Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer: A Comparison of Early Surgical Outcomes from the Society of Thoracic Surgeons National Database

Smita Sihag, Andrzej S. Kosinski, Henning A. Gaissert, Cameron D. Wright, Paul Schipper

    Research output: Contribution to journalArticle

    71 Citations (Scopus)

    Abstract

    Background Open esophagectomy results in significant morbidity and mortality. Minimally invasive esophagectomy (MIE) has become increasingly popular at specialized centers with the aim of improving perioperative outcomes. Numerous single-institution studies suggest MIE may offer lower short-term morbidity. The two approaches are compared using a large, multiinstitutional database. Methods The Society of Thoracic Surgeons (STS) National Database (v2.081) was queried for all resections performed for esophageal cancer between 2008 and 2011 (n = 3,780). Minimally invasive approaches included both transhiatal (n = 214) and Ivor Lewis (n = 600), and these were compared directly with open transhiatal (n = 1,065) and Ivor Lewis (n = 1,291) procedures, respectively. Thirty-day outcomes were examined using nonparametric statistical testing. Results Both open and MIE groups were similar in terms of preoperative risk factors. Morbidity and all-cause mortality were equivalent at 62.2% and 3.8%. MIE was associated with longer median procedure times (443.0 versus 312.0 minutes; p <0.001), but a shorter median length of hospital stay (9.0 versus 10.0 days; p <0.001). Patients who underwent MIE had higher rates of reoperation (9.9% versus 4.4%; p <0.001) and empyema (4.1% versus 1.8%; p <0.001). Open technique led to an increased rate of wound infections (6.3% versus 2.3%; p <0.001), postoperative transfusion (18.7% versus 14.1%; p = 0.002), and ileus (4.5% versus 2.2%; p = 0.002). Propensity score-matched analysis confirmed these findings. High- and low-volume centers had similar outcomes. Conclusions Early results from the STS National Database indicate that MIE is safe, with comparable rates of morbidity and mortality as open technique. Longer procedure times and a higher rate of reoperation following MIE may reflect a learning curve.

    Original languageEnglish (US)
    Pages (from-to)1281-1288
    Number of pages8
    JournalAnnals of Thoracic Surgery
    Volume101
    Issue number4
    DOIs
    StatePublished - Apr 1 2016

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    Esophagectomy
    Esophageal Neoplasms
    Databases
    Morbidity
    Reoperation
    Mortality
    Length of Stay
    Propensity Score
    Empyema
    Learning Curve
    Ileus
    Wound Infection
    Thorax

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Surgery
    • Pulmonary and Respiratory Medicine

    Cite this

    Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer : A Comparison of Early Surgical Outcomes from the Society of Thoracic Surgeons National Database. / Sihag, Smita; Kosinski, Andrzej S.; Gaissert, Henning A.; Wright, Cameron D.; Schipper, Paul.

    In: Annals of Thoracic Surgery, Vol. 101, No. 4, 01.04.2016, p. 1281-1288.

    Research output: Contribution to journalArticle

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    abstract = "Background Open esophagectomy results in significant morbidity and mortality. Minimally invasive esophagectomy (MIE) has become increasingly popular at specialized centers with the aim of improving perioperative outcomes. Numerous single-institution studies suggest MIE may offer lower short-term morbidity. The two approaches are compared using a large, multiinstitutional database. Methods The Society of Thoracic Surgeons (STS) National Database (v2.081) was queried for all resections performed for esophageal cancer between 2008 and 2011 (n = 3,780). Minimally invasive approaches included both transhiatal (n = 214) and Ivor Lewis (n = 600), and these were compared directly with open transhiatal (n = 1,065) and Ivor Lewis (n = 1,291) procedures, respectively. Thirty-day outcomes were examined using nonparametric statistical testing. Results Both open and MIE groups were similar in terms of preoperative risk factors. Morbidity and all-cause mortality were equivalent at 62.2{\%} and 3.8{\%}. MIE was associated with longer median procedure times (443.0 versus 312.0 minutes; p <0.001), but a shorter median length of hospital stay (9.0 versus 10.0 days; p <0.001). Patients who underwent MIE had higher rates of reoperation (9.9{\%} versus 4.4{\%}; p <0.001) and empyema (4.1{\%} versus 1.8{\%}; p <0.001). Open technique led to an increased rate of wound infections (6.3{\%} versus 2.3{\%}; p <0.001), postoperative transfusion (18.7{\%} versus 14.1{\%}; p = 0.002), and ileus (4.5{\%} versus 2.2{\%}; p = 0.002). Propensity score-matched analysis confirmed these findings. High- and low-volume centers had similar outcomes. Conclusions Early results from the STS National Database indicate that MIE is safe, with comparable rates of morbidity and mortality as open technique. Longer procedure times and a higher rate of reoperation following MIE may reflect a learning curve.",
    author = "Smita Sihag and Kosinski, {Andrzej S.} and Gaissert, {Henning A.} and Wright, {Cameron D.} and Paul Schipper",
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    T1 - Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer

