Anton Simorov, MD, Tiffany N Tanner, MD, Rudy P Lackner, MD, Karin P Trujillo, MD, Dmitry Oleynikov, MD, FACS, Mark A Carlson, MD, FACS. Department of Surgery, University of Nebraska Medical Center, Omaha NE.
INTRODUCTION
Some retrospective data have accumulated which suggest improved perioperative outcome with minimally invasive esophagectomy compared to open esophagectomy. The goal of the present study was to compare perioperative outcome of minimally invasive versus open esophagectomy in a large retrospective database representing a consortium of academic medical centers in the United States.
METHODS AND PROCEDURES
Using the Clinical Recourse Manager from the University HealthSystem Consortium (UHC), patients were identified who underwent esophagectomy from 2008 to 2012. Data on perioperative outcome were collected and compared with the ANOVA or chi-square analysis, with significance defined as *p < 0.05.
RESULTS
A total of 5,957 index esophagectomy cases were identified, including 5,313 (89.2%) and 644 (10.8%) open and minimally invasive cases, respectively; 182 of the latter were converted to open (conversion rate = 28.2%). The overall morbidity and mortality rates were 21.6% and 3.21%, respectively. A summary of perioperative outcome data is shown in the Table.
| variable | Open (5,313)a | Min Invas (462) | Converted (114) | p value |
|---|---|---|---|---|
| mortality | 3.20% (170)a | 3.25% (15) | 3.30% (6) | 0.996 |
| Morbidity | 21.5% (1,142)a | 20.8% (96) | 25.3% (46) | 0.435 |
| *Length Stay (days) | 16.7 ± 9.7b | 15.2 ± 9.8 | 14.8 ± 13.4 | <0.001 |
| *ICU use | 72.6% (3,855)a | 90.0% (416) | 77.5% (141) | <0.001 |
| *Readmission | 5.30% (283)a | 3.90% (18) | 9.89% (18) | 0.009 |
| Cost (x $1K) | 40.8 ± 44.4b | 39.0 ± 24.8 | 35.2 ± 33.5 | 0.165 |
a:Number of cases given in parentheses; b:standard deviations shown.
There were 114 reoperations after index procedures (1.91%). Reoperative morbidity and mortality was 87.8% and 13.2%, respectively (*p < 0.001 for both, compared to the index rates). The length of stay, ICU use, readmission rate, and hospital cost also was higher in the reoperative group compared to the index group (*p < 0.05, data not shown).
CONCLUSIONS
Mortality, morbidity, and cost were not different among open, minimally invasive, and converted esophagectomy in the UHC database from 2008-2012. The length of stay was different among the three, though just on the order of ~2 days. ICU utilization appeared to be higher with minimally invasive esophagectomy, while readmission rates were higher in the converted cases. Reoperative cases had worse outcomes in most categories compared to index cases. Better perioperative outcome with minimally invasive esophagectomy was not obvious in this analysis of UHC data.