The impact of minimally-invasive esophagectomy operative duration on post-operative outcomes.

Autor:	Tupper HI; Division of General Surgery, Department of Surgery, University of California, Los Angeles, CA, United States.; Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, United States., Roybal BO; Division of Research, Biostatistical Consulting Unit, Kaiser Permanente Northern California, Oakland, CA, United States., Jackson RW; UCSF School of Medicine, University of California, San Francisco, CA, United States., Banks KC; Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, United States.; Division of General Surgery, Department of Surgery, University of California, San Francisco-East Bay, Oakland, CA, United States., Kwak HV; Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, United States.; Division of General Surgery, Department of Surgery, University of California, San Francisco-East Bay, Oakland, CA, United States., Alcasid NJ; Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, United States.; Division of General Surgery, Department of Surgery, University of California, San Francisco-East Bay, Oakland, CA, United States., Wei J; Division of Research, Biostatistical Consulting Unit, Kaiser Permanente Northern California, Oakland, CA, United States., Hsu DS; Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, United States.; Division of General Surgery, Department of Surgery, University of California, San Francisco-East Bay, Oakland, CA, United States., Velotta JB; Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, United States.; UCSF School of Medicine, University of California, San Francisco, CA, United States.; Division of Clinical Medicine, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in surgery [Front Surg] 2024 Feb 19; Vol. 11, pp. 1348942. Date of Electronic Publication: 2024 Feb 19 (Print Publication: 2024).
DOI:	10.3389/fsurg.2024.1348942
Abstrakt:	Background: Esophagectomy, an esophageal cancer treatment mainstay, is a highly morbid procedure. Prolonged operative time, only partially predetermined by case complexity, may be uniquely harmful to minimally-invasive esophagectomy (MIE) patients for numerous reasons, including anastomotic leak, tenuous conduit perfusion and protracted single-lung ventilation, but the impact is unknown. This multi-center retrospective cohort study sought to characterize the relationship between MIE operative time and post-operative outcomes. Methods: We abstracted multi-center data on esophageal cancer patients who underwent MIE from 2010 to 2021. Predictor variables included age, sex, comorbidities, body mass index, prior cardiothoracic surgery, stage, and neoadjuvant therapy. Outcomes included complications, readmissions, and mortality. Association analysis evaluated the relationship between predictor variables and operative time. Multivariate logistic regression characterized the influence of potential predictor variables and operative time on post-operative outcomes. Subgroup analysis evaluated the association between MIE >4 h vs. ≤4 h and complications, readmissions and survival. Results: For the 297 esophageal cancer patients who underwent MIE between 2010 and 2021, the median operative duration was 4.8 h [IQR: 3.7-6.3]. For patients with anastomotic leak (5.1%) and 1-year mortality, operative duration was elevated above the median at 6.3 h [IQR: 4.8-8.6], p  = 0.008) and 5.3 h [IQR: 4.4-6.8], p  = 0.04), respectively. In multivariate logistic regression, each additional hour of operative time increased the odds of anastomotic leak and 1-year mortality by 39% and 19%, respectively. Conclusions: Esophageal cancer is a poor prognosis disease, even with optimal treatment. Operative efficiency, a modifiable surgical variable, may be an important target to improve MIE patient outcomes. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2024 Tupper, Roybal, Jackson, Banks, Kwak, Alcasid, Wei, Hsu and Velotta.)
Databáze:	MEDLINE
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