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Objective: To compare the postoperative pulmonary complications (PPC) after minimally invasive or open transthoracic esophagectomy for esophageal cancer in an international, multicenter cohort. Summary of background data: Ongoing debate exists around the optimal surgical approach for esophageal cancer, with limited data assessing the external validity of randomised trials on outcomes of MIE Methods: Patients undergoing open (OE, n = 744), hybrid (HE, n = 500), and totally minimally invasive esophagectomy (TMIE, n = 540) for esophageal cancer were identified from the international, prospective Oesophagogastric Anastomosis Audit (OGAA). Multivariable models were used to investigate PPC (primary outcome) as well as overall complications, major complications, anastomotic leak and 90-day mortality (secondary outcomes). Results: PPC rates were lower after TMIE compared to OE and HE (28% vs 37% vs 39%, p = 0.002), even on adjusted analyses compared to OE (odds ratio (OR): 0.60, CI95%: 0.45—0.78). TMIE was also associated with significantly lower overall complications (OR: 0.68, CI95%: 0.52—0.88) compared to OE, but not for major complications (OR: 0.90, CI95%: 0.67—1.21), anastomotic leak (OR: 1.39, CI95%: 0.96—2.01) and 90-day mortality (OR: 0.49, CI95%: 0.22—1.04). Sensitivity analyses by underlying respiratory disease, neoadjuvant chemoradiotherapy or high-volume centers confirmed above findings. Conclusion: This study provides real-world data that TMIE was associated with lower 90-day PPC than OE and HE approaches, especially in patients with underlying respiratory disease or receiving neoadjuvant chemoradiotherapy. These warrant a further review into causes and mechanisms in selected patients, and that quality assurance in delivery of TMIE is probably of major importance. The ideal surgical approach remains unclear, and ongoing trials will provide more evidence within a few years that may clarify the optimum approach to locally advanced esophageal cancers.
Postoperative outcomes after minimally invasive esophagectomy: an international cohort study from the Oesophagogastric Anastomosis Audit (OGAA)
Mitchell J. D.;Weyant M. J.;Scott C. D.;Singh A.;Okolo E.;Zheng R.;Berger A. C.;Rosato E. L.;Chmielewski G.;Liptay M. J.;Seder C. W.;Karush M. K.;Makey I. A.;Mccormack K.;Ben-Younes H.;Padickakudi J.;Jambulingam P.;Rashid F.;Owera A.;Powell A.;Escofet X.;Havard T.;Blackshaw G.;Ioannidi L.;Slim N.;Abbassi N.;Grace B.;Walker R.;Wyman A.;Tamhankar A.;Patel K.;Ackroyd R.;Alasmar M. M. A.;Brown R.;Chaparala R.;Akhtar K.;Vickers J.;Abdulrahman M.;Tan B.;Mohamed I.;Athanasiou A.;Pucher P.;Knight B.;Carter N.;Choh C.;Humphreys L.;Reece-Smith A.;Ariyarathenam A.;Wheatley T.;Sanders G.;Sgromo B.;Zanotti D.;Akbari