Decreasing Morbidity and Mortality in One Hundred Consecutive Esophagectomies

Kfir Ben-David, MD, George A Sarosi, MD, Juan C Cendan, Drew Howard, MD, Georgios Rossidis, MD, Steven N Hochwald. University of Florida College of Medicine

Introduction: Esophagectomy is a complex invasive procedure requiring exploration of multiple body cavities for organ removal and subsequent restoration of gastrointestinal continuity. In many institutions, esophagectomy morbidity and mortality rates remain high despite improvements in intensive care treatment. We reviewed our esophagectomy experience over a consecutive series of 100 patients to analyze trends in morbidity and mortality as we transitioned from open to minimally invasive esophagectomies.

Methods: We reviewed 104 consecutive patients undergoing operative exploration for esophagectomy from August 2007 to August 2010. The preoperative evaluation, operative technique, and postoperative care of these cases were evaluated and compared for the initial 16 patients undergoing open resection and subsequent 84 who have had a minimally invasive esophagectomy (MIE). Postoperative morbidity and mortality were reviewed and recorded.

Results: During the time frame of the study, 104 patients underwent an exploration for attempted esophagectomy. Resection was completed in 100 patients and was done for malignant disease in 93 patients and benign disease in 7 patients. There was one in hospital mortality in the 100 consecutive patients undergoing esophagectomy during this time period due to a pulmonary embolism. There was no significant difference in post operative complications consisting of transient left recurrent nerve injury (7.1% vs 12.5%) or pneumonia (11.9% vs 12.5%) in those undergoing MIE compared to open resection, respectively. However, wound infections were significantly less in patients undergoing MIE compared to open esophagectomy (2.4% vs 12.5%, respectively, p=0.01). Anastomotic leak (4.8% vs 12.5%, p=0.05) was also lower in those undergoing MIE. Median length of stay (LOS) was significantly less in patients undergoing MIE compared to open esophagectomy (9 vs 14 days, p<0.05). Finally, there was a trend towards improvement in median LOS in the 42 patients undergoing MIE in the most recent time period compared to the initial 42 patients undergoing MIE (8 vs 10 days, p=0.05)

Conclusions: Our results support the continued safe use of esophagectomy for selected esophageal diseases, including malignancy. Morbidity, especially wound infection, anastomotic leak, and length of stay is decreasing with the incorporation of minimally invasive techniques.