Benchmark values for transthoracic esophagectomy are not set as the defined °∞best possible°±°™a validation study

Helminen, Olli; Mrena, Johanna; Sihvo, Eero

doi:10.21037/jtd.2018.06.86

Cited by 17 publications

(19 citation statements)

References 41 publications

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“…Strengths of our study are completed learning curves, shown to affect outcomes [22–24], and excellent and stable reported results [13]. Therefore, technical difficulties or variations in the operations are minimal, and differences between groups in outcomes can be assumed to be mainly due to patient-specific factors.…”

Section: Discussionmentioning

confidence: 99%

“…All patients underwent en bloc lymphadenectomy with 3-dimensional optics used since June 2013. Perioperative standardized treatment protocol, extent of lymphadenectomy, and follow-up have been previously described [13, 15]. The median follow-up time was 21 (IQR 11-38) months.…”

Section: Methodsmentioning

confidence: 99%

“…Improved 3-year overall survival has been reported after MIE in a randomized trial, although without statistical significance, suggesting at least comparable oncologic outcome [11]. Nowadays, at many specialized centers, majority of esophagectomies can be performed with minimally invasive approach [12, 13]. Less invasive surgery with proven advantages could even be considered for high-risk patients unsuitable for open surgery.…”

Section: Introductionmentioning

confidence: 99%

“…The aim of the current study was to evaluate the number and the results of MIE for high-risk patients with esophageal cancer considered preoperatively unsuitable for open surgery at a specialized center with previously reported excellent surgical results [13, 15]. Outcomes were compared to those of patients suitable for any surgical approach and to high-risk patients with potentially curative disease not undergoing surgery.…”

Section: Introductionmentioning

confidence: 99%

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Can We Increase the Resection Rate by Minimally Invasive Approach? Experience from 100 Minimally Invasive Esophagectomies

Helminen

Mrena

Sihvo

2019

Journal of Oncology

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Background. Whether we can increase the resection rate of esophageal cancer by minimally invasive esophagectomy (MIE) is unknown. The aim was to report the number and results of MIE in high-risk patients considered unsuitable for open surgery and compare these results to other operated patients and to high-risk patients not undergoing surgery. Methods. At Central Finland Central Hospital, between September 2012 and July 2018, the number of operated MIEs was 100. Of these, 10 patients were prospectively considered unfit for open approach. Nineteen additional high-risk patients with operable disease were ruled out of surgery. The short- and long-term outcomes of these 3 groups were compared. Results. In patients eligible for any approach (n=90), MIE only (n=10), and no surgery (n=19), WHO performance status Grade 0 was observed in 66.7%, 20.0%, and 5.3%, respectively; stair climbing with ≥4 stairs was successfully completed in 77.8%, 50%, and 36.8%, respectively. Between any approach and MIE only groups, rate of major complications (Clavien-Dindo ≥3a) was 6.7% vs. 50.0% (p<0.001) without a difference in median hospital stay (9 vs. 10 days, p=0.542). Readmission rates were 4.4% vs. 30.0% (p=0.003). Survival rates were 100% vs. 80% (p<0.001) at 90-days, 91.5% vs. 66.7% (p=0.005) at 1-year, and 68.9% vs. 53.3% (p=0.024) at 3-years, respectively. In comparison between MIE only and no surgery groups, these survival rates from day of diagnosis were 80% vs. 100%, 68.6% vs. 67.1%, and 45.7% vs. 32.0% (p=0.290), respectively. Conclusions. By operating patients unsuitable for open approach with MIE, the resection rate increased 11.1%. These high-risk patients had, however, higher early morbidity and reduced long-term survival compared to other operated patients. Though there seems to be long-term benefit of surgery compared to nonsurgical patients, we have to be cautious when offering surgery to those considered unfit for open surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Can We Increase the Resection Rate by Minimally Invasive Approach? Experience from 100 Minimally Invasive Esophagectomies

Helminen

Mrena

Sihvo

2019

Journal of Oncology

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“…Positive resection margin, the number of examined lymph nodes and readmission rate were reported as in a previous study (22). R0 resection was defined as complete resection with at least 1 mm resection margin.…”

Section: Patientsmentioning

confidence: 99%

Thirty years of esophageal cancer surgery in Oulu University Hospital

et al. 2021

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Background: Esophagectomy is the mainstay of surgical treatment of esophageal cancer, but involves high operative risk. The aim of this study was to review the evolution surgical treatment of esophageal cancer in Northern Finland, with introduction of minimally invasive techniques.Methods: All elective esophagectomies performed in Oulu University Hospital between years 1987 and 2020 were included. Treatment strategies were compared to current guidelines including staging and use of neoadjuvant therapy, and benchmark values including postoperative morbidity, hospital stay, readmissions and 90-day mortality. Long-term survival was compared to previous national studies. Results: Between years 1987 and 2020 a total of 341 underwent an esophagectomy. Transhiatal resection was performed to 167 (49.3%), Ivor Lewis to 129 (38.1%) and McKeown to 42 (12.4%) patients. MIE was performed to 49 (14.5%) patients. During the past four years 83.7% of locally advanced diseases received neoadjuvant treatment. Since 1987, gradual improvements have occurred especially in incidence of pleural effusion requiring additional drainage procedure (highest in 2011-2013 and in last four years 14.0%),

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Meta-analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy

Schizas

Kosmopoulos

Giannopoulos

et al. 2019

British Journal of Surgery

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Background: Oesophagectomy is associated with high morbidity and mortality rates. New-onset atrial fibrillation (AF) is a frequent complication following oesophagectomy. Several studies have explored whether new-onset AF is associated with adverse events after oesophagectomy.Methods: This review was performed according to PRISMA guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane CENTRAL databases up to 25 November 2018. A meta-analysis was conducted with the use of random-effects modelling. The I 2 statistic was used to assess for heterogeneity.Results: In total, 53 studies including 9087 patients were eligible for analysis. The overall incidence of postoperative AF was 16⋅5 per cent. Coronary artery disease and hypertension were associated with AF, whereas diabetes, smoking and chronic obstructive pulmonary disease were not. Patients with AF had a significantly higher risk of overall postoperative adverse events than those without fibrillation (odds ratio (OR) 5⋅50, 95 per cent c.i. 3⋅51 to 8⋅30), including 30-day mortality (OR 2⋅49, 1⋅70 to 3⋅64), anastomotic leak (OR 2⋅65, 1⋅53 to 4⋅59) and pneumonia (OR 3⋅42, 2⋅39 to 4⋅90).Conclusion: Postoperative AF is frequently observed in patients undergoing oesophagectomy for cancer. It is associated with an increased risk of death and postoperative complications.

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Benchmark values for transthoracic esophagectomy are not set as the defined °∞best possible°±°™a validation study

Abstract: Benchmark values assessing postoperative morbidity after MIE do not represent the defined "best achievable" results after completed learning curves.

Cited by 17 publications

References 41 publications

Can We Increase the Resection Rate by Minimally Invasive Approach? Experience from 100 Minimally Invasive Esophagectomies

Can We Increase the Resection Rate by Minimally Invasive Approach? Experience from 100 Minimally Invasive Esophagectomies

Thirty years of esophageal cancer surgery in Oulu University Hospital

Meta-analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy

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