Abstract
Esophageal resection for the treatment of esophageal cancer generally entails high rates of morbidity and mortality. Patients with a smoking history have increased post-operative complications following esophagectomy. This study was undertaken to determine how smoking or a history of smoking can affect perioperative outcomes and morbidity following robotic transhiatal esophagectomy. 75 patients were prospectively followed and divided; 44 patients actively smoking or with a history of significant smoking were classified as ‘smokers’, while the other 31 patients were classified as ‘non-smokers’. Significance was determined at a p-value of ≤ 0.05 and data are presented as median (mean ± SD). 'Smokers' averaged 70(70 ± 7.8) years, 89% male, with 82% undergoing neoadjuvant therapy. 'Nonsmokers' averaged 68(69 ± 7.8) years, 74% male, and 74% receiving neoadjuvant therapy. BMI and ASA class showed no significant difference between the cohorts. 'Smokers' had an operative time of 341(343 ± 91.0) minutes and a blood loss of 150(191 ± 140.0) mL; 'nonsmokers' had 291(298 ± 65.9) minutes and 100(140 ± 120.9) mL, respectively (p = 0.02 for operative time). Tumor size and AJCC staging were similar for both cohorts. No significant differences were noted in postoperative complications, Clavien–Dindo score ≥ III, in-hospital mortality, length of stay, or 30-day readmissions. Survival rates were comparable. Hospital costs for 'smokers' were $33,131(41,091 ± 23,465.17) and $34,896 (62,154 ± 65,839.53) for 'nonsmokers' (p = 0.05). Profit/loss was $-23,155 (− 15,137 ± 35,819.29) for smokers and $-23,720 (− 16,716 ± 50,864.64) for nonsmokers. Current or past ‘smokers’ had longer operative times and lower costs following robotic transhiatal esophagectomy, with no significant difference in postoperative complications or survival compared to ‘non-smokers’.
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Due to the sensitive nature of the research data and the privacy constraints imposed by our study protocol, the data that support the findings of this study are not publicly available. All relevant data are protected to ensure participant confidentiality and comply with ethical standards.
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All authors contributed to the study's conception and design. Material preparation, data collection, and analysis were performed by MC, and TP. The first draft of the manuscript was written by SR and KM. SR, IS and AR drafted the work and revised it critically for important intellectual content. All authors commented on previous versions of the manuscript, read and approved the final manuscript.
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Dr. Sharona Ross is a consultant for Intuitive Surgical (Sunnyvale, CA) and Ethicon (Cincinnati, OH). Dr. Ross receives educational grants for her Women in Surgery Career Symposium from Intuitive Surgical and Medtronic (Minneapolis, MN). All other authors have no conflicts of interest.
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Rayman, S., Ross, S., Sucandy, I. et al. The effects of smoking history on robotic transhiatal esophagectomy patient outcomes. J Robotic Surg 18, 76 (2024). https://doi.org/10.1007/s11701-024-01829-6
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DOI: https://doi.org/10.1007/s11701-024-01829-6