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Outcomes after totally minimally invasive versus hybrid and open Ivor Lewis oesophagectomy: results from the International Esodata Study Group

Outcomes after totally minimally invasive versus hybrid and open Ivor Lewis oesophagectomy: results from the International Esodata Study Group
Outcomes after totally minimally invasive versus hybrid and open Ivor Lewis oesophagectomy: results from the International Esodata Study Group
BACKGROUND: Large studies comparing totally minimally invasive oesophagectomy (TMIE) with laparoscopically assisted (hybrid) oesophagectomy are lacking. Although randomized trials have compared TMIE invasive with open oesophagectomy, daily clinical practice does not always resemble the results reported in such trials. The aim of the present study was to compare complications after totally minimally invasive, hybrid and open Ivor Lewis oesophagectomy in patients with oesophageal cancer.

METHODS: The study was performed using data from the International Esodata Study Group registered between February 2015 and December 2019. The primary outcome was pneumonia, and secondary outcomes included the incidence and severity of anastomotic leakage, (major) complications, duration of hospital stay, escalation of care, and 90-day mortality. Data were analysed using multivariable multilevel models.

RESULTS: Some 8640 patients were included between 2015 and 2019. Patients undergoing TMIE had a lower incidence of pneumonia than those having hybrid (10.9 versus 16.3 per cent; odds ratio (OR) 0.56, 95 per cent c.i. 0.40 to 0.80) or open (10.9 versus 17.4 per cent; OR 0.60, 0.42 to 0.84) oesophagectomy, and had a shorter hospital stay (median 10 (i.q.r. 8-16) days versus 14 (11-19) days (P = 0.041) and 11 (9-16) days (P = 0.027) respectively). The rate of anastomotic leakage was higher after TMIE than hybrid (15.1 versus 10.7 per cent; OR 1.47, 1.01 to 2.13) or open (15.1 versus 7.3 per cent; OR 1.73, 1.26 to 2.38) procedures.

CONCLUSION: Compared with hybrid and open Ivor Lewis oesophagectomy, TMIE resulted in a lower pneumonia rate, a shorter duration of hospital stay, but higher anastomotic leakage rates. Therefore, no clear advantage was seen for either TMIE, hybrid or open Ivor Lewis oesophagectomy when performed in daily clinical practice.
Aged, Anastomotic Leak/diagnosis, Esophageal Neoplasms/pathology, Esophagectomy/adverse effects, Female, Hospital Mortality, Humans, Laparoscopy/adverse effects, Length of Stay, Male, Middle Aged, Neoplasm Staging, Patient Readmission, Pneumonia/diagnosis, Postoperative Care, Postoperative Complications/diagnosis
0007-1323
283-290
van der Wilk, Berend J
2044a1ed-3a21-425d-a42d-cbdcc62ec3fa
Hagens, Eliza R C
5b0ca64e-7921-4e72-bcd0-1eaa4c4b1b54
Eyck, Ben M
f27eb82d-1b56-45f2-9ad3-04473a2aa50b
Gisbertz, Suzanne S
495bfee6-26cb-45e7-b9f0-c1acc865102b
van Hillegersberg, Richard
6194c82d-0673-47ce-bbd6-6c37bbb445ff
Nafteux, Philippe
9487546d-a465-45d2-9975-4b051a555962
Schröder, Wolfgang
e628f500-a065-4964-8c78-28b2c4ab8709
Nilsson, Magnus
fe3297fb-d3fa-41f9-b982-fb3de3e55772
Wijnhoven, Bas P L
c90de263-8360-44b6-9c96-939104e2a2cb
Lagarde, Sjoerd M
ba2aa11f-580f-4ecc-a391-6ef6f498694e
van Berge Henegouwen, Mark I
cfb83cb5-59d2-4733-9146-a498e9c23a9f
Underwood, Timothy
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
International Esodata Study Group Collaborators
van der Wilk, Berend J
2044a1ed-3a21-425d-a42d-cbdcc62ec3fa
Hagens, Eliza R C
5b0ca64e-7921-4e72-bcd0-1eaa4c4b1b54
Eyck, Ben M
f27eb82d-1b56-45f2-9ad3-04473a2aa50b
Gisbertz, Suzanne S
495bfee6-26cb-45e7-b9f0-c1acc865102b
van Hillegersberg, Richard
6194c82d-0673-47ce-bbd6-6c37bbb445ff
Nafteux, Philippe
9487546d-a465-45d2-9975-4b051a555962
Schröder, Wolfgang
e628f500-a065-4964-8c78-28b2c4ab8709
Nilsson, Magnus
fe3297fb-d3fa-41f9-b982-fb3de3e55772
Wijnhoven, Bas P L
c90de263-8360-44b6-9c96-939104e2a2cb
Lagarde, Sjoerd M
ba2aa11f-580f-4ecc-a391-6ef6f498694e
van Berge Henegouwen, Mark I
cfb83cb5-59d2-4733-9146-a498e9c23a9f
Underwood, Timothy
8e81bf60-edd2-4b0e-8324-3068c95ea1c6

