Recent Publications from the Esophageal Center
Selected Recent Publications from the Esophageal Center of Excellence
- Wirsching A, El Lakis MA, Mohiuddin K, Pozzi A, Hubka M, Low DE. Acute vs. Elective Paraesophageal Hernia Repair: Endoscopic Gastric Decompression Allows Semi-Elective Surgery in a Majority of Acute Patients. J Gastrointest Surg 2018;22:194-202. Key findings: A majority of patients presenting with acute paraesophageal hernia can undergo a staged approach instead of urgent surgery with comparable outcomes to elective operations in high-volume centers.
- Giroux DJ, Van Schil P, Asamura H, Rami-Porta R, Chansky K, Crowley JJ, Rusch VW, Kernstine K, International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee. The IASLC Lung Cancer Staging Project: A Renewed Call to Participation. J Thorac Oncol 2018. Key findings: The continued success of the IASLC Staging Project in achieving its objectives will depend on the extent of international participation, the degree to which cases are entered directly into the electronic data capture system, and how closely externally submitted cases conform to the data elements for the project.
- Low DE, Kuppusamy MK, Alderson D, Cecconello I, Chang AC, Darling G, Davies A, D'Journo XB, Gisbertz SS, Griffin SM, Hardwick R, Hoelscher A, Hofstetter W, Jobe B, Kitagawa Y, Law S, Mariette C, Maynard N, Morse CR, Nafteux P, Pera M, Pramesh CS, Puig S, Reynolds JV, Schroeder W, Smithers M, Wijnhoven BPL. Benchmarking Complications Associated with Esophagectomy. Ann Surg. 2017 Dec 4. Key findings: Standardized methods provide contemporary international benchmarks for reporting outcomes after esophagectomy.
- El Lakis MA, Kaplan SJ, Hubka M, Mohiuddin K, Low DE. The Importance of Age on Short-Term Outcomes Associated With Repair of Giant Paraesophageal Hernias. Ann Thorac Surg 2017;103:1700-1709. Key findings: PEH repair is safe in physiologically stable patients, irrespective of age. Incidence of complications is higher in older patients, but complication severity and mortality are similar to those of younger patients.
- Zaninotto G, Low DE. Complications after esophagectomy: it is time to speak the same language. Dis Esophagus 2016;29:580-582. Key findings: It is unusual for the editors of a scientific journal to comment on an article published in another journal, but the study recently published in the Annals of Surgery by the Esophagectomy Complications Consensus Group (ECCG) entitled: ‘International Consensus on standardization of data collection for complications associated with esophagectomy’, deserves special attention.
- Sepesi B, Schmidt HE, Lada M, Correa AM, Walsh GL, Mehran RJ, Rice DC, Roth JA, Vaporciyan AA, Ajani JA, Watson TJ, Swisher SG, Low DE, Hofstetter WL. Survival in Patients With Esophageal Adenocarcinoma Undergoing Trimodality Therapy Is Independent of Regional Lymph Node Location. Ann Thorac Surg 2016;101:1075-1080; Discussion 1080-1071. Key findings: Age, sex, pathologic tumor depth, and the number of involved nodes were independent predictors of survival. Patients with cN+ cancers should not be deprived of potentially curative surgical resection based solely on the location of regional nodal disease.
- Schmidt HM, Mohiuddin K, Bodnar AM, El Lakis M, Kaplan S, Irani S, Gan I, Ross A, Low DE. Multidisciplinary treatment of T1a adenocarcinoma in Barrett's esophagus: contemporary comparison of endoscopic and surgical treatment in physiologically fit patients. Surg Endosc 2016;30:3391-3401. Key findings: While the results of this study provide a historical perspective and clearly demonstrate an evolution toward ET over time, the appropriate treatment modality is best selected in a multidisciplinary fashion with EMR providing the most accurate staging.
- Schmidt HM, El Lakis MA, Markar SR, Hubka M, Low DE. Accelerated Recovery Within Standardized Recovery Pathways After Esophagectomy: A Prospective Cohort Study Assessing the Effects of Early Discharge on Outcomes, Readmissions, Patient Satisfaction, and Costs. Ann Thorac Surg 2016;102:931-939. Key findings: Accelerated recovery is achievable in a significant proportion of patients undergoing esophagectomy. Accelerated recovery is associated with decreased treatment costs but does not lead to increased readmissions or decreased patient satisfaction.
