A standardized health system approach to Ivor Lewis esophagectomy.

Authors

• Luke T Meredith
• Peter Yang
• Hamza Rshaidat
• Scott Koeneman
• Darshak Thosani
• John Jacob
• Tyler Grenda
• Olugbenga Okusanya
• Francesco Palazzo
• Karen A Chojnacki
• Sung Whang
• Nathaniel R Evans

Publication/Presentation Date

12-1-2025

Abstract

BACKGROUND: With the robotic approach to Ivor Lewis esophagectomy gaining popularity, concern has been raised regarding a learning curve resulting in increased complication rates. This study aimed to present the results of a standardized health system approach to Ivor Lewis esophagectomy and the transition to the robotic-assisted technique.

METHODS: A retrospective review of our institutional database, along with individual patient chart review, was conducted. Patients who underwent Ivor Lewis esophagectomy at our institution from June 1, 2017, to July 7, 2023, were included. Preoperative patient characteristics and operative outcomes were recorded. The outcomes of the 60 most recent laparoscopic/thoracoscopic minimally invasive esophagectomies (MIEs) were compared with those of the first 60 robotic-assisted esophagectomies (RAMIEs).

RESULTS: Over the study period, 145 patients were included for review. Of the Ivor Lewis esophagectomies, 5 were performed open, 80 were performed laparoscopic/thoracoscopic, and 60 were performed robotic assisted. The length of stay ranged from 5 to 84 days, with a median of 7 days. Leak from the esophagogastric anastomosis occurred in 5 cases (3.4%). Pulmonary complications occurred in 21 cases (14.5%). There were no 90-day mortality events. In the subset analysis, there was an increased mean operative time in the RAMIE group (443 vs 504 min [95% CI, -88.1 to -34.2]), but there were no significant differences in perioperative outcomes between the MIE and RAMIE groups.

CONCLUSION: A standardized approach to perioperative management and operative technique can allow for low morbidity and mortality after Ivor Lewis esophagectomy and facilitate transitioning to a robotic-assisted technique without increasing complications.

Volume

29

Issue

12

First Page

102250

Last Page

102250

ISSN

1873-4626

Published In/Presented At

Meredith, L. T., Yang, P., Rshaidat, H., Koeneman, S., Thosani, D., Jacob, J., Grenda, T., Okusanya, O., Palazzo, F., Chojnacki, K. A., Whang, S., & Evans, N. R., 3rd (2025). A standardized health system approach to Ivor Lewis esophagectomy. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 29(12), 102250. https://doi.org/10.1016/j.gassur.2025.102250

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

41072846

Department(s)

Administration and Leadership

Document Type

Article