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Outcomes of robotic esophagectomies for esophageal cancer by hospital volume: an analysis of the national cancer database

  • 2020 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Robotic minimally invasive esophagectomies (RMIE) have been associated with superior outcomes; however, it is unclear if these are specific to robotic technique or are present only at high-volume institutions. We hypothesize that low-volume RMIE centers would have inferior outcomes.

Methods

The National Cancer Database (NCDB) identified patients receiving RMIE from 2010 to 2016. Based on the total number of RMIE performed by each hospital system, the lowest quartile performed ≤ 9 RMIE over the study period. Ninety-day mortality, number of lymph nodes evaluated, margins status, unplanned readmissions, length of stay (LOS), and overall survival were compared. Regression models were used to account for confounding.

Results

1565 robotic esophagectomies were performed by 212 institutions. 173 hospitals performed ≤ 9 RMIE (totaling 478 operations over the study period, 30.5% of RMIE) and 39 hospitals performed > 9 RMIE (1087 operations, 69.5%). Hospitals performing > 9 RMIE were more likely to be academic centers (90.4% vs 66.2%, p < 0.001), have patients with advanced tumor stage (65.3% vs 59.8%, p = 0.049), andadministered preoperative radiation (72.8% vs 66.3%, p = 0.010). There were no differences based on demographics, nodal stage, or usage of preoperative chemotherapy. On multivariable regressions, hospitals performing ≤ 9 RMIE were associated with a greater likelihood of experiencing a 90-day mortality, a reduced number of lymph nodes evaluated, and a longer LOS; however, there was no association with rates of positive margins or unplanned readmissions. Median overall survival was decreased at institutions performing ≤ 9 RMIE (37.3 vs 51.5 months, p < 0.001). Multivariable Cox regression demonstrated an association with poor survival comparing hospitals performing ≤ 9 to > 9 RMIE (HR 1.327, p = 0.018).

Conclusion

Many robotic esophagectomies occur at institutions which performed relatively few RMIE and were associated with inferior short- and long-term outcomes. These data argue for regionalization of robotic esophagectomies or enhanced training in lower volume hospitals.

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Authors and Affiliations

  1. Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA

    Jonathan J. Hue, Katelynn C. Bachman, Stephanie G. Worrell, Kelsey E. Gray, Philip A. Linden & Christopher W. Towe

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  1. Jonathan J. Hue
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Correspondence to Christopher W. Towe.

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Disclosures

Christopher W. Towe discloses that he is a consultant to Sig Medical, Zimmer Biomet, Medtronic, and Atricure, but that these relationships have not influenced the work or its conclusions. Jonathan J. Hue, Katelynn C. Bachman, Stephanie G. Worrell, Kelsey E. Gray and Philip A. Linden have no conflicts of interest or financial ties to disclose. The other authors have no disclaimers, sources of funding, or financial relationships that could inappropriately influence this work and its conclusions.

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Hue, J.J., Bachman, K.C., Worrell, S.G. et al. Outcomes of robotic esophagectomies for esophageal cancer by hospital volume: an analysis of the national cancer database. Surg Endosc 35, 3802–3810 (2021). https://doi.org/10.1007/s00464-020-07875-z

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