Evolution in the Treatment of Esophageal Disease at a Single Academic Institution

2004-2013

James Dolan, Patrick J. McLaren, Brian S. Diggs, Paul Schipper, Brandon Tieu, Brett Sheppard, Erin Gilbert, Molly A. Conroy, John Hunter

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: Management of benign and malignant esophageal disease has changed rapidly over the past decade. The aim of this study was to analyze evolution in surgical management of esophageal disease at a single academic medical center during this period. Materials and Methods: We reviewed a retrospective cohort of patients who underwent esophagectomy between 2004 and 2013. Patient, institutional, treatment, and outcomes variables were reviewed. Results: 317 patients were analyzed. Median age was 63.5 years; 80% were male. Average inhospital mortality rate was 3.8%. Operative indications changed significantly from 2004 to 2013, with more operations performed for invasive malignancy (77% vs. 95%) and fewer for high-grade dysplasia (12% vs. 3%, P = .008). In 2004, Ivor Lewis esophagectomy was the most common surgical technique, but the three-field technique was the operation of choice in 2013. A minimally invasive approach was used in 19% of cases in 2004 and 100% of cases in 2013 (P < .001). Anastomotic leak ranged from 0% to 21% with no significant difference over the study period (P = .18). Median lymph node harvest increased from seven to 18 nodes from 2004 to 2013 (P = .001). Hospital length of stay decreased from 15 to 8 days (P = .001). In 2013, 79% of patients were discharged to home, compared to 73% in 2004 (P = .04). Discussion: Over the last decade, our treatment of esophageal disease has evolved from a predominantly open Ivor Lewis to a minimally invasive three-field approach. Operations for malignancy have also increased dramatically. Postoperative complications and mortality were not significantly changed, but were consistently low during the latter years of the study.

Original languageEnglish (US)
Pages (from-to)915-923
Number of pages9
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume27
Issue number9
DOIs
StatePublished - Sep 1 2017

Fingerprint

Esophageal Diseases
Esophagectomy
Length of Stay
Anastomotic Leak
Mortality
Therapeutics
Hospital Mortality
Neoplasms
Lymph Nodes

Keywords

  • cancer outcomes
  • esophageal cancer
  • esophagectomy
  • esophagectomy-minimally invasive surgery

ASJC Scopus subject areas

  • Surgery

Cite this

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title = "Evolution in the Treatment of Esophageal Disease at a Single Academic Institution: 2004-2013",
abstract = "Introduction: Management of benign and malignant esophageal disease has changed rapidly over the past decade. The aim of this study was to analyze evolution in surgical management of esophageal disease at a single academic medical center during this period. Materials and Methods: We reviewed a retrospective cohort of patients who underwent esophagectomy between 2004 and 2013. Patient, institutional, treatment, and outcomes variables were reviewed. Results: 317 patients were analyzed. Median age was 63.5 years; 80{\%} were male. Average inhospital mortality rate was 3.8{\%}. Operative indications changed significantly from 2004 to 2013, with more operations performed for invasive malignancy (77{\%} vs. 95{\%}) and fewer for high-grade dysplasia (12{\%} vs. 3{\%}, P = .008). In 2004, Ivor Lewis esophagectomy was the most common surgical technique, but the three-field technique was the operation of choice in 2013. A minimally invasive approach was used in 19{\%} of cases in 2004 and 100{\%} of cases in 2013 (P < .001). Anastomotic leak ranged from 0{\%} to 21{\%} with no significant difference over the study period (P = .18). Median lymph node harvest increased from seven to 18 nodes from 2004 to 2013 (P = .001). Hospital length of stay decreased from 15 to 8 days (P = .001). In 2013, 79{\%} of patients were discharged to home, compared to 73{\%} in 2004 (P = .04). Discussion: Over the last decade, our treatment of esophageal disease has evolved from a predominantly open Ivor Lewis to a minimally invasive three-field approach. Operations for malignancy have also increased dramatically. Postoperative complications and mortality were not significantly changed, but were consistently low during the latter years of the study.",
keywords = "cancer outcomes, esophageal cancer, esophagectomy, esophagectomy-minimally invasive surgery",
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T1 - Evolution in the Treatment of Esophageal Disease at a Single Academic Institution

T2 - 2004-2013

AU - Dolan, James

AU - McLaren, Patrick J.

