167. NATIONAL TRENDS IN TECHNIQUE UTILIZATION FOR ESOPHAGECTOMY: DOES PRIMARY SURGEON SPECIALTY MATTER?
Adam Dyas, Benedetto Mungo, Christina Stuart, Alison Mungo, John Mitchell, Simran Randhawa, Elizabeth David, Camille Stewart, Martin Mccarter, Robert Meguid- Gastroenterology
- General Medicine
Abstract
Background
Cardiothoracic surgeons (CTS) and general surgeons (GS; including surgical oncologists) perform the vast majority of esophagectomies nationwide. We hypothesize that different clinical focus and training background could lead to different distribution in the use of open and minimally invasive surgery (MIS) techniques. Furthermore, we sought to explore whether specialty driven differences in surgical approach affect outcomes.
Methods
In a retrospective review of the ACS-NSQIP esophagectomy targeted participant user file (2016–2018), patients who underwent esophagectomy were sorted into CTS and GS cohorts. Perioperative characteristics and postoperative outcomes were compared using chi-square analysis or independent t-tests. Multivariate logistic regression controlling for perioperative variables was performed to generate risk adjusted odds ratios of postoperative outcomes by specialty.
Results
Of 3247 patients included, 1792 (55.2%) underwent esophagectomy by CTS and 1455 (44.5%) by GS as primary surgeon. CTS were more likely to use traditional MIS (p = 0.0004) or open approach (p < 0.0001) and less likely to use robotic surgery (p = 0.04) or a hybrid robotic/traditional approach (p < 0.0001) (Figure). CTS performed more Ivor Lewis esophagectomies and fewer transhiatal and McKeown esophagectomies (p < 0.0001). After risk-adjustment, there were no differences in rates of post-esophagectomy complications or rate of positive margins between CTS and GS (all p > 0.05). However, CTS were more likely to treat anastomotic leaks with surgery rather than other procedural interventions.
Conclusion
CTS and GS use MIS subtypes differently within esophagectomy. However, all risk adjusted differences in postoperative complications were driven by patient and operative characteristics rather than surgical subspecialty. Esophagectomy is being performed safely by surgeons with different clinical specialties and training pathway, with no differences in perioperative and oncologic outcomes.