Textbook Outcome after Robotic and Laparoscopic Ivor Lewis Esophagectomy is Associated with Improved Survival - A Propensity Score Matched Analysis.

Autor: Seika P; Chirurgische Klinik, Campus Charité Mitte | Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany; Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. Electronic address: philippa.seika@charite.de., Maurer MM; Chirurgische Klinik, Campus Charité Mitte | Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany; Berlin Institute of Health, Charité Universitätsmedizin Berlin, Germany., Winter A; Chirurgische Klinik, Campus Charité Mitte | Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany., Ossami-Saidy RR; Chirurgische Klinik, Campus Charité Mitte | Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany., Serwah A; Chirurgische Klinik, Campus Charité Mitte | Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany., Ritschl PV; Chirurgische Klinik, Campus Charité Mitte | Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany., Raakow J; Chirurgische Klinik, Campus Charité Mitte | Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany., Dobrindt E; Chirurgische Klinik, Campus Charité Mitte | Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany., Kurreck A; Department of Hematology and Oncology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany., Pratschke J; Chirurgische Klinik, Campus Charité Mitte | Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany., Biebl M; Department of Surgery, Ordensklinikum Linz Barmherzige Schwestern, 4010 Linz, Austria., Denecke C; Chirurgische Klinik, Campus Charité Mitte | Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Germany.
Jazyk: angličtina
Zdroj: The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2024 Nov 16. Date of Electronic Publication: 2024 Nov 16.
DOI: 10.1016/j.jtcvs.2024.11.008
Abstrakt: Background: Esophagectomy is central to curative therapy for esophageal cancer (EC). Perioperative outcomes affect both disease-free and overall survival in oncological esophageal surgery. The adoption of robotic techniques may improve surgical outcome. However, the complex nature of perioperative outcomes is not adequately captured by individual quality measures.
Methods: All patients after minimally invasive esophagectomy (MIE) or robotic-assisted MIE (RAMIE) junction between 2015 and 2022 were included. Textbook outcome was defined as negative resection margins (R0), retrieval of >20 lymph nodes, no major complications, reinterventions, ICU readmission, 30-day readmission or mortality and hospital stay <21 days. Individual propensity scores were calculated using a logistic regression model. Factors affecting TO were evaluated using a logistic regression model while multivariate Cox proportional-hazards model was used to evaluate TO and survival.
Results: Of 236 patients included in this study, 106 (44.91%) achieved TO. TO was achieved in 71 cases after MIE (n=71 (41.21%)) and 31 after RAMIE (n=31 (57.41%)(p=0.036). RAMIE was associated with achievement of TO (OR: 2.01; 95% CI: 1.07-3.80; p=0.031) in the overall cohort. Achievement of TO was due to a reduction in major complications in the RAMIE group. Patients with perioperative TO had a higher 3 year disease-free survival (DFS) rate and overall survival rate (UV: HR 2.49, 95% CI: 1.18-5.26, p=0.016; MV: HR 4.30, 95% CI: 1.60-11.55, p=0.004) compared to those without perioperative TO and disease-free survival (UV: HR 2.28, 95% CI: 1.24-4.19, p=0.008; MV: HR 2.82, 95% CI: 1.26-6.32, p=0.011) after 2 year follow up.
Conclusions: RAMIE is associated with an increased TO achievement. Achieving TO is associated with enhanced long-term survival in esophageal cancer patients and warrants continued emphasis on surgical quality improvement.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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