Andrew M Brown, MD, Michael J Pucci, MD, Adam Berger, MD, Talar Tatarian, MD, Nathaniel Evans III, MD, Ernest Rosato, MD, Francesco Palazzo, MD. Thomas Jefferson University Hospital
Introduction: Our institution has traditionally favored a McKeown esophagectomy for surgical management of esophageal cancer. Several factors have resulted in a trend towards more Ivor Lewis (IL) resections being performed. We hypothesized that MI-IL esophagectomies are less morbid in the peri-operative setting than MI-McKeown.
Methods: Our institution’s IRB-approved esophageal database was queried to identify patients who underwent totally MI esophagectomy (Ivor Lewis vs. McKeown) from June 2011 to May 2016. Patient preoperative and peri-operative data, as well as postoperative complications were analyzed. Post-operative complications were calculated using the Clavien-Dindo classification system. Statistical analyses were accomplished using a one-way ANOVA, and Fisher’s exact tests.
Results: There were 110 patients who underwent totally MI esophagectomy (Ivor Lewis n=49 [45%], McKeown n=61 [55%]). Most patients were men (n=91, 83%) with a median age of 62.5 (range: 31-83). BMI, performance status and mean Charlson Comorbidity Index were similar between groups. The rate of serious (Clavien-Dindo 3, 4, or 5) post-operative complications was significantly less in the Ivor-Lewis group (35% vs. 59%, p=0.01). Serious pulmonary complications were not significantly different (13% vs. 26%, p=0.25). Additional peri-operative data are summarized in Table 1.
Conclusion: Totally MI Ivor Lewis esophagectomy has significantly less severe peri-operative morbidity than MI McKeown esophagectomy, but similar rates of serious pulmonary complications and anastomotic leaks. These factors did not affect LOS, ICU LOS, or readmission rates at 30 days. Oncologic completeness of resection was maintained in both groups. These findings favor a trend toward minimally invasive Ivor Lewis esophagectomies for esophageal cancer when oncologically and clinically appropriate.
|Table 1. Peri-operative outcomes|
|Underwent an R0 resection (%)||100||98||1.00|
|Mean lymph nodes (n)||18.4||20.9||0.16|
|Mean positive lymph nodes (n)||0.92||0.39||0.07|
|Rate of overall complications, Clavien-Dindo grade ≥ 3 (%)||35||59||0.01|
|Rate of pulmonary complications, Clavien-Dindo grade ≥ 3 (%)||13||26||0.25|
|Anastamotic leak (%)||2||7||0.38|
|Median length of stay (days)||9||8||0.75|
|Median ICU length of stay (days)||4||5||0.40|
|30 day readmission rate (%)||4||3||1.00|
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80198
Program Number: S027
Presentation Session: Foregut 1
Presentation Type: Podium