title: Introduction of Minimally Invasive Esophagectomy in a Community Teaching Hospital.
abstract: OBJECTIVE
  The safety of minimally invasive esophagectomy (MIE) outside of high-volume centers has not been studied. Therefore, we evaluated our experience with the introduction of MIE in the setting of a community teaching hospital.
  
  
  METHODS
  A retrospective cohort of all elective esophagectomy patients treated in a community hospital from 2008 through 2015 was evaluated (n = 57; open = 31 vs MIE = 26). Clavien-Dindo complication grades were recorded prospectively.
  
  
  RESULTS
  Mean age was 63 ± 11 years (range, 30-83), mean Charlson comorbidity index was 4.5 ± 1.7 and proportion of ASA score ≥3 was 87%. The groups did not differ in age, gender distribution, or comorbidity indices. There were 108 complications observed, including 2 deaths (3.5%, both coronary events). Postoperative complication rate was 77.1% and serious complication rate (grades 3 and 4) was 50.8% in the entire cohort. The rate of serious complications was similar (58% for open vs 42% for MIE group; 2-sidedP= .089). MIE operations were longer (342 ± 109 vs 425 ± 74 minutes;P= .001). Length of stay trended toward not being significantly shorter among MIE cases (15 ± 13 vs 12 ± 12 days;P= .071). Logistic regression models including MIE status were not predictive of complications.
  
  
  CONCLUSIONS
  Introduction of MIE esophagectomy in our community hospital was associated with prolonged operative time, but no detectable adverse outcomes. Length of stay was nonsignificantly shortened by the use of MIS esophagectomy.
authors.affiliation: Division of Surgical Oncology, Mercy Medical Center, Des Moines, Iowa, USA.
authors.forename: Dante
authors.initials: D
authors.lastname: Dali
authors.affiliation: Division of Surgical Oncology, Mercy Medical Center, Des Moines, Iowa, USA.
authors.forename: Trent
authors.initials: T
authors.lastname: Howard
authors.affiliation: Division of Surgical Oncology, Mercy Medical Center, Des Moines, Iowa, USA.
authors.forename: Hanif
authors.initials: H
authors.lastname: Mian Hashim
authors.affiliation: Division of Surgical Oncology, Mercy Medical Center, Des Moines, Iowa, USA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Goldman
authors.affiliation: Division of Surgical Oncology, Mercy Medical Center, Des Moines, Iowa, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Franko
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D007484:Iowa; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D012189:Retrospective Studies
keywords: Community hospital; Minimally invasive esophagectomy; Open esophagectomy