Introduction: Complication rates associated with minimally invasive Ivor Lewis esophagectomy (MILE) have been reported to be up to 60%. The objective of this study is to explore the preoperative risk factors associated to MILE using data based on the ECCG guidelines.
Methods: We prospectively collected retrospective data on all esophagectomy cases that were performed at a single institution by a single surgeon (ZTA) from September 2013 to date. An exploratory analysis was performed to find the risk factors associated to complications after this procedure. Logistic and linear regressions and Fisher’s exact tests were used to analyze the data as appropriate.
Results: A total of 282 MILEs were analyzed. 140 (49.64%) patients experienced some sort of postoperative complications. Only 36 (12.76%) patients experienced life-threatening complications (based on Clavien-Dindo classification) which led to patient demise in 11 cases (3.9%). Increasing age was associated with the overall development of complications (OR=1.036 [CI95% 1.011-1.064], p<0.05) and with the development of life-threatening complications (OR=1.064 [CI95% 1.020-1.114], p<0.005). Patients aged 60 years or older had a significantly increased rate of overall complications vs. patients aged 59 years or younger (OR=1.804 [CI95% 1.022-3.198], p<0.05); as well as a significantly increased risk of life-threatening complications (OR=5.852 [CI95% 1.592-25.29], p=0.005). Interestingly, BMI was not associated with an increased risk of complications (OR=0.98 [CI95% 0.9416-1.022], p=0.95). Preoperative ECOG status trended towards significance when analyzed for any complication (OR=1.332 [CI95% 0.9811-1.828], p=0.066) but was strongly associated to the development of pulmonary complications including pneumonia (OR=2.225 [CI95% 1.227-4.005], p<0.05) and pleural effusion requiring drainage (OR=1.798 [CI95% 1.128-2.842], p<0.05). We also found a correlation between longer operative time vs. longer length of hospital stay (R2=0.05094, p<0.0005) and longer operative time vs. higher blood loss during surgery (R2=0.03284, p<0.005). Longer operative time did not correlate with the development of complications such as anastomotic leak (OR=1.002 [CI95% 0.9974-1.007], p=0.3347) or pneumonia (OR=1.004 [CI95% 0.9987-1.008], p=0.1518.
Conclusion: We found that age significantly correlates with the development of overall complications or life-threatening complications, especially after the age of 60 years. Interestingly, worse preoperative ECOG status was associated with development of pulmonary complications. Further studies are needed to evaluate the risk factors associated with the development of complications in different hospital settings.
