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A standardized comparison of peri-operative complications after minimally invasive esophagectomy: Ivor Lewis versus McKeown

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Abstract

Background

While our institutional approach to esophageal resection for cancer has traditionally favored a minimally invasive (MI) 3-hole, McKeown esophagectomy (MIE 3-hole) during the last five years several factors has determined a shift in our practice with an increasing number of minimally invasive Ivor Lewis (MIE IL) resections being performed. We compared peri-operative outcomes of the two procedures, hypothesizing that MIE IL would be less morbid in the peri-operative setting compared to MIE 3-hole.

Methods

Our institution’s IRB-approved esophageal database was queried to identify all patients who underwent totally MI esophagectomy (MIE IL vs. MIE 3-hole) from June 2011 to May 2016. Patient demographics, preoperative and peri-operative data, as well as post-operative complications were compared between the two groups. Post-operative complications were analyzed using the Clavien-Dindo classification system.

Results

There were 110 patients who underwent totally MI esophagectomy (MIE IL n = 49 [45%], MIE 3-hole n = 61 [55%]). The majority of patients were men (n = 91, 83%) with a median age of 62.5 (range 31–83). Preoperative risk stratifiers such as ECOG score, ASA, and Charlson Comorbidity Index were not significantly different between groups. Anastomotic leak rate was 2.0% in the MIE IL group compared to 6.6% in the MIE 3-hole group (p = 0.379). The rate of serious (Clavien-Dindo 3, 4, or 5) post-operative complications was significantly less in the MIE IL group (34.7 vs. 59.0%, p = 0.013). Serious pulmonary complications were not significantly different (16.3 vs. 26.2%, p = 0.251) between the two groups.

Conclusions

In this cohort, totally MIE IL showed significantly less severe peri-operative morbidity than MIE 3-hole, but similar rates of serious pulmonary complications and anastomotic leaks. These findings confirm the safety of minimally invasive Ivor Lewis esophagectomies for esophageal cancer when oncologically and clinically appropriate. Minimally invasive McKeown esophagectomy remains a satisfactory and appropriate option when clinically indicated.

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Authors and Affiliations

  1. Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut St. 5th Floor, Philadelphia, PA, 19107, USA

    Andrew M. Brown, Michael J. Pucci, Adam C. Berger, Talar Tatarian, Nathaniel R. Evans III, Ernest L. Rosato & Francesco Palazzo

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  1. Andrew M. Brown
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  2. Michael J. Pucci
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  3. Adam C. Berger
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  4. Talar Tatarian
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  5. Nathaniel R. Evans III
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  6. Ernest L. Rosato
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  7. Francesco Palazzo
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Corresponding author

Correspondence to Francesco Palazzo.

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Disclosures

Drs. Andrew M Brown, Michael J Pucci, Adam C Berger, Talar Tatarian, Nathaniel R Evans III, Ernest L Rosato, and Francesco Palazzo have no conflicts of interest or financial ties to disclose.

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Brown, A.M., Pucci, M.J., Berger, A.C. et al. A standardized comparison of peri-operative complications after minimally invasive esophagectomy: Ivor Lewis versus McKeown. Surg Endosc 32, 204–211 (2018). https://doi.org/10.1007/s00464-017-5660-4

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  • DOI: https://doi.org/10.1007/s00464-017-5660-4

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