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Updated: Feb 6, 2026

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Operative time in esophagectomy: Does it affect outcomes?

Nakul Valsangkar1, Hai V N Salfity1, Lava Timsina2

  • 1Indiana University School of Medicine Department of General Surgery, Indianapolis, IN.

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|August 19, 2018
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Summary

Longer operative times in esophagectomy increase postoperative complications, especially with transhiatal approaches. Specific operative time cut points can predict outcomes for transhiatal and Ivor-Lewis esophagectomy.

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Area of Science:

  • Surgical Oncology
  • Thoracic Surgery
  • Gastrointestinal Surgery

Background:

  • The impact of operative duration on esophagectomy outcomes remains unclear.
  • Investigating the link between operative time and postoperative complications is crucial for patient care.

Purpose of the Study:

  • To analyze the relationship between operative duration and postoperative outcomes in esophagectomy.
  • To identify if operative time is an independent predictor of complications, regardless of patient comorbidities.

Main Methods:

  • Utilized data from the National Surgical Quality Improvement Program (2010-2015) for esophagectomies with gastric reconstruction.
  • Employed linear and multivariate regression analyses to assess operative duration's correlation with outcomes.
  • Conducted subset analyses based on the specific surgical approach (transhiatal, Ivor-Lewis, McKeown).

Main Results:

  • A total of 5,098 patients were analyzed, with a median operative time of 353 minutes.
  • Longer operative times in transhiatal esophagectomy correlated with increased pneumonia, prolonged intubation, septic shock, reoperation, and mortality.
  • Ivor-Lewis esophagectomy showed correlations with complications but not mortality, while McKeown approach had no significant correlations.

Conclusions:

  • Prolonged operative time adversely impacts postoperative morbidity, with effects varying by surgical approach.
  • Identified critical operative time thresholds: 333 minutes for transhiatal and 422 minutes for Ivor-Lewis esophagectomy.
  • These time cut points can serve as prognostic markers and quality metrics for selected esophagectomy patients.