Universität zu Köln

Schmidt, Henner M., Gisbertz, Susanne S., Moons, Johnny ORCID: 0000-0003-4553-3102, Rouvelas, Ioannis ORCID: 0000-0003-0774-1904, Kauppi, Juha, Brown, Andrew ORCID: 0000-0001-9375-7501, Asti, Emanuele, Luyer, Misha, Lagarde, Sjoerd M., Berlth, Felix ORCID: 0000-0002-3780-0728, Philippron, Annouck, Bruns, Christiane, Holscher, Arnulf, Schneider, Paul M., Raptis, Dimitri A., Henegouwen, Mark I. van Berge, Nafteux, Philippe, Nilsson, Magnus, Rasanen, Jari ORCID: 0000-0002-7826-532X, Palazzo, Francesco, Rosato, Ernest, Mercer, Stuart, Bonavina, Luigi, Nieuwenhuijzen, Grard, Wijnhoven, Bas P. L., Schroeder, Wolfgang, Pattyn, Piet, Grimminger, Peter P. and Gutschow, Christian A. (2017). Defining Benchmarks for Transthoracic Esophagectomy A Multicenter Analysis of Total Minimally Invasive Esophagectomy in Low Risk Patients. Ann. Surg., 266 (5). S. 814 - 822. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1528-1140

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Abstract

Objective: To define best possible outcomes in total minimally invasive transthoracic esophagectomy (ttMIE). Background: TtMIE, performed by experts in patients with low comorbidity, may serve as a benchmark procedure for esophagectomy. Patients and Methods: From a cohort of 1057 ttMIE, performed over a 5-year period in 13 high-volume centers for esophageal surgery, we selected a study group of 334 patients (31.6%) that fulfilled criteria of low comorbidity (American Society of Anesthesiologists score <= 2, WHO/ECOG score <= 1, age <= 65 years, body mass index 19-29 kg/m(2)). Endpoints included postoperative morbidity measured by the Clavien-Dindo classification and the comprehensive complication index. Benchmark values were defined as the 75th percentile of the median outcome parameters of the participating centers to represent best achievable results. Results: Benchmark patients were predominantly male (82.9%) with a median age of 58 years (53-62). High intrathoracic (Ivor Lewis) and cervical esophagogastrostomy (McKeown) were performed in 188 (56.3%) and 146 (43.7%) patients, respectively. Median (IQR) ICU and hospital stay was 0 (0-2) and 12 (9-18) days, respectively. 56.0% of patients developed at least 1 complication, and 26.9% experienced major morbidity (>= grade III), mostly related to pulmonary complications (25.7%), anastomotic leakage (15.9%), and cardiac events (13.5%). Benchmark values at 30 days after hospital discharge were <= 55.7% and <= 30.8% for overall and major complications, <= 18.0% for readmission, <= 3.1% for positive resection margins, and >= 23 for lymph node yield. Benchmarks at 30 and 90 days were <= 1.0% and <= 4.6% for mortality, and <= 40.8 and <= 42.8 for the comprehensive complication index, respectively. Conclusion: This outcome analysis of patients with low comorbidity undergoing ttMIE may serve as a reference to evaluate surgical performance in major esophageal resection.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schmidt, Henner M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gisbertz, Susanne S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Moons, Johnny UNSPECIFIED orcid.org/0000-0003-4553-3102 UNSPECIFIED Rouvelas, Ioannis UNSPECIFIED orcid.org/0000-0003-0774-1904 UNSPECIFIED Kauppi, Juha UNSPECIFIED UNSPECIFIED UNSPECIFIED Brown, Andrew UNSPECIFIED orcid.org/0000-0001-9375-7501 UNSPECIFIED Asti, Emanuele UNSPECIFIED UNSPECIFIED UNSPECIFIED Luyer, Misha UNSPECIFIED UNSPECIFIED UNSPECIFIED Lagarde, Sjoerd M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Berlth, Felix UNSPECIFIED orcid.org/0000-0002-3780-0728 UNSPECIFIED Philippron, Annouck UNSPECIFIED UNSPECIFIED UNSPECIFIED Bruns, Christiane UNSPECIFIED UNSPECIFIED UNSPECIFIED Holscher, Arnulf UNSPECIFIED UNSPECIFIED UNSPECIFIED Schneider, Paul M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Raptis, Dimitri A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Henegouwen, Mark I. van Berge UNSPECIFIED UNSPECIFIED UNSPECIFIED Nafteux, Philippe UNSPECIFIED UNSPECIFIED UNSPECIFIED Nilsson, Magnus UNSPECIFIED UNSPECIFIED UNSPECIFIED Rasanen, Jari UNSPECIFIED orcid.org/0000-0002-7826-532X UNSPECIFIED Palazzo, Francesco UNSPECIFIED UNSPECIFIED UNSPECIFIED Rosato, Ernest UNSPECIFIED UNSPECIFIED UNSPECIFIED Mercer, Stuart UNSPECIFIED UNSPECIFIED UNSPECIFIED Bonavina, Luigi UNSPECIFIED UNSPECIFIED UNSPECIFIED Nieuwenhuijzen, Grard UNSPECIFIED UNSPECIFIED UNSPECIFIED Wijnhoven, Bas P. L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schroeder, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Pattyn, Piet UNSPECIFIED UNSPECIFIED UNSPECIFIED Grimminger, Peter P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gutschow, Christian A. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-213253
DOI:	10.1097/SLA.0000000000002445
Journal or Publication Title:	Ann. Surg.
Volume:	266
Number:	5
Page Range:	S. 814 - 822
Date:	2017
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1528-1140
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CANCER; OUTCOMES; SURGERY; COMPLICATIONS; ADJUSTMENT; MORBIDITY; MORTALITY; RESECTION Multiple languages Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/21325