title: Quality and outcomes of synchronous two-team Ivor-Lewis oesophagectomy: Revisiting a variant technique.
abstract: OBJECTIVE
  In 1975, a modification of popular two-stage Ivor-Lewis oesophagectomy was published with synchronous resection in chest and abdomen. As data on this technique are rare and inconsistent, we aimed to investigate safety, feasibility, and outcome of this approach.
  
  
  METHODS
  Outcome of 201 patients undergoing synchronous oesophagectomy from 2000 to 2013 was analysed retrospectively. Two groups (early: 2000-2006; late: 2007-2013) were analysed to allow comparison of outcome over time.
  
  
  RESULTS
  Patients in the later period had fewer respiratory comorbidities (P = 0.010), median blood loss decreased significantly over time while lymph node yield increased (P < 0.001). Overall complications occurred in 58.9 (early) versus 51.7% (late) of patients (P = 0.320), anastomotic leaks in 14.3 versus 6.7% (P = 0.112), respiratory complications in 48.2 versus 34.8% (P = 0.063). Thirty-day/90-day mortality was 2.7% versus 3.4, respectively, 8.1% versus 6.8% (P ≤ 0.793). Long-term survival was better in the later cohort (P = 0.004).
  
  
  CONCLUSIONS
  Our data of 201 patients over a period of 14 years suggests that this technique is a quick, feasible, safe, and reasonable alternative to standard two-stage Ivor-Lewis oesophagectomy. Quality of this approach and ultimate outcomes have improved over time, with similar complication rates/outcomes to literature accepted standards for two-stage approach, especially in the later time period. J. Surg. Oncol. 2016;114:719-724. © 2016 Wiley Periodicals, Inc.
authors: Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia.
authors: Richard
authors: R
authors: Hummel
authors: Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia.
authors: Soeren Torge
authors: ST
authors: Mees
authors: Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors: Lorelle
authors: L
authors: Smith
authors: Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors: Glyn G
authors: GG
authors: Jamieson
authors: Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia.
authors: George
authors: G
authors: Kiroff
authors: Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia. jon.shenfine@adelaide.edu.au.
authors: Jonathan
authors: J
authors: Shenfine
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Ivor-Lewis oesophagectomy; outcome; synchronous; two-stage