Background and Objectives:The safety of minimally invasive esophagectomy (MIE) outside of high-volume centers has not been studied. Therefore, we evaluated our experience with the introduction of MIE in the setting of a community teaching hospital.Methods:A retrospective cohort of all elective esophagectomy patients treated in a community hospital from 2008 through 2015 was evaluated (n = 57; open = 31 vs MIE = 26). Clavien-Dindo complication grades were recorded prospectively.Results:Mean age was 63 ± 11 years (range, 30–83), mean Charlson comorbidity index was 4.5 ± 1.7 and proportion of ASA score ≥3 was 87%. The groups did not differ in age, gender distribution, or comorbidity indices. There were 108 complications observed, including 2 deaths (3.5%, both coronary events). Postoperative complication rate was 77.1% and serious complication rate (grades 3 and 4) was 50.8% in the entire cohort. The rate of serious complications was similar (58% for open vs 42% for MIE group; 2-sided P = .089). MIE operations were longer (342 ± 109 vs 425 ± 74 minutes; P = .001). Length of stay trended toward not being significantly shorter among MIE cases (15 ± 13 vs 12 ± 12 days; P = .071). Logistic regression models including MIE status were not predictive of complications.Conclusions:Introduction of MIE esophagectomy in our community hospital was associated with prolonged operative time, but no detectable adverse outcomes. Length of stay was nonsignificantly shortened by the use of MIS esophagectomy.

Graphical abstract

overall morbidity (51.3% vs 3.9%, respectively, p<0.05) and mortality (1.2% vs 0.1% respectively, p<0.05). Multivariate analysis identified risk factors for reoperation, which included American Society of Anesthesiologists (ASA) class > 2 (adjusted odds ratio [AOR] 1.217; 95% CI, 1.014-1.460, p<0.05), preoperative COPD (AOR 1.795; 95% CI, 1.192-2.703, p<0.05), and dependent functional status (AOR 2.230; 95% CI, 1.113-4.466, p<0.05). Compared with those having RYGB, patients with SG were 50% less likely to need a reoperation (AOR 0.505; 95% CI, 0.430-0.592, p<0.05). Postoperative hemorrhage (10%) was the most common indication for reoperation, and diagnostic laparoscopy (16%) was the most common reoperative procedure. CONCLUSIONS: Unplanned reoperation after bariatric surgery is a rare but devastating complication causing a 10-fold increase in postoperative morbidity and mortality. Patients with RYGB are twice as likely to require a reoperation compared with those having SG.

No abstract

No abstract