Effect of body mass index on operative outcome after robotic-assisted Ivor-Lewis esophagectomy: retrospective analysis of 129 cases at a single high-volume tertiary care center.

The impact of body weight on outcomes after robotic-assisted esophageal surgery for cancer has not been studied. We examined the short-term operative outcomes in patients according to their body mass index following robotic-assisted Ivor-Lewis esophagectomy at a high-volume tertiary-care referral cancer center and evaluated the safety of robotic surgery in patients with an elevated body mass index. A retrospective review of all patients who underwent robotic-assisted Ivor-Lewis esophagectomy between April 2010 and June 2013 for pathologically confirmed distal esophageal cancer was conducted.

Body Mass Index and Perioperative Complications After Esophagectomy for Cancer.

Background: Given the increasing rate of obesity, the effects of excessive body weight on surgical outcomes constitute a relevant quality of care concern. Our aim was to determine the relationship between preoperative body mass index (BMI) on perioperative complications after esophagectomy for cancer.

Methods: From our comprehensive esophageal cancer database consisting of 510 patients, we identified 166 obese (BMI ≥30), 176 overweight (BMI 25-29), and 148 normal-weight (BMI 20-24) patients.

A human factors subsystems approach to trauma care.

Importance: A physician-centered approach to systems design is fundamental to ameliorating the causes of many errors, inefficiencies, and reliability problems.

Objective: To use human factors engineering to redesign the trauma process based on previously identified impediments to care related to coordination problems, communication failures, and equipment issues.

Design, Setting, And Participants: This study used an interrupted time series design to collect historically controlled data via prospective direct observation by trained observers.

Single-institution retrospective comparison of preoperative versus definitive chemoradiotherapy for adenocarcinoma of the esophagus.

Purpose: We sought to determine the impact of esophagectomy on survival in patients with adenocarcinoma of the esophagus cancer after chemoradiotherapy (CRT).

Methods: A database of esophageal cancer was queried for nonmetastatic patients with adenocarcinoma treated between 2000 and 2011 with CRT. Overall survival (OS) and recurrence-free survival (RFS) curves were calculated according to the Kaplan-Meier method and log-rank analysis.

Flow disruptions during trauma care.

Background: Flow disruptions (FDs) are deviations from the progression of care that compromise safety or efficiency. The frequency and specific causes of FDs remain poorly documented in trauma care. We undertook this study to identify and quantify the rate of FDs during various phases of trauma care.

Extent of lymphadenectomy does not predict survival in patients treated with primary esophagectomy.

Background: The number of lymph nodes resected and its impact on survival for patients with esophageal cancer remains undefined. Current guidelines recommend extended lymphadenectomy in patients not receiving neoadjuvant therapy. We reviewed our single institutional experience with nodal harvest for esophageal cancer in a non-neoadjuvant therapy setting.

Adjuvant radiation therapy and lymphadenectomy in esophageal cancer: a SEER database analysis.

Objectives: This study seeks to determine the effects of postoperative radiation therapy and lymphadenectomy on survival in esophageal cancer.

Methods: An analysis of patients with surgically resected esophageal cancer from the SEER database between 2004 and 2008 was performed to determine association of adjuvant radiation and lymph node dissection on survival. Survival curves were calculated according to the Kaplan-Meier method and log-rank analysis.

Defining the learning curve for robotic-assisted esophagogastrectomy.

Introduction: The expansion of robotic-assisted surgery is occurring quickly, though little is generally known about the "learning curve" for the technology with utilization for complex esophageal procedures. The purpose of this study is to define the learning curve for robotic-assisted esophagogastrectomy with respect to operative time, conversion rates, and patient safety.

Methods: We have prospectively followed all patients undergoing robotic-assisted esophagogastrectomy and compared operations performed at our institutions by a single surgeon in successive cohorts of 10 patients.

Body mass index and perioperative complications after oesophagectomy for adenocarcinoma: a systematic database review.

Objective: Given the increasing rate of obesity, the effects of excessive body weight on surgical outcomes constitute a relevant quality of care concern. Our aim was to determine the relationship between preoperative body mass index (BMI) on perioperative complications after oesophagectomy for adenocarcinoma of the oesophagus.

Design: Retrospective database review.

Lymph node harvest in esophageal cancer after neoadjuvant chemoradiotherapy.

Background: This study was designed to determine the effects of lymph node (LN) harvest on survival in esophageal cancer after neoadjuvant chemoradiation (nCRT).

Methods: An analysis of surgically resected esophageal cancer patients after nCRT was performed to determine an association between the number of LNs resected and survival. Overall survival (OS) and disease-free survival (DFS) curves were calculated according to the Kaplan-Meier method and log-rank analysis.

The impact of body mass index on esophageal cancer.

Background: Surgeons are increasingly operating on patients who are overweight or obese. The influence of obesity on surgical and oncologic outcomes has only recently been addressed. We focus this review on obesity and its impact on esophageal cancer.

Minimally invasive surgery for esophageal cancer: review of the literature and institutional experience.

