E. N. Konrade1, R. Morse1, T. Mouw2, M. Moreno1, P. DiPasco2, M. Al-kasspooles2 1University of Kansas,School Of Medicine,Kansas City, KS, USA 2University of Kansas Medical Center,Department Of Surgery,Kansas City, KS, USA
Introduction: Although the disparity between various esophagectomy approaches have previously been described, there is a paucity of data describing perioperative outcomes and morbidity with the changing demographics of esophageal cancer. As adenocarcinoma surpasses squamous cell carcinoma as the dominant pathologic subtype, a concern has been raised that older studies are no longer applicable.
Methods: Using the University of Kansas Medical Center (KUMC) database (2007 to 2018), we identified 245 patients who underwent esophagectomy for esophageal cancer. Patients were then stratified into three groups based on the esophagectomy approach and included: Ivor-Lewis (transthoracic), transhiatal esophagectomy (THE) and minimally invasive esophagectomy (MIE). We evaluated operative mortality, length of stay and morbidity for each approach. As a surrogate for postoperative quality of life, we also assessed the subsequent need for anastomotic dilation and stenting.
Results: 53 patients underwent the Ivor-Lewis approach (22%), 62 patients underwent the minimally invasive approach (25%), and 130 patients underwent the THE approach (53%). 81% percent of the patients were male, with an average age of 62.5 years and average BMI of 28.2. 78% of patients had adenocarcinoma with 73% having neoadjuvant chemoradiation. Median operative time was 336 minutes. 5.7% of Ivor-Lewis patients developed an anastomotic leak, while 9.4% and 15.9% leak rates were observed in the MIE and THE groups, respectively. Stenosis developed in 5.3% of Ivor-Lewis, 6.9% of MIE and 12.7% of THE patients. If a leak was present, stenosis occurred in 2.9% of Ivor-Lewis, 4.9% of MIE and 11% of THE patients. Median comprehensive complication index scores were 26.2, 31.4 and 25.7 for Ivor-Lewis, MIE, and THE, respectively. The average length of stay was 20 days for MIE, 15 days for THE and 14 days for Ivor-Lewis. The readmission rate was 35% with average time to readmit 37.7 days, 20.7 days, and 27.5 days for Ivor-Lewis, MIE and THE respectively.
Conclusion: MIE was associated with a longer length of hospital stay and increased perioperative complications as compared to Ivor-Lewis or transhiatal approaches. Time to readmission was also shorter with MIE.