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Publication Date
2025
Faculty Advisor/Mentor
Dr. Rachit Shah
Description
Objective: To examine the learning curve of one surgeon performing minimally invasive esophagectomy (MIE) over a 10-year period since the beginning of their practice with a focus on patient outcomes. Methods: This is a retrospective study of all patients undergoing MIE for malignancy by one surgeon at an academic high-volume tertiary center over a 10-year period (10/2012 to 9/2022). Patients were stratified into 2 equal groups based on chronological order and termed Early MIE and Late MIE. Primary outcomes included operative measures and patient outcomes over a 1- year period post-operatively. Results: A total of 128 patients were identified, divided into Early MIE (64 patients) and Late MIE (64 patients). Mean age was 64±9 years, with a majority of white (114 [89%]), male (95 [74%]) patients who received neoadjuvant chemoradiation therapy (98 [77%]). Patients in the Late MIE group had higher median Charlson Comorbidity Index (5 vs 4; p=0.046), more prior chest and/or abdominal surgeries (45 [70%] vs 33 [52%]); p=0.030), and higher mean preoperative albumin levels (3.9 vs 3.5; p=0.019). More patients in the Early MIE group had conversion to open procedure (9 [14.1%] vs 1 [1.6%]; p=0.008). Comparing Early MIE vs Late MIE, mean operative time was 517 vs 443 minutes (p< 0.001), estimated blood loss was 223 vs 164 cc (p=0.044), and median hospital stay was 9 vs 8 days (p=0.019). All resections had negative margins confirmed on frozen sections, with higher lymph node yield in the Late MIE group (21 vs 17; p=0.013). Figure 1 is a summary of post-operative complication events. Conclusions: Improving operative measures and patient outcomes despite more complex patient medical and surgical histories is strongly supportive of a learning curve in this technically challenging procedure.
Keywords
minimally invasive, esophagectomy, learning curve, leak, stenosis
Disciplines
Surgery
Rights
Dr. Mohamad Chehab and Dr. Rachit Shah