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Erschienen in: Langenbeck's Archives of Surgery 2/2018

23.03.2018 | ORIGINAL ARTICLE

Standardizing procedures improves and homogenizes short-term outcomes after minimally invasive esophagectomy

verfasst von: Taro Oshikiri, Tetsu Nakamura, Hiroshi Hasegawa, Masashi Yamamoto, Shingo Kanaji, Kimihiro Yamashita, Takeru Matsuda, Yasuo Sumi, Yasuhiro Fujino, Masahiro Tominaga, Satoshi Suzuki, Yoshihiro Kakeji

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 2/2018

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Abstract

Purpose

Esophageal cancer is one of the deadliest cancers worldwide. Esophagectomy with lymphadenectomy is regarded as the only curative option for resectable esophageal cancer, but it is associated with high morbidity and mortality. Multidisciplinary team (MDT) management was recently associated with improved outcomes after surgery for esophageal cancer. The aim of this study was to investigate the effect of standardizing procedures for minimally invasive esophagectomy (MIE) in the MDT setting.

Methods

This was a case-matched control study of 154 patients with esophageal cancer who underwent thoracoscopic esophagectomy in the prone position (TEP) between 2012 and 2016. Surgery was performed by two attending surgeons (surgeons A and B) who began working together in the same MDT in 2015. At that time, the following surgical procedures were standardized between surgeons A and B: mediastinal lymphadenectomy, abdominal procedures, and estimation of the blood supply of the gastric conduit. Short-term outcomes were compared between the following paired groups using propensity scores: surgeon A’s pre- and post-standardization groups, surgeon B’s pre- and post-standardization groups, and surgeon A’s post-standardization group and surgeon B’s post-standardization group.

Results

Concerning surgeon A, the estimated total blood loss in the post-standardization group (142 ± 87 mL) was significantly lower than that in the pre-standardization group (376 ± 215 mL, P = 0.006). The rate of left recurrent laryngeal nerve palsy in the post-standardization group (13%) was significantly lower than that in the pre-standardization group (47%, P = 0.046). Concerning surgeon B, the rate of anastomotic leakage in the post-standardization group (0%) was significantly lower than that in the pre-standardization group (11%, P = 0.039). Comparing the post-standardization groups of surgeons A and B, there were no significant differences in operative outcomes or morbidity.

Conclusions

Standardizing procedures for MIE improved and homogenized surgical short-term outcomes.
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Metadaten
Titel
Standardizing procedures improves and homogenizes short-term outcomes after minimally invasive esophagectomy
verfasst von
Taro Oshikiri
Tetsu Nakamura
Hiroshi Hasegawa
Masashi Yamamoto
Shingo Kanaji
Kimihiro Yamashita
Takeru Matsuda
Yasuo Sumi
Yasuhiro Fujino
Masahiro Tominaga
Satoshi Suzuki
Yoshihiro Kakeji
Publikationsdatum
23.03.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 2/2018
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-018-1661-6

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