• Henner M Schmidt, Susanne S Gisbertz, Johnny Moons, Ioannis Rouvelas, Juha Kauppi, Andrew Brown, Emanuele Asti, Misha Luyer, Sjoerd M Lagarde, Felix Berlth, Annouck Philippron, Christiane Bruns, Arnulf Hölscher, Paul M Schneider, Dimitri A Raptis, Mark I van Berge Henegouwen, Philippe Nafteux, Magnus Nilsson, Jari Räsanen, Francesco Palazzo, Ernest Rosato, Stuart Mercer, Luigi Bonavina, Grard Nieuwenhuijzen, WijnhovenBas P LBPL, Wolfgang Schröder, Piet Pattyn, Peter P Grimminger, and Christian A Gutschow.
• *Department of General and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland †Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands ‡Department of Thoracic Surgery, University Ziekenhuisen Leuven, Leuven, Belgium §Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden ¶Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Helsinki, Finland ||Department of Surgery, Thomas Jefferson University, Philadelphia, PA **Department of Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy ††Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands ‡‡Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands §§Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Cologne, Germany ¶¶Department of Surgery, University Center Ghent, Ghent, Belgium ||||Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom ***Department of General, Visceral and Transplant Surgery, University Medical Center, Mainz, Germany.
• Ann. Surg. 2017 Nov 1; 266 (5): 814-821.

ObjectiveTo define "best possible" outcomes in total minimally invasive transthoracic esophagectomy (ttMIE).BackgroundTtMIE, performed by experts in patients with low comorbidity, may serve as a benchmark procedure for esophagectomy.Patients And MethodsFrom a cohort of 1057 ttMIE, performed over a 5-year period in 13 high-volume centers for esophageal surgery, we selected a study group of 334 patients (31.6%) that fulfilled criteria of low comorbidity (American Society of Anesthesiologists score ≤2, WHO/ECOG score ≤1, age ≤65 years, body mass index 19-29 kg/m). Endpoints included postoperative morbidity measured by the Clavien-Dindo classification and the comprehensive complication index. Benchmark values were defined as the 75th percentile of the median outcome parameters of the participating centers to represent best achievable results.ResultsBenchmark patients were predominantly male (82.9%) with a median age of 58 years (53-62). High intrathoracic (Ivor Lewis) and cervical esophagogastrostomy (McKeown) were performed in 188 (56.3%) and 146 (43.7%) patients, respectively. Median (IQR) ICU and hospital stay was 0 (0-2) and 12 (9-18) days, respectively. 56.0% of patients developed at least 1 complication, and 26.9% experienced major morbidity (≥grade III), mostly related to pulmonary complications (25.7%), anastomotic leakage (15.9%), and cardiac events (13.5%). Benchmark values at 30 days after hospital discharge were ≤55.7% and ≤30.8% for overall and major complications, ≤18.0% for readmission, ≤3.1% for positive resection margins, and ≥23 for lymph node yield. Benchmarks at 30 and 90 days were ≤1.0% and ≤4.6% for mortality, and ≤40.8 and ≤42.8 for the comprehensive complication index, respectively.ConclusionThis outcome analysis of patients with low comorbidity undergoing ttMIE may serve as a reference to evaluate surgical performance in major esophageal resection.

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