Defining Benchmarks for Transthoracic Esophagectomy

Schmidt, Henner; Gisbertz, Suzanne S.; Moons, Johnny; Rouvelas, Ioannis; Kauppi, Juha; Brown, Andrew; Asti, Emanuele; Luyer, Misha; Lagarde, Sjoerd M.; Berlth, Felix; Philippron, Annouck; Bruns, Christiane; Schneider, Paul M.; Raptis, Dimitri Aristotle; Henegouwen, Mark I. van Berge; Nafteux, Philippe; Nilsson, Magnus; Räsänen, Jari; Palazzo, Francesco; Rosato, Ernest L.; Mercer, Stuart; Bonavina, Luigi; Nieuwenhuijzen, Grard A. P.; Wijnhoven, Bas P. L.; Schröder, Wolfgang; Pattyn, Piet; Grimminger, Peter P.; Gutschow, Christian A.

doi:10.1097/sla.0000000000002445

Cited by 212 publications

(55 citation statements)

References 26 publications

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“…As shown in Figure 6 , no statistically significant difference existed between the 2 groups (OR =1.76, 95% CI =0.92–3.36, P =0.08), with statistical homogeneity ( I 2 =0%). Additionally, 3 studies containing 499 cases reported 90-day mortality, 21 , 27 , 28 and no statistically significant difference was found between the 2 groups (OR =2.22, 95% CI =0.71–6.98, P =0.17), as shown in Figure 7 .…”

Section: Resultsmentioning

confidence: 93%

“…Despite the higher complications caused by MIME, a similar 30-day/in-hospital mortality was observed in the 2 groups, which is in concordance with the 2 latest studies. 27 , 32 This may partly be explained by our previous result that the 2 procedures had similar incidence of causing severe anastomotic leakage. Walters et al 35 suggested that 90-day mortality may provide a better understanding on true death risk for the surgery and patient.…”

Section: Discussionmentioning

confidence: 93%

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Comparison of short-term outcomes between minimally invasive McKeown and Ivor Lewis esophagectomy for esophageal or junctional cancer: a systematic review and meta-analysis

Deng¹,

Su²,

Ren³

et al. 2018

OTT

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PurposeMinimally invasive esophagectomy is increasingly performed for esophageal or gastroesophageal junctional cancer, with advantages of improved perioperative outcomes in comparison with open esophagectomy. McKeown and Ivor Lewis are widely used procedures of minimally invasive esophagectomy, and there have been controversies on which one is preferred for patients with resectable esophageal or junctional cancer.Patients and methodsThis review was registered at the International Prospective Register of Systematic Reviews (number CRD42017075989). Studies in PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov were thoroughly investigated. Eligible studies included prospective and retrospective studies evaluating short-term outcomes of minimally invasive McKeown esophagectomy (MIME) vs minimally invasive Ivor Lewis esophagectomy (MILE) in patients with resectable esophageal or junctional tumors. Main parameters included anastomotic leak and 30-day/in-hospital mortality. Overall incidence rates (ORs)/weighted mean difference (WMD) with 95% confidence intervals (CIs) were calculated by employing random-effects models.ResultsFourteen studies containing 3,468 cases were included in this meta-analysis. Age, male sex, and American Joint Committee on Cancer (AJCC) stage between the 2 groups were not statistically different. MIME led to more blood loss, longer operating time, and longer hospital stay than MILE. MIME was associated with higher incidence of pulmonary complications (OR =1.96, 95% CI =1.28–3.00) as well as total anastomotic leak (OR =2.55, 95% CI =1.40–4.63), stricture (OR =2.07, 95% CI =1.05–4.07), and vocal cord injury/palsy (OR =5.62, 95% CI =3.46–9.14). In addition, the differences of R0 resection rate, number of lymph modes retrieved, blood transfusion rate, length of intensive care unit stay, incidence of cardiac arrhythmia, and Chyle leak between MIME and MILE were not statistically significant. Notably, incidence of severe anastomotic leak (OR =1.28, 95% CI =0.73–2.24) and 30-day/in-hospital mortality (OR =1.76, 95% CI =0.92–3.36) as well as 90-day mortality (OR =2.22, 95% CI =0.71–6.98) between the 2 procedures were also not significantly different.ConclusionThis study suggests that MIME and MILE are comparable with respect to clinical safety. MILE may be a better option when oncologically and clinically suitable. MIME is still a safe alternative procedure when clinically indicated. However, this evidence is at risk for bias; randomized controlled trials are needed to validate or correct our results.

