918 Operative Time for Esophagectomy in Esophageal Cancer: Does Time Really Matter? A Nsqip Study

Nuckles, Brandon; Fatunmbi, Ayobami; Wang, Shengxuan; Blansfield, Joseph

doi:10.1016/s0016-5085(21)02909-7

Cited by 1 publication

(2 citation statements)

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“…Esophagectomy is a highly morbid procedure with long average operative times and high complication rates. Prolonged open esophagectomy operative time is associated with many undesirable post-operative complications, including unplanned reoperation, prolonged intubation, increased anastomotic leak, increased pneumonia, and elevated mortality ( 6 , 7 ). Operative duration is only partially pre-determined by case complexity and machine learning indicates that surgeon factors are influential, potentially modifiable, variables ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

“…There is a lack of robust evidence in the existing literature about the effect of MIE operative times on post-operative outcomes. Understanding this relationship will become increasingly important as MIE becomes the standard approach for more surgeons ( 6 , 9 , 10 ). The aim of this study was to characterize the relationship between MIE operative (cut-to-close) time and key post-operative outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The impact of minimally-invasive esophagectomy operative duration on post-operative outcomes

Tupper,

Roybal,

Jackson

et al. 2024

Front. Surg.

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BackgroundEsophagectomy, an esophageal cancer treatment mainstay, is a highly morbid procedure. Prolonged operative time, only partially predetermined by case complexity, may be uniquely harmful to minimally-invasive esophagectomy (MIE) patients for numerous reasons, including anastomotic leak, tenuous conduit perfusion and protracted single-lung ventilation, but the impact is unknown. This multi-center retrospective cohort study sought to characterize the relationship between MIE operative time and post-operative outcomes.MethodsWe abstracted multi-center data on esophageal cancer patients who underwent MIE from 2010 to 2021. Predictor variables included age, sex, comorbidities, body mass index, prior cardiothoracic surgery, stage, and neoadjuvant therapy. Outcomes included complications, readmissions, and mortality. Association analysis evaluated the relationship between predictor variables and operative time. Multivariate logistic regression characterized the influence of potential predictor variables and operative time on post-operative outcomes. Subgroup analysis evaluated the association between MIE >4 h vs. ≤4 h and complications, readmissions and survival.ResultsFor the 297 esophageal cancer patients who underwent MIE between 2010 and 2021, the median operative duration was 4.8 h [IQR: 3.7–6.3]. For patients with anastomotic leak (5.1%) and 1-year mortality, operative duration was elevated above the median at 6.3 h [IQR: 4.8–8.6], p = 0.008) and 5.3 h [IQR: 4.4–6.8], p = 0.04), respectively. In multivariate logistic regression, each additional hour of operative time increased the odds of anastomotic leak and 1-year mortality by 39% and 19%, respectively.ConclusionsEsophageal cancer is a poor prognosis disease, even with optimal treatment. Operative efficiency, a modifiable surgical variable, may be an important target to improve MIE patient outcomes.

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Section: Introductionmentioning

confidence: 99%