Is Esophagectomy for Benign Conditions Benign?

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 \u3c 0.001). In addition, these patients had a longer hospital length of stay (17.2 days vs 14.5 days, p \u3c 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 \u3c 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

Long-Term Outcomes after Robotic-Assisted Ivor-Lewis Esophagectomy

Purpose: Robotic assistance has gained a measure of acceptance in thoracic procedures, including esophagectomy. However, there is a paucity of data regarding long-term outcomes for robotic esophagectomy. We have previously reported our initial series of robot assisted Ivor-Lewis (RAIL) esophagectomy. We report long-term outcomes to assess the efficacy of the procedure.Methods : We performed a retrospective review of 112 consecutive patients who underwent a RAIL at our institution. Patient demographics, diagnosis, pathology, operative characteristics, post-operative complications, and long-term outcomes were documented. Descriptive statistical analysis was performed for all the variables. Primary endpoints were mortality and disease-free survival. Overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method. Results: Of the 112 patients, 106 had a diagnosis of cancer, with adenocarcinoma the dominant histology (87.5%). Of the 106 cancer patients, 81(76.4%) received neo-adjuvant chemoradiation (stage 3A most common). The 30, 60, and 90-day mortality was 1 (0.9%), 3 (2.7%), and 4 (3.6%) respectively. There were 9 anastomotic leaks (8%) and 18 (16.1%) patients had a stricture requiring dilation. All patient OS at 1, 3, and 5 years was 81.4%, 60.5%, and 51.0%, respectively. For cancer patients, the 1, 3, and 5 years OS was 81.3%, 59.2%, and 49.4% respectively and the DFS was 75.3%, 42.3%, and 44.0%. Conclusion: We have shown that long term outcomes after RAIL esophagectomy are similar to other non-robotic esophagectomies. Given the potential advantages of robotic assistance, our results are crucial to demonstrate that RAIL does not result in inferior outcomes.https://scholarlycommons.henryford.com/merf2019clinres/1060/thumbnail.jp

(P44) Is Prophylactic Cranial Irradiation Necessary in Stage I-IIA Small Cell Lung Cancer Patients? A Single Institution Experience

Background: The advent of screening chest computed tomography (CT) for high-risk patients has increased the patient population presenting with early-stage small cell lung cancer (SCLC). While surgical resection continues to be standard of care, stereotactic body radiation therapy (SBRT) is an option for non-surgical candidates. Although the effectiveness of PCI in patients with limited stage SCLC has been well established, decreasing the brain metastasis incidence from approximately 70% to 30%, the role of PCI in early-stage SCLC (T1-T2) has not been fully elucidated. This study reports our experience omitting PCI in early-stage SCLC. Objectives: This study reports our experience omitting PCI in early stage SCLC. Methods: Fourteen patients with early-stage SCLC, nine patients with clinical stage I (T1) and five patients with stage IA (T2) SCLC, ranging in age from 54-81 years old, treated with surgical resection or SBRT from July 2015 to May 2021 at our institution, were retrospectively reviewed. Positron emission tomography (PET) was used in the staging of 93% of patients. All patients had initial negative brain MRI and opted not to receive PCI. 71% of the patients had brain scan surveillance for follow-up. Risk factors including age, gender, and tumor size, were analyzed for overall survival (OS), loco-regional recurrence (LRR), and distant metastasis (DM) using the Log-rank test. Results: With a median follow-up of 13 months (range 2-63), none of our patients developed metastases to the brain. Adjuvant chemotherapy, with a mean of 4 cycles (2-6) was administered to 13 out of 14 patients (92%). The 2-year OS, LRR and DM estimates were 47% [95% CI (0.14, 0.75)], 57% [95% CI (0.19, 0.82)], and 51% [95% CI (0.17, 0.77)], respectively. The OS and the frequency of LRR were not found to be correlated with age, gender, or tumor size. DM was significantly higher in males vs females (P=0.016). Conclusions: Our experience in patients with Stage I-IIA SCLC treated with surgery or SBRT did not demonstrate any development of brain metastases. As PCI carries long term risks of neurotoxicity, close surveillance with regular brain imaging may be a reasonable alternative. Adjuvant systemic therapy remains an important component of treatment

