Decreasing Complications After Ivor-Lewis Esophagectomy: Is a Totally Minimally Invasive Approach the Solution?

IF 2 3区医学 Q3 ONCOLOGY

Journal of Surgical Oncology Pub Date : 2025-06-18 DOI:10.1002/jso.70011

Parit T Mavani, Caitlin Sok, Pranay S Ajay, Yichun Cao, Alicia M Bonanno, Kenneth Cardona, Felix G Fernandez, Seth D Force, Onkar V Khullar, Maria C Russell, Charles A Staley, Mihir M Shah, David A Kooby, Manu S Sancheti

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引用次数: 0

Abstract

Background: Despite improvements over time, Ivor Lewis Esophagectomy (ILE), a potentially curative surgical option for patients with invasive esophageal cancer, carries high morbidity and mortality. We analyzed postoperative outcomes in patients undergoing ILE at our institution, comparing open (OE), hybrid (HE), and totally minimally invasive (TMIE) approaches.

Methods: We reviewed the records of patients who underwent elective ILE for benign or malignant pathology at our institution (2018-2022). Patients who underwent transhiatal or McKeown esophagectomy, as well as those undergoing emergent procedures, were excluded. Factors associated with major postoperative complications (Clavien-Dindo Grade ≥ 3) were assessed using multivariable analysis (MVA).

Results: Of 260 patients, 135 met the inclusion criteria: 40 (29.6%) underwent OE, 50 (37.0%) underwent HE, and 45 (33.3%) underwent TMIE. Median length of stay was shorter for patients undergoing TMIE compared to OE and HE (9 vs. 12 and 13 days, p < 0.001). A higher major postoperative complication rate was noted in patients undergoing OE and HE compared to TMIE (32.5% and 36% vs. 13.3%) (p = 0.03). This result persisted on MVA (OE: aOR 3.4, p = 0.04; HE: aOR 5.5, p = 0.002; reference:TMIE).

Conclusion: A totally minimally invasive approach to Ivor-Lewis Esophagectomy is associated with lower major postoperative complications and shortened length of stay at our institution. Prospective evaluations in the United States population are warranted to optimize and standardize surgical approaches.

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减少Ivor-Lewis食管切除术后的并发症：全微创入路是解决方案吗？

背景：尽管随着时间的推移，Ivor Lewis食管切除术（ILE）作为侵袭性食管癌患者的一种可能治愈的手术选择，具有很高的发病率和死亡率。我们分析了我院接受ILE患者的术后结果，比较了开放（OE）、混合（HE）和完全微创（TMIE）入路。方法：我们回顾了我院（2018-2022）因良性或恶性病理接受选择性ILE的患者记录。接受过经食管切除术或McKeown食管切除术的患者以及接受紧急手术的患者被排除在外。术后主要并发症相关因素（Clavien-Dindo分级≥3）采用多变量分析（MVA）进行评估。结果：260例患者中，135例符合纳入标准：40例（29.6%）行OE， 50例（37.0%）行HE， 45例（33.3%）行TMIE。与OE和HE相比，TMIE患者的中位住院时间更短（9天vs. 12天和13天）。结论：Ivor-Lewis食管切除术的全微创入路与较低的术后主要并发症和缩短的住院时间相关。美国人群的前瞻性评估有必要优化和标准化手术入路。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Oncology 医学-外科

CiteScore

4.70

自引率

4.00%

发文量

367

审稿时长

2 months

期刊介绍： The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.