K.;van Boxel G.;Singh P.;Reilly J. J.;Theophilidou E.;Couch J.;Yanni F.;Tewari N.;Ahmad A.;Warrilow H.;Singh M.;Evans R.;Bouras G.;Willem J.;Noaman I.;Patil P.;Wilson M.;Lorenzi B.;Kordzadeh A.;Moussa O.;Chaudry A.;Kumar S.;Ahmed A.;Butt Z.;Supramaniam K.;Hunter D.;Palser T.;To N.;Hayden J.;Mehta S.;Sue Ling H.;Sarela A.;Pursnani K.;Ball C.;Shetty V.;Ward J.;Verma R.;Watson L.;Bromley G.;Davis P.;Powell-Brett S.;Kapoulas S.;Tucker O.;Singhal R.;Mistry P.;McKay S.;Di Maggio F.;Davies A.;Kelly M.;Saad M.;Baker C.;Wadley M.;Jaunoo S.;Hornby S.;Dwerryhouse S.;Craig C.;MacKay C.;Macdonald A.;Fullarton G.;McGregor R.;Walls L.;Iqbal R.;Worku D.;Al Khyatt W.;Cox M.;Das N.;Brewer H.;Sharp C.;Koshy R.;McLaughlin E.;Tan L. C.;Menon V.;Cowen M.;Elshaer A.;Wong V.;Mitton D.;Byrne B.;Schiller M.;Blencowe N.;Manby P.;Young R.;Bennett D.;Mayo D.;Wilson I.;Davies N.;Dobson G.;Harris A.;McCain S.;Kennedy R.;Wiggins T. H.;Mukherjee S.;Mukherjee D.;Amalesh T.;Gilbert T.;Exarchou K.;Chan B.;Shrotri M.;Afzal Z.;Bennett J.;Sujendran V.;Safranek P.;Hardwick R.;Damburaci N.;Karahan O.;Akkapulu N.;Baki B. E.;Yildirim R.;Turkyilmaz A.;Turkyilmaz S.;Kurnaz E.;Er S.;Schnider A.;Colucci N.;Mickael C.;Sundbom M.;Rutegard M.;Lindberg F.;Dzhendov T.;Ahmed M. E.;Sanchez D. P.;Choolani Bhojwani E.;Tinoco Carrasco C.;Bailon Cuadrado M.;Perez Sanchez L. E.;Rosat Rodrigo A.;Diaz Lopez C.;Concepcion Martin V.;Magadan Alvarez C.;Fernandez Diaz M. J.;Martinez E. T.;Santos E. P. G.;Garcia S. S.;Rendo A. G.;Campos P. V.;Alvarez L. S.;Turienzo S. A.;Pais S. A.;Rodicio Miravalles J. L.;Martinez Corcoles J. A.;Pagan Pomar A.;Rico M.;Rifa S.;Dal Cero M.;Ramon J. M.;Leturio S.;Diez del Val I.;Kim G.;Shabbir A.;Chin T. S.;Babic T.;Veselinovic M.;Gunjic D.;Ganjara I.;Agasiev M.;Shneider V.;Tomsa R.;Hoara P. A.;Predescu D.;Birla R. D.;Cordos I.;Negoita V.;Ciubotaru C.;Stoica B.;Beuran M.;Obleaga C. V.;Racu A. E.;Paitici S.;Ciuce C.;Apostu R.;Drasovean R.;Videira J. F.;Correia A. M.;Martins P. C.;Gomes M. P.;Cabral F.;Ramos P.;Monteiro C.;Braga T.;Matos H.;Campos J. C.;Bernardes A.;da Silva R.;Pinho A. C.;Naeem A.;Ahmed H. H.;BaigNoor M. M. A.;Khattak S.;Nasir I.;Shakeel O.;Zakir Z.;Farmanali J.;Jhanzaib M. H.;Raza A.;Shehzadi A.;Sarwar M. Z.;Qudus S. B. A.;Mirza Z. U.;Haris M.;Khalil N.;Wajid A.;Shaikh K.;Memon A. H.;Ekwunife C.;Smith B.;Young M.;MacCormick A.;Patel R.;Johnston P.;Evenett N.;de Maat M.;van der Sluis P. C.;Ruurda J. P.;van Workum F.;Verstegen M.;Klarenbeek B.;Bouwense S.;Matthijsen R.;Martijnse I.;Jansen W. A.;Cords C.;van Lanschot J. J. B.;Lagarde S. M.;Cortes-Gonzalez R.;Basave H. N. L.;Tan J. H.;Pang W. S.;Ho C. A.;Thannimalai S.;Tan Y. R.;Wong L. F.;Makkai-Popa S. T.;Elnagar H. F.;Elnagar F. A.;Elhadi A.;Shebani A. O.;Ahmed H. A.;AlShehab D.;Mwachiro E.;Odera A.;Fekadu A.;Mwachiro