Comparative Perioperative Outcomes by Esophagectomy Surgical Technique
Kenneth L Meredith1, Taylor Maramara2, Paige Blinn2
1Gastrointestinal Oncology, Florida State University College Of Medicine/Sarasota Memorial Health Care System, 1950 Arlington Street, Suite 101, Sarasota, FL, 34239, USA. kensurg@hotmail.com.
Summary
Minimally invasive esophagectomy techniques, particularly robotic-assisted Ivor Lewis (RAIL) and minimally invasive esophagectomy Ivor Lewis (MIE IVL), show reduced complications. These advanced surgical approaches offer improved outcomes for esophageal cancer patients.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Surgical resection is a cornerstone of curative treatment for esophageal cancer.
- Numerous surgical techniques for esophagectomy exist, leading to variations in patient outcomes.
- Standardizing and evaluating these techniques is crucial for optimizing patient care.
Purpose of the Study:
- To compare perioperative outcomes of different esophagectomy surgical techniques.
- To evaluate the impact of surgical approach on complication rates and mortality.
- To identify superior techniques for esophageal cancer management.
Main Methods:
- Analysis of a prospectively managed esophagectomy database (1996-2016).
- Comparison of transhiatal versus Ivor-Lewis approaches.
- Comparison of minimally invasive esophagectomy (MIE) versus open procedures.
- Data collection included demographics, tumor characteristics, operative details, and postoperative outcomes.
Main Results:
- 856 patients underwent esophagectomy; 543 (63.4%) received neoadjuvant therapy.
- Minimally invasive esophagectomy (MIE) was performed in 35.2% of cases, open in 58.8%.
- No significant difference in mortality (1.5%) across techniques.
- RAIL and MIE IVL showed significantly fewer overall and pulmonary complications (p<0.001).
- Ivor Lewis (IVL) approaches had fewer anastomotic leaks than transhiatal (p=0.03).
- MIE patients had less blood loss and higher lymph node yields but longer operative times.
Conclusions:
- Minimally invasive and robotic Ivor Lewis techniques offer significant advantages in reducing postoperative complications.
- Oncologic outcomes also appear favorable with MIE IVL and RAIL approaches.
- These findings support the adoption of advanced minimally invasive techniques in esophageal cancer surgery.
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