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Section: Resultsmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 93%

Comparison of short-term outcomes between minimally invasive McKeown and Ivor Lewis esophagectomy for esophageal or junctional cancer: a systematic review and meta-analysis

Deng¹,

Su²,

Ren³

et al. 2018

OTT

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“…After successful implementation of ERAS programs in colorectal cancer patients, ERAS has been widely implemented in different types of major abdominal surgery with comparable beneficial results (6,(16)(17)(18)(19)(20). The described gains in short-term outcomes include similar or decreased complication and mortality rates, reduction in length of hospital stay, less intensive care unit (ICU) (re)admission, similar or decreased hospital readmission and reduction of hospital costs (16)(17)(18)(19).…”

Section: Improvement In Perioperative Carementioning

confidence: 99%

“…The described gains in short-term outcomes include similar or decreased complication and mortality rates, reduction in length of hospital stay, less intensive care unit (ICU) (re)admission, similar or decreased hospital readmission and reduction of hospital costs (16)(17)(18)(19). Also in patients undergoing an esophagectomy, introduction of an ERAS program resulted in a reduction of overall complications, reduced length of ICU stay and length of hospital stay, and a reduction of hospital costs without an increase in readmission rate or a decrease in patient satisfaction (5,6,20).…”

Section: Improvement In Perioperative Carementioning

confidence: 99%

“…Pulmonary complications are the main contributor to postoperative morbidity in esophagectomy patients, accounting for up to 31% of all postoperative complications (1,20). In a cohort of 118 patients undergoing an extended esophagectomy for squamous cell carcinoma, Kinugasa et al found a correlation between pneumonia and increased in-hospital mortality and poorer 5-year overall survival; respectively 26.7% and 53.4% for patients with and without pneumonia (46).…”

Section: Effect Of Complications On Long-term Survivalmentioning

confidence: 99%

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Effects of improving outcomes after esophagectomy on the short- and long-term: a review of literature

Fransen

Luyer

2019

J. Thorac. Dis

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An esophagectomy is still correlated with a high morbidity rate, despite advances made in minimally invasive surgery, enhanced recovery after surgery (ERAS) and centralization of this type of surgery. The short-term benefits are clearly described for esophageal cancer surgery patients, however, the longterm effects are yet to be determined. In colorectal cancer, the association between complications, especially anastomotic leakage, shows detrimental effects on long-term survival and cancer recurrence. In esophageal cancer surgery, current evidence is scarce and the described results are conflicting. Optimization of perioperative care by introduction of minimally invasive surgery, ERAS programs and patient prehabilitation is promising and shows a clear effect on short-term outcomes. Potentially, this may also result in better outcomes on the long-term, although current evidence is insufficient to infer definite conclusions. Reduction of anastomotic leakage seems important to reduce risk of cancer recurrence and improve long-term outcome.

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Improving surgical outcomes through benchmarking

Staiger

Schwandt

Puhan

et al. 2019

Journal of British Surgery

130

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Benchmarking is a popular quality‐improvement tool in economic practice. Its basic principle consists of identifying the best (the benchmark), then comparing with the best, and learning from the best. In healthcare, the concept of benchmarking or establishing benchmarks has been less specific, where comparisons often do not target the best, but the average results. The goal, however, remains improvement in patient outcome. This article outlines the application of benchmarking and proposes a standard approach of benchmark determination in surgery, including the establishment of best achievable real‐world postoperative outcomes. Parameters used for this purpose must be reproducible, objective and universal. A systematic approach for determining benchmarks enables self‐assessment of surgical outcome and facilitates the detection of areas for improvement. The intention of benchmarking is to stimulate surgeons' genuine endeavour for perfection, rather than to judge centre or surgeon performance.

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Defining Benchmarks for Transthoracic Esophagectomy

Abstract: This outcome analysis of patients with low comorbidity undergoing ttMIE may serve as a reference to evaluate surgical performance in major esophageal resection.

Cited by 212 publications

References 26 publications

Comparison of short-term outcomes between minimally invasive McKeown and Ivor Lewis esophagectomy for esophageal or junctional cancer: a systematic review and meta-analysis

Comparison of short-term outcomes between minimally invasive McKeown and Ivor Lewis esophagectomy for esophageal or junctional cancer: a systematic review and meta-analysis

Effects of improving outcomes after esophagectomy on the short- and long-term: a review of literature

Improving surgical outcomes through benchmarking

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