TY - JOUR
T1 - Defining Benchmarks for Transthoracic Esophagectomy A Multicenter Analysis of Total Minimally Invasive Esophagectomy in Low Risk Patients
AU - Schmidt, Henner M.
AU - Gisbertz, Susanne S.
AU - Moons, Johnny
AU - Rouvelas, Ioannis
AU - Kauppi, Juha
AU - Brown, Andrew
AU - Asti, Emanuele
AU - Luyer, Misha
AU - Lagarde, Sjoerd M.
AU - Berlth, Felix
AU - Philippron, Annouck
AU - Bruns, Christiane
AU - Hölscher, Arnulf
AU - Schneider, Paul M.
AU - Raptis, Dimitri A.
AU - van Berge Henegouwen, Mark I.
AU - Nafteux, Philippe
AU - Nilsson, Magnus
AU - Räsanen, Jari
AU - Palazzo, Francesco
AU - Rosato, Ernest
AU - Mercer, Stuart
AU - Bonavina, Luigi
AU - Nieuwenhuijzen, Grard
AU - Wijnhoven, Bas P. L.
AU - Schröder, Wolfgang
AU - Pattyn, Piet
AU - Grimminger, Peter P.
AU - Gutschow, Christian A.
PY - 2017
Y1 - 2017
N2 - Objective: To define "best possible" outcomes in total minimally invasive transthoracic esophagectomy (ttMIE). Background: TtMIE, performed by experts in patients with low comorbidity, may serve as a benchmark procedure for esophagectomy. Patients and Methods: From a cohort of 1057 ttMIE, performed over a 5-year period in 13 high-volume centers for esophageal surgery, we selected a study group of 334 patients (31.6%) that fulfilled criteria of low comorbidity (American Society of Anesthesiologists score <= 2, WHO/ECOG score <= 1, age <= 65 years, body mass index 19-29 kg/m(2)). Endpoints included postoperative morbidity measured by the Clavien-Dindo classification and the comprehensive complication index. Benchmark values were defined as the 75th percentile of the median outcome parameters of the participating centers to represent best achievable results. Results: Benchmark patients were predominantly male (82.9%) with a median age of 58 years (53-62). High intrathoracic (Ivor Lewis) and cervical esophagogastrostomy (McKeown) were performed in 188 (56.3%) and 146 (43.7%) patients, respectively. Median (IQR) ICU and hospital stay was 0 (0-2) and 12 (9-18) days, respectively. 56.0% of patients developed at least 1 complication, and 26.9% experienced major morbidity (>= grade III), mostly related to pulmonary complications (25.7%), anastomotic leakage (15.9%), and cardiac events (13.5%). Benchmark values at 30 days after hospital discharge were <= 55.7% and <= 30.8% for overall and major complications, <= 18.0% for readmission, <= 3.1% for positive resection margins, and >= 23 for lymph node yield. Benchmarks at 30 and 90 days were <= 1.0% and <= 4.6% for mortality, and <= 40.8 and <= 42.8 for the comprehensive complication index, respectively. Conclusion: This outcome analysis of patients with low comorbidity undergoing ttMIE may serve as a reference to evaluate surgical performance in major esophageal resection
AB - Objective: To define "best possible" outcomes in total minimally invasive transthoracic esophagectomy (ttMIE). Background: TtMIE, performed by experts in patients with low comorbidity, may serve as a benchmark procedure for esophagectomy. Patients and Methods: From a cohort of 1057 ttMIE, performed over a 5-year period in 13 high-volume centers for esophageal surgery, we selected a study group of 334 patients (31.6%) that fulfilled criteria of low comorbidity (American Society of Anesthesiologists score <= 2, WHO/ECOG score <= 1, age <= 65 years, body mass index 19-29 kg/m(2)). Endpoints included postoperative morbidity measured by the Clavien-Dindo classification and the comprehensive complication index. Benchmark values were defined as the 75th percentile of the median outcome parameters of the participating centers to represent best achievable results. Results: Benchmark patients were predominantly male (82.9%) with a median age of 58 years (53-62). High intrathoracic (Ivor Lewis) and cervical esophagogastrostomy (McKeown) were performed in 188 (56.3%) and 146 (43.7%) patients, respectively. Median (IQR) ICU and hospital stay was 0 (0-2) and 12 (9-18) days, respectively. 56.0% of patients developed at least 1 complication, and 26.9% experienced major morbidity (>= grade III), mostly related to pulmonary complications (25.7%), anastomotic leakage (15.9%), and cardiac events (13.5%). Benchmark values at 30 days after hospital discharge were <= 55.7% and <= 30.8% for overall and major complications, <= 18.0% for readmission, <= 3.1% for positive resection margins, and >= 23 for lymph node yield. Benchmarks at 30 and 90 days were <= 1.0% and <= 4.6% for mortality, and <= 40.8 and <= 42.8 for the comprehensive complication index, respectively. Conclusion: This outcome analysis of patients with low comorbidity undergoing ttMIE may serve as a reference to evaluate surgical performance in major esophageal resection
U2 - https://doi.org/10.1097/SLA.0000000000002445
DO - https://doi.org/10.1097/SLA.0000000000002445
M3 - Article
C2 - 28796646
SN - 0003-4932
VL - 266
SP - 814
EP - 821
JO - Annals of surgery
JF - Annals of surgery
IS - 5
ER -