Safety comparison of minimally invasive abdomen-only esophagectomy versus minimally invasive Ivor Lewis esophagectomy: a retrospective cohort study

Christopher P Wang; Michael P Rogers; Gregory Bach; Joseph Sujka; Rahul Mhaskar; Christopher DuCoin

doi:10.1007/s00464-021-08468-0

Safety comparison of minimally invasive abdomen-only esophagectomy versus minimally invasive Ivor Lewis esophagectomy: a retrospective cohort study

Surg Endosc. 2022 Mar;36(3):1887-1893. doi: 10.1007/s00464-021-08468-0. Epub 2021 Apr 6.

Authors

Christopher P Wang¹, Michael P Rogers², Gregory Bach², Joseph Sujka², Rahul Mhaskar³, Christopher DuCoin⁴

Affiliations

¹ University of South Florida Morsani College of Medicine, Tampa, FL, USA.
² Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA.
³ Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
⁴ Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA. cducoin@usf.edu.

PMID: 33825009
DOI: 10.1007/s00464-021-08468-0

Abstract

Background: We report mortality and post-operative complications from esophageal resection in the treatment of gastroesophageal adenocarcinoma or stricture, comparing a minimally invasive abdomen-only esophagectomy (MIAE) approach with a minimally invasive Ivor Lewis esophagectomy (MIILE) approach.

Methods: A single-center retrospective cohort study of patients with esophageal adenocarcinoma or stricture treated by either MIAE or MIILE was conducted. MIAE was offered for strictures less than five centimeters or cancers that were American Joint Committee on Cancer (AJCC) Stage ≤ T2 without lymphadenopathy. Patients treated with these surgical techniques were analyzed to assess pre-operative risk, intra and post-operative variables, adverse events, and overall survival.

Results: This study included 17 patients undergoing MIAE and 32 patients treated with MIILE. There were a fewer median number of lymph nodes resected (p < 0.001) and shorter operative duration (p < 0.001) for MIAE compared to MIILE. MIAE patients also had significantly higher Charlson Comorbidity Index scores and ACS National Surgical Quality Improvement Program (NSQIP) surgical risk values than MIILE patients (p < 0.05). There was no difference in median estimated blood loss, length of stay, pulmonary or cardiac complications between groups. There was no significant difference in 90-day survival.

Conclusion: A minimally invasive abdomen-only approach in a specific patient population is comparable in safety to a minimally invasive Ivor Lewis approach, with associated shorter median operative duration. MIAE patients had significantly greater pre-operative comorbidities and higher calculated peri-operative risk of complication but demonstrated similar post-operative outcomes. This suggests that MIAE may be a suitable surgical approach for treating gastroesophageal adenocarcinoma or stricture in patients deemed unsuitable for MIILE.

Keywords: Abdomen-only esophagectomy; Adenocarcinoma; Ivor Lewis; Minimally invasive esophagectomy; Safety comparison; Stricture.

MeSH terms

Abdomen / pathology
Adenocarcinoma* / complications
Adenocarcinoma* / surgery
Esophageal Neoplasms* / pathology
Esophagectomy / methods
Humans
Minimally Invasive Surgical Procedures / methods
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / surgery
Retrospective Studies
Treatment Outcome