M.;Ishii K.;Makuuchi R.;Irino T.;Niihara M.;Tsubosa Y.;De Pasqual C. A.;La Mendola R.;Giacopuzzi S.;De Manzoni G.;Salmaso B.;Saadeh L.;Scarpa M.;Provenzano L.;Merigliano S.;Bernardi D.;Asti E.;Sartarelli L.;Bianchini S.;Vaccari S.;Cervellera M.;Donlon N.;Ravi N.;Khizer H.;Ivanovski I.;Hennessy M. M.;O Suilleabhain C. B.;Quinn A.;McAnena O.;Mastrosimone A.;Baban C.;Bolger J.;Balalis D.;Manatakis D. K.;Charalabopoulos A.;Mpoura M.;Balli E.;Michalinos A.;Schizas D.;Triantafyllou S.;Reeh M.;Boecher U.;Volovnik L.;Hesse J.;Albanese G.;Kreuser N.;Niebisch S.;Ebeling M.;Azizian A.;Emons G.;Golcher H.;Weber G.;Krautz C.;Gruetzmann R.;Merilainen S.;Koivukangas V.;Kauppila J. H.;Tizazu A.;Teferra E.;Nega B.;Brandt B.;Siemsen M.;Thorsteinsson M.;Holm J.;Eckardt J.;Stilling N. M.;Ainswort A. P.;Kruhlikava I.;Morten B.;Ingemann T.;Katballe N.;Mortensen P. B.;Sevcikova M.;Faltova H.;Snajdauf M.;Pazdro A.;Duarte S.;Caceres S.;Cetares C.;Cortes N.;Gomez-Mayorga J.;Bastidas A.;Pineda M.;Castilla L.;Beltran-Garcia T. C.;Nino-Torres L.;Ortega J.;Gonzalez F.;Vargas-Barato F.;Carroll P.;Allison F.;Yeung J.;Shea P.;Srinathan S.;Tan L.;Buduhan G.;Ferrer J. A. P.;Coelho J. D. S.;Tercioti V.;Lopes L. R.;da Rocha J. R. M.;Sallum R. A. A.;Cecconello I.;Bui H.;Bassari R.;Johnson M.;Read M.;Ward S.;Fisher O. M.;Loi K.;Cabalag C.;Dingle A.;Thorpe T.;Albadawi F.;Yacob M.;Spillane J.;Liem H.;Richardson M.;McQuillan P.;Cerdeira M. P.;Wright T.;Cheah S.;Salim J.;Mosse C.;Beenen E.;Fergusson J.;Meguid R. A.;Palazzo F.;Arndt A. T.;Thomas M.;Bryce G.;Al-Bahrani A.;Lewis W.;Dawas K.;Underwood T.;Kelty C.;Melhado R.;Puig S.;Mercer S.;Berrisford R.;Maynard N.;Vohra R.;Beardsmore D.;Cheong E.;Oglesby S.;Allum W. H.;Boddy A.;Dexter S.;Turner P.;Viswanath Y. K. S.;Nijjar R.;Gossage J.;Higgs S.;Forshaw M.;Skipworth R.;Iftikhar S.;Robertson K.;Chan D.;Jain P.;Wilkerson P.;Gokhale J.;Byrom R.;Khoo D.;Khan I.;Hindmarsh A.;Sevinc B.;Colak E.;Tirnaksiz M. B.;Guner A.;Tez M.;Gutknecht S.;Monig S.;Hedberg J.;Halldestam I.;Elmahi S.;Citores Pascual M. A.;Vallve-Bernal M.;Trugeda Carrera M. S.;Martin Fernandez J.;Moreno Gijon M.;Bianchi A.;Pera M.;Loureiro C.;Gacevski G.;So J. B. Y.;Bjelovic M.;Sekhniaidze D.;Constantinoiu S.;Bolca C.;Mogoanta S. S.;Scurtu R. R.;Costa R. C. T.;Casaca R.;Freire J.;Leite J.;Vicente C. S.;Barbosa J.;Syed A. A.;Naqi S. A.;Qureshi A. U.;Pal K. M. I.;Rossaak J. I.;Gordon A.;Babor R.;Beban G.;van Hillegersberg R.;Rosman C.;Heisterkamp J.;Okonta K. E.;Lau P. C.;Medina-Franco H.;Leon-Takahashi A. M.;Elhadi M.;Alghunaim E.;White R. E.;Terashima M.;Weindelmayer J.;Bardini R.;Valmasoni M.;Bonavina L.;Migliore M.;Tonini V.;Reynolds J.;Murphy T.;Collins C.;Robb W. B.;Korkolis D. P.;Liakakos T.;Theodorou D.;Saarnio J.;Achiam M. P.;Larsen M. H.;Kjaer D. W.;Dikinis S.;Egberts