A standardized health system approach to Ivor Lewis esophagectomy

With the robotic approach to Ivor Lewis esophagectomy gaining popularity, concern has been raised regarding a learning curve resulting in increased complication rates. This study aimed to present the results of a standardized health system approach to Ivor Lewis esophagectomy and the transition to the robotic-assisted technique.

A retrospective review of our institutional database, along with individual patient chart review, was conducted. Patients who underwent Ivor Lewis esophagectomy at our institution from June 1, 2017, to July 7, 2023, were included. Preoperative patient characteristics and operative outcomes were recorded. The outcomes of the 60 most recent laparoscopic/thoracoscopic minimally invasive esophagectomies (MIEs) were compared with those of the first 60 robotic-assisted esophagectomies (RAMIEs).

Over the study period, 145 patients were included for review. Of the Ivor Lewis esophagectomies, 5 were performed open, 80 were performed laparoscopic/thoracoscopic, and 60 were performed robotic assisted. The length of stay ranged from 5 to 84 days, with a median of 7 days. Leak from the esophagogastric anastomosis occurred in 5 cases (3.4%). Pulmonary complications occurred in 21 cases (14.5%). There were no 90-day mortality events. In the subset analysis, there was an increased mean operative time in the RAMIE group (443 vs 504 min [95% CI, -88.1 to -34.2]), but there were no significant differences in perioperative outcomes between the MIE and RAMIE groups.

A standardized approach to perioperative management and operative technique can allow for low morbidity and mortality after Ivor Lewis esophagectomy and facilitate transitioning to a robotic-assisted technique without increasing complications.