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Conversion to open surgery during minimally invasive esophagectomy portends worse short-term outcomes: an analysis of the National Cancer Database

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Abstract

Objective

The objectives were to determine factors associated with conversion to open surgery in patients with esophageal cancer who underwent minimally invasive esophagectomy (MIE, including laparo-thoracoscopic and robotic) and the impact of conversion to open surgery on patient outcomes.

Methods

We included patients from the National Cancer Database with esophageal and gastroesophageal junction cancer who underwent MIE from 2010 to 2015. Patient-, tumor-, and facility-related characteristics as well as short-term and oncologic outcomes were compared between patients who were converted to open surgery and those who underwent successful MIE without conversion to open surgery. Multivariable logistic regression models were used to analyze risk factors for conversion to open surgery from attempted MIE.

Results

7306 patients underwent attempted MIE. Of these patients, 82 of 1487 (5.2%) robotic-assisted esophagectomies were converted to open, compared to 691 of 5737 (12.0%) laparo-thoracoscopic esophagectomies (p < 0.001). Conversion rates decreased significantly over the study period (ptrend = 0.010). Patient age, tumor size, and nodal involvement were independently associated with conversion. Facility minimally invasive cumulative volume and robotic approach were associated with decreased conversion rates. Patients whose MIEs were converted had increased 90-day mortality [Odds Ratio (OR) 1.49; 95% Confidence Interval (CI) 1.10, 2.02], prolonged hospital stay (OR 1.39; 95% CI 1.17, 1.66), and higher rates of unplanned readmission (OR 1.67; 95% CI 1.27, 2.20). No significant differences were found in surgical margins or number of lymph nodes harvested.

Conclusion

Patients undergoing attempted MIE requiring conversion to open surgery had significantly worse short-term outcomes including postoperative mortality. Patient factors and hospital experience contribute to conversion rates. These findings should inform surgeons and patients considering esophagectomy for cancer.

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Abbreviations

MIE:

Minimally invasive esophagectomy

OE:

Open esophagectomy

RAMIE:

Robotic-assisted minimally invasive esophagectomy

VAMIE:

Video-assisted minimally invasive esophagectomy

NCDB:

National Cancer Database

RCT:

Randomized controlled trial

GE:

Gastroesophageal

MIS:

Minimally invasive surgical

LOS:

Length of stay

OR:

Odds ratio

CI:

Confidence interval

References

  1. Torre LA, Siegel RL, Ward EM, Jemal A (2016) Global cancer incidence and mortality rates and trends: an update. Cancer Epidemiol Biomark Prev 25:16–27

    Article  Google Scholar 

  2. Torre LA, Bray F, Siegel RL et al (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108

    Article  Google Scholar 

  3. National Comprehensive Cancer Network Esophageal and Esophagogastric Junction Cancers (2018)

  4. Bhagat R, Bronsert MR, Juarez-Colunga E et al (2018) Postoperative complications drive unplanned readmissions after esophagectomy for cancer. Ann Thorac Surg 105:1476–1482

    Article  Google Scholar 

  5. Thirunavukarasu P, Gabriel E, Attwood K et al (2016) Nationwide analysis of short-term surgical outcomes of minimally invasive esophagectomy for malignancy. Int J Surg 25:69–75

    Article  Google Scholar 

  6. Sihag S, Kosinski AS, Gaissert HA et al (2016) Minimally invasive versus open esophagectomy for esophageal cancer: A comparison of early surgical outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg 101:1281–1288 (Discussion 1288–1289)

    Article  Google Scholar 

  7. Seesing MFJ, Gisbertz SS, Goense L et al (2017) A propensity score matched analysis of open versus minimally invasive transthoracic esophagectomy in the Netherlands. Ann Surg 266:839–846

    Article  Google Scholar 

  8. Luketich JD, Pennathur A, Awais O et al (2012) Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg 256:95–103

    Article  Google Scholar 

  9. Mu JW, Gao SG, Xue Q et al (2015) Updated experiences with minimally invasive McKeown esophagectomy for esophageal cancer. World J Gastroenterol 21:12873–12881

    Article  CAS  Google Scholar 

  10. Luketich JD, Pennathur A, Franchetti Y et al (2015) Minimally invasive esophagectomy: results of a prospective phase II multicenter trial-the eastern cooperative oncology group (E2202) study. Ann Surg 261:702–707

    Article  Google Scholar 

  11. He H, Wu Q, Wang Z et al (2018) Short-term outcomes of robot-assisted minimally invasive esophagectomy for esophageal cancer: a propensity score matched analysis. J Cardiothorac Surg 13:52

    Article  Google Scholar 

  12. Yerokun BA, Sun Z, Yang CJ et al (2016) Minimally invasive versus open esophagectomy for esophageal cancer: a population-based analysis. Ann Thorac Surg 102:416–423

    Article  Google Scholar 

  13. Biere SS, van Berge Henegouwen MI, Maas KW et al (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 379:1887–1892

    Article  Google Scholar 

  14. Mariette C, Markar SR, Dabakuyo-Yonli TS et al (2019) Hybrid minimally invasive esophagectomy for esophageal cancer. N Engl J Med 380:152–162

