In a highly selected cohort of low-risk patients undergoing total minimally invasive transthoracic esophagectomy, the benchmark value for overall complications at 30 days after discharge was ≤55.7%.
Cohort (n=1,057)
Yes
This study establishes benchmark values for postoperative outcomes in low-comorbidity patients undergoing total minimally invasive transthoracic esophagectomy, providing a reference standard for evaluating surgical performance.
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). 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.
Schmidt et al. (Tue,) conducted a cohort in Esophageal cancer (n=1,057). Total minimally invasive transthoracic esophagectomy (ttMIE) was evaluated on Benchmark value (75th percentile of median outcomes) for overall complications at 30 days after hospital discharge. In a highly selected cohort of low-risk patients undergoing total minimally invasive transthoracic esophagectomy, the benchmark value for overall complications at 30 days after discharge was ≤55.7%.