    T2 - A Comparison of Early Surgical Outcomes from the Society of Thoracic Surgeons National Database

    AU - Sihag, Smita

    AU - Kosinski, Andrzej S.

    AU - Gaissert, Henning A.

    AU - Wright, Cameron D.

    AU - Schipper, Paul

    PY - 2016/4/1

    Y1 - 2016/4/1

    N2 - Background Open esophagectomy results in significant morbidity and mortality. Minimally invasive esophagectomy (MIE) has become increasingly popular at specialized centers with the aim of improving perioperative outcomes. Numerous single-institution studies suggest MIE may offer lower short-term morbidity. The two approaches are compared using a large, multiinstitutional database. Methods The Society of Thoracic Surgeons (STS) National Database (v2.081) was queried for all resections performed for esophageal cancer between 2008 and 2011 (n = 3,780). Minimally invasive approaches included both transhiatal (n = 214) and Ivor Lewis (n = 600), and these were compared directly with open transhiatal (n = 1,065) and Ivor Lewis (n = 1,291) procedures, respectively. Thirty-day outcomes were examined using nonparametric statistical testing. Results Both open and MIE groups were similar in terms of preoperative risk factors. Morbidity and all-cause mortality were equivalent at 62.2% and 3.8%. MIE was associated with longer median procedure times (443.0 versus 312.0 minutes; p <0.001), but a shorter median length of hospital stay (9.0 versus 10.0 days; p <0.001). Patients who underwent MIE had higher rates of reoperation (9.9% versus 4.4%; p <0.001) and empyema (4.1% versus 1.8%; p <0.001). Open technique led to an increased rate of wound infections (6.3% versus 2.3%; p <0.001), postoperative transfusion (18.7% versus 14.1%; p = 0.002), and ileus (4.5% versus 2.2%; p = 0.002). Propensity score-matched analysis confirmed these findings. High- and low-volume centers had similar outcomes. Conclusions Early results from the STS National Database indicate that MIE is safe, with comparable rates of morbidity and mortality as open technique. Longer procedure times and a higher rate of reoperation following MIE may reflect a learning curve.

    AB - Background Open esophagectomy results in significant morbidity and mortality. Minimally invasive esophagectomy (MIE) has become increasingly popular at specialized centers with the aim of improving perioperative outcomes. Numerous single-institution studies suggest MIE may offer lower short-term morbidity. The two approaches are compared using a large, multiinstitutional database. Methods The Society of Thoracic Surgeons (STS) National Database (v2.081) was queried for all resections performed for esophageal cancer between 2008 and 2011 (n = 3,780). Minimally invasive approaches included both transhiatal (n = 214) and Ivor Lewis (n = 600), and these were compared directly with open transhiatal (n = 1,065) and Ivor Lewis (n = 1,291) procedures, respectively. Thirty-day outcomes were examined using nonparametric statistical testing. Results Both open and MIE groups were similar in terms of preoperative risk factors. Morbidity and all-cause mortality were equivalent at 62.2% and 3.8%. MIE was associated with longer median procedure times (443.0 versus 312.0 minutes; p <0.001), but a shorter median length of hospital stay (9.0 versus 10.0 days; p <0.001). Patients who underwent MIE had higher rates of reoperation (9.9% versus 4.4%; p <0.001) and empyema (4.1% versus 1.8%; p <0.001). Open technique led to an increased rate of wound infections (6.3% versus 2.3%; p <0.001), postoperative transfusion (18.7% versus 14.1%; p = 0.002), and ileus (4.5% versus 2.2%; p = 0.002). Propensity score-matched analysis confirmed these findings. High- and low-volume centers had similar outcomes. Conclusions Early results from the STS National Database indicate that MIE is safe, with comparable rates of morbidity and mortality as open technique. Longer procedure times and a higher rate of reoperation following MIE may reflect a learning curve.

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