    Article  Google Scholar 

  15. Straatman J, van der Wielen N, Cuesta MA et al (2017) Minimally invasive versus open esophageal resection: three-year follow-up of the previously reported randomized controlled trial: the TIME trial. Ann Surg 266:232–236

    Article  Google Scholar 

  16. Weksler B, Sharma P, Moudgill N et al (2012) Robot-assisted minimally invasive esophagectomy is equivalent to thoracoscopic minimally invasive esophagectomy. Dis Esophagus 25:403–409

    Article  CAS  Google Scholar 

  17. Park SY, Kim DJ, Yu WS, Jung HS (2016) Robot-assisted thoracoscopic esophagectomy with extensive mediastinal lymphadenectomy: experience with 114 consecutive patients with intrathoracic esophageal cancer. Dis Esophagus 29:326–332

    Article  CAS  Google Scholar 

  18. Dunn DH, Johnson EM, Anderson CA et al (2017) Operative and survival outcomes in a series of 100 consecutive cases of robot-assisted transhiatal esophagectomies. Dis Esophagus 30:1–7

    Article  CAS  Google Scholar 

  19. Biebl M, Andreou A, Chopra S et al (2018) Upper gastrointestinal surgery: robotic surgery versus laparoscopic procedures for esophageal malignancy. Visc Med 34:10–15

    Article  Google Scholar 

  20. Coker AM, Barajas-Gamboa JS, Cheverie J et al (2014) Outcomes of robotic-assisted transhiatal esophagectomy for esophageal cancer after neoadjuvant chemoradiation. J Laparoendosc Adv Surg Tech A 24:89–94

    Article  Google Scholar 

  21. Tapias LF, Morse CR (2014) Minimally invasive Ivor Lewis esophagectomy: description of a learning curve. J Am Coll Surg 218:1130–1140

    Article  Google Scholar 

  22. Hernandez JM, Dimou F, Weber J et al (2013) Defining the learning curve for robotic-assisted esophagogastrectomy. J Gastrointest Surg 17:1346–1351

    Article  Google Scholar 

  23. National Cancer Database (2017) National Cancer Database

  24. Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619

    Article  CAS  Google Scholar 

  25. World Health Organization, Interim Commission of the World Health Organization, High-Level Working Group on the H et al (1976) International classification of diseases for oncology. World Health Organization, Geneva

  26. Birkmeyer JD, Dimick JB (2004) Potential benefits of the new Leapfrog standards: effect of process and outcomes measures. Surgery 135:569–575

    Article  Google Scholar 

  27. Chandra V, Nehra D, Parent R et al (2010) A comparison of laparoscopic and robotic assisted suturing performance by experts and novices. Surgery 147:830–839

    Article  Google Scholar 

  28. Claassen L, van Workum F, Rosman C (2018) Learning curve and postoperative outcomes of minimally invasive esophagectomy. J Thor Dis 11:S777–S785

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Section of General Thoracic Surgery, Department of Surgery, University of Colorado Denver, Aurora, CO, USA

    Alison L. Halpern, Mohammed H. Al-Musawi, John D. Mitchell, Christopher D. Scott, Robert A. Meguid & Michael J. Weyant

  2. Division of Surgical Oncology, Department of Surgery, University of Colorado Denver, Aurora, CO, USA

    Chloe Friedman, Robert J. Torphy, Martin D. McCarter & Ana L. Gleisner

  3. Surgical Outcomes and Applied Research (SOAR), University of Colorado Denver, Aurora, CO, USA

    Robert A. Meguid & Ana L. Gleisner

  4. University of Colorado School of Medicine, 12631 E. 17th Avenue, MS C313, Aurora, CO, 80045, USA

    Ana L. Gleisner

Authors
  1. Alison L. Halpern
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  2. Chloe Friedman
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  3. Robert J. Torphy
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  4. Mohammed H. Al-Musawi
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  5. John D. Mitchell
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  6. Christopher D. Scott
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  7. Robert A. Meguid
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  8. Martin D. McCarter
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  10. Ana L. Gleisner
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Corresponding author

Correspondence to Ana L. Gleisner.

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Disclosure

Dr. John D. Mitchell MD is a consultant on the Advisory Board for Medtronic, Dr. Alison L. Halpern MD, Ms. Chloe Friedman MPH, Dr. Robert J. Torphy MD, Dr. Mohammed H. Al-Musawi, MD MSc, Dr. Christopher D. Scott MD, Dr. Robert A. Meguid MD MPH, Dr. Martin D. McCarter MD, Dr. Michael J. Weyant MD, and Ana L. Gleisner MD PhD have no conflicts of interest or financial ties to disclose.

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Halpern, A.L., Friedman, C., Torphy, R.J. et al. Conversion to open surgery during minimally invasive esophagectomy portends worse short-term outcomes: an analysis of the National Cancer Database. Surg Endosc 34, 3470–3478 (2020). https://doi.org/10.1007/s00464-019-07124-y

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  • DOI: https://doi.org/10.1007/s00464-019-07124-y

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