J. H.;Izbicki J.;Reim D.;Gaedcke J.;Raptis D.;Arias-Amezquita F.;Rosero G.;Isaza-Restrepo A.;Darling G.;Johnston B.;Andreollo N. A.;Jacobs R.;Hii M. W.;Talbot M.;Duong C.;Devadas M.;Wills V.;Gananadha S.;Isik A.;Hsu P. K.;Schneider P. M.;Wallner B.;Blanco R.;Negoi I.;Sampaio A. S.;Sousa M.;Sayyed R. H.;El Kafsi J.;Wijnhoven B. P. L.;Mejia-Fernandez L.;Mahendran H. A.;Azagra J. S.;Bagajevas A.;Da Roit A.;Kennedy A.;Gockel I.;Kechagias A.;Bekele A.;Harustiak T.;Guevara Castro R.;Kidane B.;Takeda F. R.;Moreno J. I.;Gjata A.;Whitehouse T.;Wanigasooriya K.;Siaw-Acheampong K.;Nepogodiev D.;Kamarajah S. K.;Jefferies B.;Griffiths E. A.;Evans R. P. T.;Bundred J.;Alderson D.
2025-01-01
Abstract
Objective: To compare the postoperative pulmonary complications (PPC) after minimally invasive or open transthoracic esophagectomy for esophageal cancer in an international, multicenter cohort. Summary of background data: Ongoing debate exists around the optimal surgical approach for esophageal cancer, with limited data assessing the external validity of randomised trials on outcomes of MIE Methods: Patients undergoing open (OE, n = 744), hybrid (HE, n = 500), and totally minimally invasive esophagectomy (TMIE, n = 540) for esophageal cancer were identified from the international, prospective Oesophagogastric Anastomosis Audit (OGAA). Multivariable models were used to investigate PPC (primary outcome) as well as overall complications, major complications, anastomotic leak and 90-day mortality (secondary outcomes). Results: PPC rates were lower after TMIE compared to OE and HE (28% vs 37% vs 39%, p = 0.002), even on adjusted analyses compared to OE (odds ratio (OR): 0.60, CI95%: 0.45—0.78). TMIE was also associated with significantly lower overall complications (OR: 0.68, CI95%: 0.52—0.88) compared to OE, but not for major complications (OR: 0.90, CI95%: 0.67—1.21), anastomotic leak (OR: 1.39, CI95%: 0.96—2.01) and 90-day mortality (OR: 0.49, CI95%: 0.22—1.04). Sensitivity analyses by underlying respiratory disease, neoadjuvant chemoradiotherapy or high-volume centers confirmed above findings. Conclusion: This study provides real-world data that TMIE was associated with lower 90-day PPC than OE and HE approaches, especially in patients with underlying respiratory disease or receiving neoadjuvant chemoradiotherapy. These warrant a further review into causes and mechanisms in selected patients, and that quality assurance in delivery of TMIE is probably of major importance. The ideal surgical approach remains unclear, and ongoing trials will provide more evidence within a few years that may clarify the optimum approach to locally advanced esophageal cancers.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11770/397550
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.
