Afshin Heidari, MD, Kenneth W Bueltmann, MD, Marek Rudnicki, MD. UIC/MGH
Introduction: Surgical management of patients with cardioesophageal or distal esophageal cancer has remained a challenging problem for surgeons. Newly developed minimally invasive surgical techniques (MIS) could offer some treatment alternatives for patients. It might be expected that following many other intraabdominal and intrathoracic surgeries, laparoscopic and/or robotic technology has been increasingly used to potentially improve outcomes in the cardioesophgaeal and distal esophageal cancer.
Methods: The Nationwide Inpatient Sample was queried for patients who underwent either Ivor–Lewis distal esophagectomy or total esophagectomy (ICD9 codes 42.52 and 42.42) for cardioesophageal or distal esophageal cancer (ICD9 diagnosis code 151.0 or 150.5 codes respectively). A confounding subset of patients in whom MIS were used were identified: ICD9 code 54.21 for laparoscopy and ICD-9 code 17.41 for robotic use. Trends in utilization of these procedures were evaluated over a five-year period from 2010 – 2014. SAS Enterprise 6.1 was utilized to compute and compare the groups.
Results: The Total number of both Ivor-Lewis and total esophagectomy for cardioesophageal or distal esophageal cancer was 2453 operations nationwide between 2010 – 2014. In Ivor-lewis group (n=1055), MIS was used in 103 patients (9.76%). In Total esophagectomy group (n=1398), 143 (10.22%) cases employed minimally invasive techniques. Trends in utilization of both procedures is presented in Table1.
|MIS Ivor-Lewis ICD9 42.52||12.06%||5.62%||10.49%||8.45%||13.17%||9.79%(103)|
|MIS Esophagectomy 42.42||6.61%||9.41%||12.54%||10.88%||12.20%||10.22%(143)|
The average length of stay(LOS) decreased in patients undergoing MIS Ivor-Lewis procedure from 18.1 in 2010 to 15 days in 2014. Whereas mean LOS in MIS esophagectomy patients showed no changes (15.97 Vs 15.94). Mortality rate was 5% for open cases and approached zero for laparoscopic cases. Total charges (adjusted to inflation rate) for Ivor- Lewis decreased from $291,928 in 2010 to $227,957 in 2014 and for total esophagectomy increased from $192,579 in 2010 to $221,037 in 2014.
Conclusion: Utilization of MIS for esophagectomy patients almost doubled during 5-year period whereas use during Ivor–Lewis procedure did not change. The addition of laparoscopic/robotic techniques seems to reduce mortality in esophageal cancer surgery when compared to open surgeries. Despite this improved technology and technical expertise in use of MIS, surgeons are rather careful with employing these techniques in practice of esophageal surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88513
Program Number: S109
Presentation Session: Residents/Fellows Session
Presentation Type: ResFel