%0 Journal Article %1 Lorimer:2018:Ann-Surg-Oncol:30382434 %A Lorimer, P D %A Motz, B M %A Boselli, D M %A Reames, M K %A Hill, J S %A Salo, J C %D 2018 %J Ann Surg Oncol %K MIE myown %R 10.1245/s10434-018-6938-z %T Quality Improvement in Minimally Invasive Esophagectomy: Outcome Improvement Through Data Review %U https://www.ncbi.nlm.nih.gov/pubmed/30382434 %X Esophagectomy is a complex operation in which outcomes are profoundly influenced by operative experience and volume. We report the effects of experience and innovation on outcomes in minimally invasive esophagectomy.Esophageal resections for cancer from 2007 to 2016 at Levine Cancer Institute at Carolinas Medical Center (Charlotte, NC) were reviewed. During this time, three changes in technique were made to improve outcomes: vascular evaluation of the gastric conduit to improve anastomotic healing (beginning at case \#63), one-stage approach to permit access to abdomen and chest through one draped surgical field (case \#82), and adoption of a lung-protective anesthetic protocol (case \#101). Mortality, operative time, complications, and length of stay were analyzed relative to these interventions using GLM regression.200 patients underwent minimally invasive esophagectomy. There were no mortalities at 30�days, and no change in mortality rate at 60 and 90�days. Anastomotic leak decreased significantly after the introduction of intraoperative vascular evaluation of the gastric conduit (3.6 vs 19.4%). Operative time decreased with adoption of a one-stage approach (416 vs 536�min). Pulmonary complications decreased coincident with a change in anesthetic technique (pneumonia 6 vs 28%). Lymph node harvest increased over time. Length of stay was driven primarily by complications and decreased with operative experience.Postoperative complications, operative time, and length of stay decreased with case experience and alterations in surgical and anesthetic technique. We believe that adoption of the techniques and technology described herein can reduce complications, reduce hospital stay, and improve patient outcomes.

@article{Lorimer:2018:Ann-Surg-Oncol:30382434, abstract = {Esophagectomy is a complex operation in which outcomes are profoundly influenced by operative experience and volume. We report the effects of experience and innovation on outcomes in minimally invasive esophagectomy.Esophageal resections for cancer from 2007 to 2016 at Levine Cancer Institute at Carolinas Medical Center (Charlotte, NC) were reviewed. During this time, three changes in technique were made to improve outcomes: vascular evaluation of the gastric conduit to improve anastomotic healing (beginning at case \#63), one-stage approach to permit access to abdomen and chest through one draped surgical field (case \#82), and adoption of a lung-protective anesthetic protocol (case \#101). Mortality, operative time, complications, and length of stay were analyzed relative to these interventions using GLM regression.200 patients underwent minimally invasive esophagectomy. There were no mortalities at 30�days, and no change in mortality rate at 60 and 90�days. Anastomotic leak decreased significantly after the introduction of intraoperative vascular evaluation of the gastric conduit (3.6 vs 19.4%). Operative time decreased with adoption of a one-stage approach (416 vs 536�min). Pulmonary complications decreased coincident with a change in anesthetic technique (pneumonia 6 vs 28%). Lymph node harvest increased over time. Length of stay was driven primarily by complications and decreased with operative experience.Postoperative complications, operative time, and length of stay decreased with case experience and alterations in surgical and anesthetic technique. We believe that adoption of the techniques and technology described herein can reduce complications, reduce hospital stay, and improve patient outcomes.}, added-at = {2018-11-30T23:04:05.000+0100}, author = {Lorimer, P D and Motz, B M and Boselli, D M and Reames, M K and Hill, J S and Salo, J C}, biburl = {https://www.bibsonomy.org/bibtex/21850ca8cda4bc65cdb046b7a9a030c9e/jcsalo}, description = {Quality Improvement in Minimally Invasive Esophagectomy: Outcome Improvement Through Data Review. - PubMed - NCBI}, doi = {10.1245/s10434-018-6938-z}, interhash = {d117d5da092291d27c4a9cac43a24932}, intrahash = {1850ca8cda4bc65cdb046b7a9a030c9e}, journal = {Ann Surg Oncol}, keywords = {MIE myown}, month = oct, pmid = {30382434}, timestamp = {2018-11-30T23:04:05.000+0100}, title = {Quality Improvement in Minimally Invasive Esophagectomy: Outcome Improvement Through Data Review}, url = {https://www.ncbi.nlm.nih.gov/pubmed/30382434}, year = 2018 }