasive surgery is associated with decreased postoperative complications after esophagectomy</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2023-07</date><risdate>2023</risdate><volume>166</volume><issue>1</issue><spage>268</spage><epage>278</epage><pages>268-278</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Although some studies have compared esophagectomy outcomes by technique or approach, there is opportunity to strengthen our knowledge surrounding these outcomes. We aimed to perform a comprehensive comparison of esophagectomy postoperative complications.
We retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program database (2007-2018). Esophagectomies were identified using Current Procedural Terminology codes and grouped by operative technique (Ivor Lewis, transhiatal, McKeown) and surgical approach (minimally invasive vs open esophagectomy). Twelve postoperative complications were compared. Significant complications underwent risk adjustment using multivariate logistic regression.
Analysis was performed on 13,457 esophagectomies: 11,202 (83.2%) open and 2255 (16.8%) minimally invasive. There were 7611 (56.6%) Ivor Lewis, 3348 (24.9%) transhiatal, and 2498 (18.6%) McKeown procedures. There were significant differences among the surgical techniques in 6 of 12 risk-adjusted complications. When comparing the outcomes of minimally invasive techniques, there were only significant differences in 2 of 12 complications: overall morbidity (minimally invasive Ivor Lewis 30.5%, minimally invasive transhiatal 43.4%, minimally invasive McKeown 40.3%, P = .0009) and infections (minimally invasive Ivor Lewis 15.4%, minimally invasive transhiatal 26.0%, minimally invasive McKeown 25.3%, P = .0003). Patients who underwent minimally invasive surgery were less likely to have overall morbidity (odds ratio, 0.68; 95% confidence interval, 0.62-0.75), respiratory complications (odds ratio, 0.77; 95% confidence interval, 0.68-0.87), urinary tract infection (odds ratio, 0.61; 95% confidence interval, 0.43-0.88), renal complications (odds ratio, 0.52; 95% confidence interval, 0.34-0.81), bleeding complications (odds ratio, 0.36; 95% confidence interval, 0.30-0.43), and nonhome discharge (odds ratio, 0.54; 95% confidence interval, 0.45-0.64), and had shorter length of stay (9.7 vs 13.2 days, P < .0001).
Patients undergoing minimally invasive esophagectomy have lower rates of postoperative complications regardless of esophagectomy techniques. The minimally invasive approach was associated with reduced complication variance among 3 common esophagectomy techniques.
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| source | ScienceDirect Journals (5 years ago - present) |
| subjects | ACS-NSQIP esophagectomy MIE minimally invasive robotic surgery |
| title | Minimally invasive surgery is associated with decreased postoperative complications after esophagectomy |
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