AU - Diggs, Brian S.

AU - Schipper, Paul

AU - Tieu, Brandon

AU - Sheppard, Brett

AU - Gilbert, Erin

AU - Conroy, Molly A.

AU - Hunter, John

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Introduction: Management of benign and malignant esophageal disease has changed rapidly over the past decade. The aim of this study was to analyze evolution in surgical management of esophageal disease at a single academic medical center during this period. Materials and Methods: We reviewed a retrospective cohort of patients who underwent esophagectomy between 2004 and 2013. Patient, institutional, treatment, and outcomes variables were reviewed. Results: 317 patients were analyzed. Median age was 63.5 years; 80% were male. Average inhospital mortality rate was 3.8%. Operative indications changed significantly from 2004 to 2013, with more operations performed for invasive malignancy (77% vs. 95%) and fewer for high-grade dysplasia (12% vs. 3%, P = .008). In 2004, Ivor Lewis esophagectomy was the most common surgical technique, but the three-field technique was the operation of choice in 2013. A minimally invasive approach was used in 19% of cases in 2004 and 100% of cases in 2013 (P < .001). Anastomotic leak ranged from 0% to 21% with no significant difference over the study period (P = .18). Median lymph node harvest increased from seven to 18 nodes from 2004 to 2013 (P = .001). Hospital length of stay decreased from 15 to 8 days (P = .001). In 2013, 79% of patients were discharged to home, compared to 73% in 2004 (P = .04). Discussion: Over the last decade, our treatment of esophageal disease has evolved from a predominantly open Ivor Lewis to a minimally invasive three-field approach. Operations for malignancy have also increased dramatically. Postoperative complications and mortality were not significantly changed, but were consistently low during the latter years of the study.

AB - Introduction: Management of benign and malignant esophageal disease has changed rapidly over the past decade. The aim of this study was to analyze evolution in surgical management of esophageal disease at a single academic medical center during this period. Materials and Methods: We reviewed a retrospective cohort of patients who underwent esophagectomy between 2004 and 2013. Patient, institutional, treatment, and outcomes variables were reviewed. Results: 317 patients were analyzed. Median age was 63.5 years; 80% were male. Average inhospital mortality rate was 3.8%. Operative indications changed significantly from 2004 to 2013, with more operations performed for invasive malignancy (77% vs. 95%) and fewer for high-grade dysplasia (12% vs. 3%, P = .008). In 2004, Ivor Lewis esophagectomy was the most common surgical technique, but the three-field technique was the operation of choice in 2013. A minimally invasive approach was used in 19% of cases in 2004 and 100% of cases in 2013 (P < .001). Anastomotic leak ranged from 0% to 21% with no significant difference over the study period (P = .18). Median lymph node harvest increased from seven to 18 nodes from 2004 to 2013 (P = .001). Hospital length of stay decreased from 15 to 8 days (P = .001). In 2013, 79% of patients were discharged to home, compared to 73% in 2004 (P = .04). Discussion: Over the last decade, our treatment of esophageal disease has evolved from a predominantly open Ivor Lewis to a minimally invasive three-field approach. Operations for malignancy have also increased dramatically. Postoperative complications and mortality were not significantly changed, but were consistently low during the latter years of the study.

KW - cancer outcomes

KW - esophageal cancer

KW - esophagectomy

KW - esophagectomy-minimally invasive surgery

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U2 - 10.1089/lap.2017.0069

DO - 10.1089/lap.2017.0069

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VL - 27

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EP - 923

JO - Journal of Laparoendoscopic and Advanced Surgical Techniques

JF - Journal of Laparoendoscopic and Advanced Surgical Techniques

SN - 1092-6429

IS - 9

ER -