International Esodata Study Group Collaborators (2022) Outcomes after totally minimally invasive versus hybrid and open Ivor Lewis oesophagectomy: results from the International Esodata Study Group. British Journal of Surgery, 109 (3), 283-290. (doi:10.1093/bjs/znab432).

Record type: Article

Abstract

BACKGROUND: Large studies comparing totally minimally invasive oesophagectomy (TMIE) with laparoscopically assisted (hybrid) oesophagectomy are lacking. Although randomized trials have compared TMIE invasive with open oesophagectomy, daily clinical practice does not always resemble the results reported in such trials. The aim of the present study was to compare complications after totally minimally invasive, hybrid and open Ivor Lewis oesophagectomy in patients with oesophageal cancer.

METHODS: The study was performed using data from the International Esodata Study Group registered between February 2015 and December 2019. The primary outcome was pneumonia, and secondary outcomes included the incidence and severity of anastomotic leakage, (major) complications, duration of hospital stay, escalation of care, and 90-day mortality. Data were analysed using multivariable multilevel models.

RESULTS: Some 8640 patients were included between 2015 and 2019. Patients undergoing TMIE had a lower incidence of pneumonia than those having hybrid (10.9 versus 16.3 per cent; odds ratio (OR) 0.56, 95 per cent c.i. 0.40 to 0.80) or open (10.9 versus 17.4 per cent; OR 0.60, 0.42 to 0.84) oesophagectomy, and had a shorter hospital stay (median 10 (i.q.r. 8-16) days versus 14 (11-19) days (P = 0.041) and 11 (9-16) days (P = 0.027) respectively). The rate of anastomotic leakage was higher after TMIE than hybrid (15.1 versus 10.7 per cent; OR 1.47, 1.01 to 2.13) or open (15.1 versus 7.3 per cent; OR 1.73, 1.26 to 2.38) procedures.

CONCLUSION: Compared with hybrid and open Ivor Lewis oesophagectomy, TMIE resulted in a lower pneumonia rate, a shorter duration of hospital stay, but higher anastomotic leakage rates. Therefore, no clear advantage was seen for either TMIE, hybrid or open Ivor Lewis oesophagectomy when performed in daily clinical practice.

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Accepted/In Press date: 18 November 2021
Published date: 13 January 2022
Additional Information: Publisher Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. Copyright: This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine
Keywords: Aged, Anastomotic Leak/diagnosis, Esophageal Neoplasms/pathology, Esophagectomy/adverse effects, Female, Hospital Mortality, Humans, Laparoscopy/adverse effects, Length of Stay, Male, Middle Aged, Neoplasm Staging, Patient Readmission, Pneumonia/diagnosis, Postoperative Care, Postoperative Complications/diagnosis

Identifiers

Local EPrints ID: 456370
URI: http://eprints.soton.ac.uk/id/eprint/456370
ISSN: 0007-1323
PURE UUID: ec5f47f4-443a-484a-b216-eeb9e67090f5
ORCID for Timothy Underwood: ORCID iD orcid.org/0000-0001-9455-2188

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Date deposited: 27 Apr 2022 15:10
Last modified: 28 Apr 2022 01:52

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Contributors

Author: Berend J van der Wilk
Author: Eliza R C Hagens
Author: Ben M Eyck
Author: Suzanne S Gisbertz
Author: Richard van Hillegersberg
Author: Philippe Nafteux
Author: Wolfgang Schröder
Author: Magnus Nilsson
Author: Bas P L Wijnhoven
Author: Sjoerd M Lagarde
Author: Mark I van Berge Henegouwen
Corporate Author: International Esodata Study Group Collaborators

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