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Using Benchmarking Standards to Evaluate Transition to Minimally Invasive Esophagectomy
Paul A Carroll1, Nithin Jacob1, Jonathan C Yeung1
1Division of Thoracic Surgery, Toronto General Hospital, University Hospital Network, Toronto, Ontario, Canada.
The Annals of Thoracic Surgery
|September 22, 2019
Summary
Minimally invasive esophagectomy (MIE) offers improved complication rates and complexity compared to open esophagectomy (OE). This study supports MIE as a standard approach for esophageal cancer, advocating for benchmarking against international standards.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Thoracic Surgery
Background:
- Minimally invasive esophagectomy (MIE) is increasingly adopted worldwide, yet complication reporting varies.
- Standardized definitions are crucial for comparing MIE with open esophagectomy (OE).
Purpose of the Study:
- To compare the outcomes and complications of MIE versus OE using standardized definitions.
- To evaluate the feasibility of MIE as a standard surgical approach for esophageal cancer.
Main Methods:
- A prospectively curated database identified 383 patients undergoing esophagectomy between 2007 and 2017.
- Complications were defined by the Esophageal Complications Consensus Group (ECCG) and graded using Clavien-Dindo and comprehensive complication index.
Main Results:
- MIE was performed in 49.6% of patients, with no significant differences in demographics or cancer stage compared to OE.
- The MIE group demonstrated better overall complication frequency, severity, and complexity.
- Specific complication rates (e.g., pneumonia, ICU readmission, atrial fibrillation) and leak grades showed no significant differences between MIE and OE.
Conclusions:
- MIE can be the standard approach for surgical management of esophageal cancer.
- Surgeons should benchmark their MIE outcomes against international standards for consistent quality.