FIP1/RCP Binding to Golgin-97 Regulates Retrograde Transport from Recycling Endosomes to the trans-Golgi Network

This study shows that Rab11 and its binding protein FIP1 are required for retrograde delivery of TGN38 and Shiga toxin from early/recycling endosomes to the TGN. We also demonstrate that Golgin-97 as a FIP1-binding protein and that this binding regulates the targeting of retrograde transport vesicles to the TGN

Long-term outcomes after robotic-assisted Ivor Lewis esophagectomy

Robotic assistance has gained acceptance in thoracic procedures, including esophagectomy. There is a paucity of data regarding long-term outcomes for robotic esophagectomy. We previously reported our initial series of robot-assisted Ivor Lewis (RAIL) esophagectomy. We report long-term outcomes to assess the efficacy of the procedure. We performed a retrospective review of 112 consecutive patients who underwent a RAIL. Patient demographics, diagnosis, pathology, operative characteristics, post-operative complications, and long-term outcomes were documented. Descriptive statistical analysis was performed for all the variables. Primary endpoints were mortality and disease-free survival. Overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method. Of the 112 patients, 106 had a diagnosis of cancer, with adenocarcinoma the dominant histology (87.5%). Of these 106 patients, 81 (76.4%) received neo-adjuvant chemoradiation. The 30-, 60-, and 90-day mortality was 1 (0.9%), 3 (2.7%), and 4 (3.6%), respectively. There were 9 anastomotic leaks (8%) and 18 (16.1%) patients had a stricture requiring dilation. All-patient OS at 1, 3, and 5 years was 81.4%, 60.5%, and 51.0%, respectively. For cancer patients, the 1-, 3-, and 5-year OS was 81.3%, 59.2%, and 49.4%, respectively, and the DFS was 75.3%, 42.3%, and 44.0%. We have shown that long-term outcomes after RAIL esophagectomy are similar to other non-robotic esophagectomies. Given the potential advantages of robotic assistance, our results are crucial to demonstrate that RAIL does not result in inferior outcomes

Understanding Racial Differences in Lung Cancer Surgery Through a Statewide Quality Collaborative

BACKGROUND: Persistent racial disparities in lung cancer incidence, treatment, and survival are well documented. Given the importance of surgical resection for lung cancer treatment, racial disparities in surgical quality were investigated using a statewide quality collaborative. METHODS: This retrospective study used data from the Michigan Society of Cardiothoracic Surgeons General Thoracic database, which includes data gathered for the Society of Thoracic Surgeons General Thoracic Surgery Database at 17 institutions in Michigan. Adult patients undergoing resection for lung cancer between 2015 and 2021 were included. Propensity score-weighting methodology was used to assess differences in surgical quality, including extent of resection, adequate lymph node evaluation, 30-day mortality, and 30-day readmission rate between white and black patients. RESULTS: The cohort included 5073 patients comprising 357 (7%) black and 4716 (93%) white patients. The black patients had significantly higher unadjusted rates of wedge resection than the white patients, but after propensity score-weighting for clinical factors, wedge resection did not differ from lobectomy (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.78-1.49; P = 0.67). The black patients had fewer lymph nodes collected (incidence rate ratio [IRR], 0.77; 95% CI, 0.73-0.81; P \u3c 0.0001) and lymph node stations sampled (IRR, 0.89; 95% CI, 0.84-0.94; P \u3c 0.0001). The black patients did not differ from the white patients in terms of mortality (OR, 0.65; 95% CI, 0.19-2.34; P = 0.55) or readmission (OR, 0.79; 95 % CI, 0.49-1.27; P = 0.32). The black patients had longer hospital stays (OR, 1.08; 95% CI, 1.02-1.14; P = 0.01). CONCLUSION: In a statewide quality collaborative that included high-volume centers, black patients received a less extensive lymph node evaluation, with fewer non-anatomic wedge resections performed, and a more limited lymph node evaluation with lobectomy