Impact of unplanned events on early postoperative results of minimally invasive esophagectomy

BACKGROUND Minimally invasive esophagectomy (MIE) is increasingly performed worldwide. Unplanned events during thoracoscopy or laparoscopy can jeopardize the procedure, sometimes necessitating conversion to open surgery. The aim of this study was to evaluate the impact of unplanned events on early postoperative outcomes after MIE. METHOD A consecutive group of 303 patients who underwent MIE between January 2011 and December 2015 were reviewed. The patients were allocated to two groups comprising those with (G-UPE, 85 patients) and without unplanned events (G-Regular, 218 patients). Unplanned events, defined as events that clearly changed or prolonged the procedure included intraoperative bleeding, chest and/or peritoneal adhesions, tumor invasion (sT4a + T4b), non-radical resection (R2 resection), and conversion for any reason. Differences in postoperative complications between the groups were analyzed. RESULTS The most common unplanned events were pleural and/or peritoneal adhesions (28/89, 31.5%), followed by intraoperative discovery of tumor invasion (sT4a + T4b, 25/89, 28.1%). There were significant differences in the incidence of respiratory (57.6% vs. 8.3%) and nervous system complications (10.6% vs. 2.7%), postoperative infection (32.9% vs. 5.0%), and chylothorax (8.2% vs. 0.9%) between the G-UPE and G-Regular groups, respectively (P < 0.05). The most common reasons for conversion to open procedures were pleural and/or peritoneal adhesions (9/38, 23.8%) and intraoperative bleeding (7/38, 18.4%). The main reasons for R2 resection were tumor invasion of the trachea or bronchus (7/21, 33.2%) and of the aorta (5/21, 23.8%). CONCLUSION Unplanned events during MIE increase the incidence of postoperative complications. Improved clinical staging and more careful surgery minimize unplanned events.