What question did this study set out to answer?

To evaluate the implementation process, learning curve, and perioperative outcomes following the introduction of a minimally invasive esophagectomy program at a high-volume surgical center.

September 5, 2023International Journal of SurgeryOpen Access

Implementing the first program of minimally invasive esophagectomy for cancer in Israel: shifting the paradigm in a high-volume center – a cohort study

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Why the study?

Limited data are available on the implementation process and outcomes of minimally invasive techniques for esophagectomy.

Does the implementation of a minimally invasive esophagectomy program improve operative and clinical outcomes over time in patients with esophageal carcinoma?

Population

300 patients who underwent minimally invasive esophagectomy for esophageal carcinoma

Comparison

Early vs late cohorts, plus a secondary historical cohort undergoing open esophagectomy

Design

Single-center cohort study

Authors

DSDaniel SolomonBen-Gurion University of the Negev ESElad SarfatyTel Aviv University NMNikolai MenasherovTel Aviv University

Discussion

Member takes

Implication

Mentorship enables safe MIE adoption at new high-volume centers; extends implementation data but leaves open need for prospective outcome validation.

Key Points

To evaluate the implementation process, learning curve, and perioperative outcomes following the introduction of a minimally invasive esophagectomy program at a high-volume surgical center.
Analyzed 300 patients who underwent minimally invasive esophagectomy (MIE) for esophageal carcinoma between 2011 and 2022, categorized into early and late cohorts to evaluate the surgical learning curve.
Assessed outcomes across three-field MIE (n=242) and two-field MIE (n=58) approaches, comparing trends against historical open esophagectomies (1997–2011).
In three-field MIE, the late cohort achieved a higher lymph node yield (median 17, IQR 12–23 vs. 12, IQR 8–12; P < 0.001) despite longer operative times (median 300 min vs. 262.5 min; P < 0.001).
In two-field MIE, the late cohort had significantly lower rates of prolonged ICU stays (6.9% vs. 31.0%, P = 0.041), overall complications (41.4% vs. 79.3%, P < 0.001), and severe 30-day complications (24.1% vs. 79.3%, P = 0.003).

Structured PICO

Does the implementation of a minimally invasive esophagectomy program improve operative and clinical outcomes over time in patients with esophageal carcinoma?

Population

300 patients who underwent minimally invasive esophagectomy for esophageal carcinoma between 2011-2022 at a high-volume center in Israel. Secondary analysis included patients who underwent open esophagectomy 1997-2011.

Intervention

Minimally invasive esophagectomy (MIE), including three-field (3F-MIE, n=242) and two-field (2F-MIE, n=58)

Comparator

Early vs. late cohorts (learning curve analysis) and historical open esophagectomy cohort (1997-2011)

Outcome

Implementation processes and outcomes including retrieved lymph nodes, operative time, prolonged ICU admissions, and 30-day complications

The implementation of a minimally invasive esophagectomy program was safe, with improved nodal yield compared to open surgery and decreasing complication rates over the learning curve.

Cite This Study

Solomon et al. (2023) studied this question.

synapsesocial.com/papers/6a7a72fb756812e395899762 https://doi.org/10.1097/js9.0000000000000646

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Implication

Mentorship enables safe MIE adoption at new high-volume centers; extends implementation data but leaves open need for prospective outcome validation.

Implementing the first program of minimally invasive esophagectomy for cancer in Israel: shifting the paradigm in a high-volume center – a cohort study

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Implementing the first program of minimally invasive esophagectomy for cancer in Israel: shifting the paradigm in a high-volume center – a cohort study

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider