Key result
Transthoracic minimally invasive esophagectomy at a medium-volume center achieved better outcomes (45.1% any complications, 6.1% major morbidity) than suggested benchmark values.
Why the study?
Does transthoracic minimally invasive esophagectomy at a medium-volume center achieve better postoperative morbidity outcomes compared to established benchmark values?
Observational (n=82)
No
Does transthoracic minimally invasive esophagectomy at a medium-volume center achieve better postoperative morbidity outcomes compared to established benchmark values?
Absolute Event Rate: 45.1% vs 55.7%
Outcomes after minimally invasive esophagectomy at a medium-volume center were superior to established benchmark values from high-volume centers, suggesting current benchmarks do not represent the best achievable results.
May support updating esophagectomy benchmarks; leaves open generalizability beyond this single-center cohort.
BACKGROUND: Recently, benchmark values for low-comorbidity patients at high-volume centers were set to define "best achievable results" for transthoracic minimally invasive esophagectomy (MIE). We aimed to validate suggested benchmark values by comparing them to outcomes at a medium-volume center in Finland. METHODS: All MIEs (n=82) performed at Central Finland Central Hospital between September 2012 and November 2017 including 75 totally MIE and 7 hybrid procedures. The aim of the study was to compare the results to previously suggested benchmark parameters for postoperative morbidity measured with the Clavien-Dindo classification and comprehensive complication index. Target benchmark parameters were ≤55.7% for any complications, ≤30.8% for major complications (Clavien-Dindo ≥3a), ≤40.8% for 30-day and ≤42.8% for 90-day comprehensive complication index, ≤20% for anastomosis leak, ≤31.6% for pulmonary complications, ≤1.0% for 30-day mortality and ≤4.6% for 90-day mortality. RESULTS: 58 years), with more comorbidities. All parameters measuring complications showed better results in our study than benchmark values. Median intensive care unit stay of 1 (IQR, 1-1) and hospital stay of 9 (IQR, 9-12) days were also shorter. At least 1 complication developed in 45.1%, and 6.1% faced major morbidity. Median (IQR) comprehensive complication index for both 30 and 90 days was 0 (IQR, 0-20.9 days). Anastomosis leak and pulmonary complications were observed in 3.7% and 22.0%, respectively. The 30- and 90-day mortality was 1.2% (1/82). CONCLUSIONS: Benchmark values assessing postoperative morbidity after MIE do not represent the defined "best achievable" results after completed learning curves.
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Helminen et al. (2018) conducted an observational in Esophageal cancer or conditions requiring esophagectomy (n=82). Transthoracic minimally invasive esophagectomy (MIE) vs. Suggested benchmark values from high-volume centers was evaluated on Any complications. Transthoracic minimally invasive esophagectomy at a medium-volume center achieved better outcomes (45.1% any complications, 6.1% major morbidity) than suggested benchmark values.
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