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Morbidity Associated With Introduction of MIS Esophagectomy in a Community Hospital.
Dante Dali*, Trent Howard, Charles D. Goldman, Jan Franko
General Surgery, Mercy medical center Des Moines, Des moines, IA
Morbidity associated with introduction of MIS esophagectomy in a community hospital.
BACKGROUND: Esophagectomy remains a high-risk procedure. Safety of minimally invasive (MIS) esophagectomy outside of high-volume centers has not been studied. Therefore we evaluated our experience with introduction of MIS esophagectomy in settings of community teaching hospital without formal university affiliation.
METHODS: A retrospective cohort of all elective esophagectomy patients treated in a community hospital in 2008-2014 was evaluated (n=50,open vs. MIS?). Clavien-Dindo complication grades were recorded prospectively.
RESULTS: Mean age was 63 ± 11 years (range 30-83), mean Charlson comorbidity index was 4.6±1.8 and mean ASA score 2.9±0.4. The groups did not differ in ASA score, age, gender distribution, and Charlson or Seattle comorbidity indices. There were a total of 98 complications including 2 deaths (4%, both coronary events). Any complications occurred among 75% versus 77% cases (open versus MIS group, p=0.825), grade 3-4 complications 59% versus 39% (p=0.164), and mortality nil versus 2 cases (p=0.595). Esophagectomy (open versus MIS) was associated with average 2.1±1.8 versus 1.7±1.4 complications (p=0.518), and 1±1.1 versus 0.7±1.0 grade 3-4 complications (p=0.344). MIS operations were longer (342±109 versus 425±74 minutes, p=0.001). Length of stay was trending non significantly shorter among MIS cases (17±4 vs 11±9 days, p=0.173). Logistic regression models including gender, Charlson comorbidity index, Seattle comorbidity index, ASA score, age, and MIS status were not predictive of complication development.
CONCLUSION: Introduction of MIS esophagectomy in our community hospital was associated with prolonged operative time, but no detectable adverse outcomes.Length of stay was non-significantly shortened by the use of MIS esophagectomy.
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