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Atrial Fibrillation Is a Rare Complication After Robotic Assisted Ivor Lewis Esophagectomy
Andrea M. Abbott*1, Ravi Shridhar1, Sarah Hoffe1, Khaldoun Almhanna1, Kenneth Meredith2
1Moffitt Cancer Center, Tampa, FL; 2Surgery, University of Wisconsin Hospitals and Clinic, Madison, WI
Background: Atrial fibrillation has historically been a common complication after esophagectomy. It has even been considered a clinical hallmark for anastomotic leak after open esophagectomy. With the emergence of minimally invasive techniques, the relevance of atrial fibrillation as a predictor of esophageal leak is unknown. We thus examined rates of atrial fibrillation following robotic-assisted Ivor-Lewis esophagectomy (RAIL) at a high-volume tertiary-care referral cancer center.
Methods: We retrospectively evaluated patients who underwent RAIL for pathologically confirmed esophageal malignancy and assessed demographics and intraoperative outcomes relative to atrial fibrillation. Age, body mass index (BMI), neoadjuvant therapy (NT), operative details, and length of stay (LOS) were assessed. Statistics were calculated using student's t-test and chi-square test with significance value of p<0.05.
Results: 136 patients (109 male/27 female), average age 67 years, were evaluated. 17 (12.5%) patients developed post-operative atrial fibrillation. None of the patients who had atrial fibrillation developed a leak. Of the patients with atrial fibrillation, 13 (76%) were male with a median BMI of 28. 12 (71%) received NT. The median operative time was 381 minutes with a median blood loss of 125 cc. The median LOS was 11 days. There were 119 patients (96 male/23 female) without atrial fibrillation with an average age of 70 years and a median BMI of 28. There were 4 leaks in this cohort. NT was given to 92 (77%) of patients. The median operative time was 409 minutes with a median blood loss of 150 cc. The median length of stay was 9 days. When the two cohorts were compared, the only statistically significant difference was operative time p <0.003. There was no significant difference in gender, age, blood loss, LOS, or receipt of NT.
Conclusions: We demonstrate that atrial fibrillation is an uncommon occurrence after RAIL. The low leak rate limits our ability to comment on the clinical relevance of atrial fibrillation as a predictor of anastomotic leak but in this series it does not appear to be predictive of a leak.
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