Is Esophagectomy for Benign Conditions Benign?
Masabni K, Kandagatla P, Popoff AM, Rubinfeld I, and Hammoud Z. Is esophagectomy for benign conditions benign? Ann Thorac Surg 2018;106(2):368-374.
Annals of Thoracic Surgery
BACKGROUND: Outcomes data on esophagectomy performed for benign conditions is scarce. Using the National Surgical Quality Improvement Program database, we sought to analyze outcomes of esophagectomy performed for benign conditions.
METHODS: The National Surgical Quality Improvement Program database was queried for all esophagectomies performed from 2005 to 2015. Outcomes for benign conditions were analyzed and compared with outcomes for malignant conditions.
RESULTS: Esophagectomy was performed in 7,477 patients during the study period. Of those, 6,762 underwent esophagectomy for malignant conditions and 715 for benign conditions. For patients with benign conditions, reconstruction was performed using gastric conduit in 631 and colon/intestine in 84. The anastomosis was intrathoracic in 420 and cervical in 295. Benign esophagectomies were more likely to be emergent (10.1% vs 0.4%, p < 0.001). In addition, these patients had a longer hospital length of stay (17.2 days vs 14.5 days, p < 0.001) and higher occurrence of Clavien-Dindo grade IV complications (25% vs 20%, p = 0.003). Mortality was similar at 4%. In patients with benign conditions, reconstruction with colon/intestine had higher occurrence of Clavien-Dindo Grade IV complications (37% vs 23%, p = 0.006), surgical wound infections (33% vs 16%, p < 0.001), and death (10% vs 4%, p = 0.017) compared with gastric reconstruction. Site of anastomosis did not affect outcomes.
CONCLUSIONS: Benign esophagectomies are associated with significant morbidity. Although the site of the anastomosis does not alter outcomes, use of colon/intestine conduit should be pursued with caution.
Medical Subject Headings
Adult; Aged; Analysis of Variance; Anastomosis, Surgical; Biopsy, Needle; Databases, Factual; Disease-Free Survival; Esophageal Neoplasms; Esophagectomy; Female; Hospital Mortality; Humans; Immunohistochemistry; Length of Stay; Male; Middle Aged; Postoperative Complications; Prognosis; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Survival Analysis; Treatment Outcome