Outcomes after minimally invasive esophagectomy

Review of over 1000 patients

James D. Luketich, Arjun Pennathur, Omar Awais, Ryan M. Levy, Samuel Keeley, Manisha Shende, Neil A. Christie, Benny Weksler, Rodney J. Landreneau, Ghulam Abbas, Matthew J. Schuchert, Katie S. Nason

Research output: Contribution to journalArticle

379 Citations (Scopus)

Abstract

Background: Esophagectomy is a complex operation and is associated with significant morbidity and mortality. In an attempt to lower morbidity, we have adopted a minimally invasive approach to esophagectomy. Objectives: Our primary objective was to evaluate the outcomes of minimally invasive esophagectomy (MIE) in a large group of patients. Our secondary objective was to compare the modified McKeown minimally invasive approach (videothoracoscopic surgery, laparoscopy, neck anastomosis [MIE-neck]) with our current approach, a modified Ivor Lewis approach (laparoscopy, videothoracoscopic surgery, chest anastomosis [MIE-chest]). Methods: We reviewed 1033 consecutive patients undergoing MIE. Elective operation was performed on 1011 patients; 22 patients with nonelective operations were excluded. Patients were stratified by surgical approach and perioperative outcomes analyzed. The primary endpoint studied was 30-day mortality. Results: The MIE-neck was performed in 481 (48%) and MIE-Ivor Lewis in 530 (52%). Patients undergoing MIE-Ivor Lewis were operated in the current era. The median number of lymph nodes resected was 21. The operative mortality was 1.68%. Median length of stay (8 days) and ICU stay (2 days) were similar between the 2 approaches. Mortality rate was 0.9%, and recurrent nerve injury was less frequent in the Ivor Lewis MIE group (P < 0.001). Conclusions: MIE in our center resulted in acceptable lymph node resection, postoperative outcomes, and low mortality using either an MIE-neck or an MIE-chest approach. The MIE Ivor Lewis approach was associated with reduced recurrent laryngeal nerve injury and mortality of 0.9% and is now our preferred approach. Minimally invasive esophagectomy can be performed safely, with good results in an experienced center.

Original languageEnglish (US)
Pages (from-to)95-103
Number of pages9
JournalAnnals of surgery
Volume256
Issue number1
DOIs
StatePublished - Jul 1 2012

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Esophagectomy
Mortality
Neck
Thorax
Laparoscopy
Recurrent Laryngeal Nerve Injuries
Lymph Nodes
Morbidity

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Luketich, J. D., Pennathur, A., Awais, O., Levy, R. M., Keeley, S., Shende, M., ... Nason, K. S. (2012). Outcomes after minimally invasive esophagectomy: Review of over 1000 patients. Annals of surgery, 256(1), 95-103. https://doi.org/10.1097/SLA.0b013e3182590603

Outcomes after minimally invasive esophagectomy : Review of over 1000 patients. / Luketich, James D.; Pennathur, Arjun; Awais, Omar; Levy, Ryan M.; Keeley, Samuel; Shende, Manisha; Christie, Neil A.; Weksler, Benny; Landreneau, Rodney J.; Abbas, Ghulam; Schuchert, Matthew J.; Nason, Katie S.

In: Annals of surgery, Vol. 256, No. 1, 01.07.2012, p. 95-103.

Research output: Contribution to journalArticle

Luketich, JD, Pennathur, A, Awais, O, Levy, RM, Keeley, S, Shende, M, Christie, NA, Weksler, B, Landreneau, RJ, Abbas, G, Schuchert, MJ & Nason, KS 2012, 'Outcomes after minimally invasive esophagectomy: Review of over 1000 patients', Annals of surgery, vol. 256, no. 1, pp. 95-103. https://doi.org/10.1097/SLA.0b013e3182590603
Luketich JD, Pennathur A, Awais O, Levy RM, Keeley S, Shende M et al. Outcomes after minimally invasive esophagectomy: Review of over 1000 patients. Annals of surgery. 2012 Jul 1;256(1):95-103. https://doi.org/10.1097/SLA.0b013e3182590603
Luketich, James D. ; Pennathur, Arjun ; Awais, Omar ; Levy, Ryan M. ; Keeley, Samuel ; Shende, Manisha ; Christie, Neil A. ; Weksler, Benny ; Landreneau, Rodney J. ; Abbas, Ghulam ; Schuchert, Matthew J. ; Nason, Katie S. / Outcomes after minimally invasive esophagectomy : Review of over 1000 patients. In: Annals of surgery. 2012 ; Vol. 256, No. 1. pp. 95-103.
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abstract = "Background: Esophagectomy is a complex operation and is associated with significant morbidity and mortality. In an attempt to lower morbidity, we have adopted a minimally invasive approach to esophagectomy. Objectives: Our primary objective was to evaluate the outcomes of minimally invasive esophagectomy (MIE) in a large group of patients. Our secondary objective was to compare the modified McKeown minimally invasive approach (videothoracoscopic surgery, laparoscopy, neck anastomosis [MIE-neck]) with our current approach, a modified Ivor Lewis approach (laparoscopy, videothoracoscopic surgery, chest anastomosis [MIE-chest]). Methods: We reviewed 1033 consecutive patients undergoing MIE. Elective operation was performed on 1011 patients; 22 patients with nonelective operations were excluded. Patients were stratified by surgical approach and perioperative outcomes analyzed. The primary endpoint studied was 30-day mortality. Results: The MIE-neck was performed in 481 (48{\%}) and MIE-Ivor Lewis in 530 (52{\%}). Patients undergoing MIE-Ivor Lewis were operated in the current era. The median number of lymph nodes resected was 21. The operative mortality was 1.68{\%}. Median length of stay (8 days) and ICU stay (2 days) were similar between the 2 approaches. Mortality rate was 0.9{\%}, and recurrent nerve injury was less frequent in the Ivor Lewis MIE group (P < 0.001). Conclusions: MIE in our center resulted in acceptable lymph node resection, postoperative outcomes, and low mortality using either an MIE-neck or an MIE-chest approach. The MIE Ivor Lewis approach was associated with reduced recurrent laryngeal nerve injury and mortality of 0.9{\%} and is now our preferred approach. Minimally invasive esophagectomy can be performed safely, with good results in an experienced center.",
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