Surgeon proficiency and outcomes in esophagectomy: a perspective and comment on an analysis of the Swedish Cancer Registry

Lee, Fred; Sarkaria, Inderpal S.; Luketich, James D.

doi:10.21037/jtd.2017.02.92

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…2 As treatment options and surgical proficiency have evolved over the past 50 years, all-cause and disease-related mortality have slowly improved. 3 The last 20 years in particular has seen significant increases in the utilization of minimally invasive surgical techniques for esophagectomy, leading to a significant reduction in morbidity and hospital length of stay. 4 Despite the success of minimally invasive esophagectomy (MIE), a small percentage of patients require conversion to an open procedure.…”

Section: Introductionmentioning

confidence: 99%

Lower Rates of Unplanned Conversion to Open in Robotic Approach to Esophagectomy for Cancer

Silva

Putnam

et al. 2022

The American Surgeon™

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Background Minimally invasive approaches to esophagectomy have gained popularity worldwide; however, unplanned conversion to an open approach is not uncommon. This study sought to investigate risk factors associated with converting to an open approach and to evaluate outcomes following conversion. Methods Patients undergoing minimally invasive esophagectomy (MIE) for cancer were identified using the 2016-2019 Procedure Targeted NSQIP Database. Multivariable, stepwise logistic regression analysis was performed to investigate factors associated with unplanned conversion to open esophagectomy. Propensity-matched comparison of robotic (RAMIE) to traditional MIE was performed. Results A total of 1347 patients were included; 140 patients (10%) underwent conversion to open. Morbid obesity, diabetes, hypertension, American Society of Anesthesiologists class, and squamous cell carcinoma were associated with a higher likelihood of conversion. A robotic approach was associated with a lower likelihood of conversion to open (OR .57, 95% CI 0.32-.99). On multivariable analysis, squamous cell carcinoma pathology was the only variable independently associated with higher odds of conversion (OR 2.66, 95% CI 1.02-6.98). Propensity-matched comparison of RAMIE vs MIE showed no significant difference in conversion rate (6.5% vs 9.1%, P = .298), morbidity, or mortality. Discussion A robotic approach to esophagectomy was associated with a lower likelihood of unplanned conversion to open, and patients who were converted to open experienced worse outcomes. Future studies should aim to determine why a robotic esophagectomy approach may lead to fewer open conversions as it may be an underappreciated benefit of this newest operative approach.

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Section: Introductionmentioning

confidence: 99%

Lower Rates of Unplanned Conversion to Open in Robotic Approach to Esophagectomy for Cancer

Silva

Putnam

et al. 2022

The American Surgeon™

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“…Coordination of complex care and increased efficiencies in healthcare for improved patient outcomes is an important underpinning of health care reform. 16 -18…”

Section: Introductionmentioning

confidence: 99%

“…Coordination of complex care and increased efficiencies in healthcare for improved patient outcomes is an important underpinning of health care reform. [16][17][18] Although multidisciplinary surgical collaboration is thought to improve patient outcomes, the supporting evidence is not substantial and often lacking. This analysis aims to explore the relationship between an on-site cardiac surgery program and short-term general thoracic surgical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Effect of On-Site Cardiac Surgery Program on General Thoracic Surgery Outcomes

Nguyen

Selevany

Turner

et al. 2021

Innovations�(Phila)

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Objective Limited data exist exploring the relationship between multispecialty surgical collaboration and outcomes in general thoracic surgery. To address this, the Nationwide Inpatient Sample (NIS) was analyzed to determine whether the presence of an on-site cardiac surgery program is associated with improved general thoracic surgery outcomes. Methods The NIS (1999-2008) was utilized to identify 389,959 patients who had a lobectomy, pneumonectomy, or esophagectomy. Short-term outcomes of patients undergoing these procedures were compared between hospitals with and without an on-site cardiac surgery program. Univariate and multivariate analyses were performed to determine patient and hospital predictors of mortality and morbidity. Results During the study period, patients undergoing lobectomy ( n = 314,130), pneumonectomy ( n = 34,860), or esophagectomy ( n = 40,969) were identified. Univariate analysis demonstrated lower mortality for lobectomy ( P < 0.001) and esophagectomy ( P < 0.001) but not pneumonectomy ( P = 0.344) in hospitals with a cardiac surgery program. All-cause morbidity was significantly lower for all 3 procedures in hospitals with a cardiac surgery program. However, multivariate analysis demonstrated that a cardiac surgery program was not an independent predictor when adjusted for known confounders, particularly procedure volume and hospital academic teaching status. Conclusions The presence of an on-site cardiac surgery program is not in and of itself associated with improved general thoracic surgery outcomes. The presence of a cardiac surgery program is likely a surrogate for other known predictors of improved outcomes such as hospital teaching status and procedure volume.

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Thoracoscopic-laparoscopic esophagectomy and two-field lymph node dissection

Wang

Liu

et al. 2019

J. Thorac. Dis

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Surgeon proficiency and outcomes in esophagectomy: a perspective and comment on an analysis of the Swedish Cancer Registry

Cited by 3 publications

References 23 publications

Lower Rates of Unplanned Conversion to Open in Robotic Approach to Esophagectomy for Cancer

Lower Rates of Unplanned Conversion to Open in Robotic Approach to Esophagectomy for Cancer

Effect of On-Site Cardiac Surgery Program on General Thoracic Surgery Outcomes

Thoracoscopic-laparoscopic esophagectomy and two-field lymph node dissection

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