- Mohiuddin K, Dorer R, El Lakis MA, Hahn H, Speicher J, Hubka M, Low DE. Outcomes of Surgical Resection of T1bN0 Esophageal Cancer and Assessment of Endoscopic Mucosal Resection for Identifying Low-Risk Cancers Appropriate for Endoscopic Therapy. Ann Surg Oncol 2016;23:2673-2678. Key findings: Clinical staging of superficial esophageal cancer can be inaccurate especially in submucosal tumors. EMR should be routinely used for preoperative staging. Healthy patients with clinical tumor stage greater than cT1a should undergo multidisciplinary review and be considered for surgical resection.
- Blackmon SH, Cooke DT, Whyte R, Miller D, Cerfolio R, Farjah F, Rocco G, Blum M, Hazelrigg S, Howington J, Low D, Swanson S, Fann JI, Ikonomidis JS, Wright C, Grondin SC. The Society of Thoracic Surgeons Expert Consensus Statement: A Tool Kit to Assist Thoracic Surgeons Seeking Privileging to Use New Technology and Perform Advanced Procedures in General Thoracic Surgery. Ann Thorac Surg 2016;101:1230-1237. Key findings: Incorporation of outcomes into a quality-driven thoracic surgery database is important to facilitate ongoing monitoring of outcomes and continuous quality improvement as well as assess new technology and advanced procedures.
- Schmidt HM, Roberts JM, Bodnar AM, Kunz S, Kirtland SH, Koehler RP, Hubka M, Low DE. Thoracic multidisciplinary tumor board routinely impacts therapeutic plans in patients with lung and esophageal cancer: a prospective cohort study. Ann Thorac Surg 2015;99:1719-1724. Key findings: Complex thoracic cancer patients will benefit from multidisciplinary review and should ideally be presented at tumor board.
- Porteous GH, Neal JM, Slee A, Schmidt H, Low DE. A standardized anesthetic and surgical clinical pathway for esophageal resection: impact on length of stay and major outcomes. Reg Anesth Pain Med 2015;40:139-149. Key findings: We present a detailed anesthetic and surgical perioperative pathway for esophageal resection, along with evidence of improved or stable patient outcomes despite an increase in comorbidity burden and increasingly advanced tumor stage.
- Munasinghe A, Markar SR, Mamidanna R, Darzi AW, Faiz OD, Hanna GB, Low DE. Is It Time to Centralize High-risk Cancer Care in the United States? Comparison of Outcomes of Esophagectomy Between England and the United States. Ann Surg 2015;262:79-85. Key findings: This paper suggests that centralization of high-risk cancer surgery to centers of excellence with a high procedural volume translates into an improved clinical outcome. These findings should be factored into discussions regarding future service configuration of major cancer surgery in the United States.
- Mohiuddin K, Low DE. Functional Conduit Disorder Complicating Esophagectomy. Thorac Surg Clin 2015;25:471-483. Key findings: Esophagectomy remains a key component of treatment for esophageal cancer and is also required in certain benign conditions. Operative strategies to minimize functional disorders have been developed and all surgeons should have a structured approach to dealing with functional issues when they occur.
- Markar SR, Karthikesalingam A, Low DE. Enhanced recovery pathways lead to an improvement in postoperative outcomes following esophagectomy: systematic review and pooled analysis. Dis Esophagus 2015;28:468-475. Key findings: This study suggests a benefit to the utilization of ERP following esophagectomy. The pathways provide a template for all medical personnel interacting with these patients in order to provide incremental changes in all aspects of clinical care that translates into global improvements seen in postoperative outcomes.
- Low DE, Alderson D, Cecconello I, Chang AC, Darling GE, D'Journo XB, Griffin SM, Holscher AH, Hofstetter WL, Jobe BA, Kitagawa Y, Kucharczuk JC, Law SY, Lerut TE, Maynard N, Pera M, Peters JH, Pramesh CS, Reynolds JV, Smithers BM, van Lanschot JJ. International Consensus on Standardization of Data Collection for Complications Associated With Esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg 2015;262:286-294. Key findings: The proposed system for defining and recording perioperative complications associated with esophagectomy provides an infrastructure to standardize international data collection and facilitate future comparative studies and quality improvement projects.