Background: Esophageal cancer represents a major public health problem in the world. Several minimally invasive esophagectomy (MIE) techniques have been described and represent a safe alternative for the surgical management of esophageal cancer in selected centers with high volume and surgeons experienced in minimally invasive procedures.

Methods: The authors reviewed the most recent and largest studies published in the medical literature that reported the outcomes for MIE techniques.

Initial experience from a large referral center with robotic-assisted Ivor Lewis esophagogastrectomy for oncologic purposes.

Background: We report our initial experience of patients undergoing robotic-assisted Ivor Lewis esophagogastrectomy (RAIL) for oncologic purposes at a large-referral center.

Methods: A retrospective review of all consecutive patients undergoing RAIL from 2010-2011 was performed. Basic demographics were recorded.

Outcomes associated with surgery for T4 esophageal cancer.

Background: T4 esophageal cancer often portends a dismal prognosis even after surgical resection. Historical incomplete resections and poor survival rates often make surgery palliative rather than curative.

Methods: Using a comprehensive esophageal cancer database, we identified patients who underwent an esophagectomy for T4 tumors between 1994 and 2011.

Body mass index and survival in esophageal adenocarcinoma treated with chemoradiotherapy followed by esophagectomy.

Background: Body mass index (BMI) has been linked with inferior outcomes in gastrointestinal malignancies. The purpose of this study is to evaluate the effect of BMI on survival in patients with esophageal adenocarcinoma.

Methods: Medical records were analyzed for patients who underwent esophagectomy after neoadjuvant chemoradiotherapy (nCRT) for adenocarcinoma from 2000 to the present.

Adverse events: root causes and latent factors.

This article describes the process of root cause analysis (RCA), the theories of error that underlie the concept of systemic or latent factors that allow errors to occur or to be propagated without correction; the difference between the process in health care and those found in high-reliability organizations; and suggests some ways to augment the standard health care RCA into a more robust and helpful process.

Pathologic nonresponders after neoadjuvant chemoradiation for esophageal cancer demonstrate no survival benefit compared with patients treated with primary esophagectomy.

Background: Neoadjuvant chemoradiation (NCRT) has become the preferred treatment for patients with locally advanced esophageal cancer. Survival often is correlated to degree of pathologic response; however, outcomes in patients who are found to be pathologic nonresponders (pNR) remain uninvestigated. This study was designed to evaluate survival in pNR to NCRT compared with patients treated with primary esophagectomy (PE).

An elevated body mass index does not reduce survival after esophagectomy for cancer.

Background: Incidences of esophageal cancer and obesity are both rising in the United States. The aim of this study was to determine the influence of elevated body mass index on outcomes after esophagectomy for cancer.

Methods: Overall and disease-free survivals in obese (BMI ≥ 30), overweight (BMI 25-29), and normal-weight (BMI 20-24) patients undergoing esophagectomy constituted the study end points.

Evidence-based surgical practice in academic medical centers: consistently anecdotal?

Introduction: Randomized trials, meta-analyses, and guidelines form the basis of clinical decision making. We queried a small sample of surgeons at three academic medical centers to determine whether key elements of surgical practice were concordant with available evidence.

Materials And Methods: A French Society of Digestive Surgery (FSDS) questionnaire was submitted to general surgery trainees and faculty at the University of South Florida and University of Chicago and to surgical oncology fellows at the Memorial Sloan-Kettering Cancer Center.

Pathologic response after neoadjuvant therapy is the major determinant of survival in patients with esophageal cancer.

Background: Esophageal cancer remains a malignancy with high morbidity and mortality despite improvements to diagnosis, staging, chemotherapy, radiation, and surgery. Neoadjuvant therapy (NT) may improve oncologic outcome in many patients, however the degree to which patients benefit remains unclear. We examined the relationship between pathologic response to NT and magnitude of benefit in patients with esophageal cancer.

Technique of resection of esophageal adenocarcinoma after Roux-en-Y gastric bypass and literature review of esophagogastric tumors after bariatric procedures.

Background: The number of bariatric procedures has continued to increase worldwide. However, experience with tumors arising in the esophagus or stomach after gastric bypass is lacking. We report our technique for curative resection of esophageal adenocarcinoma in a patient who had undergone previous gastric bypass and review the reported data on esophagogastric tumors after bariatric surgery.

Correlations between neoadjuvant treatment, anemia, and perioperative complications in patients undergoing esophagectomy for cancer.

Introduction: The influence of preoperative hemoglobin levels on outcomes of patients undergoing esophagectomy for cancer is not clearly defined. The goal of this article was to explore the association between combined modality therapy, preoperative anemia status, and perioperative blood transfusion and risk of postoperative complications among patients undergoing esophageal resection.

Methods: From a retrospective esophageal database, 413 patients were identified.

Aviation.

Background: An increased awareness of the need for safety in medicine in general and in surgery in particular has prompted comparisons between the cockpit and the operating room. These comparisons seem to make sense but tend to be oversimplified.

Discussion: Attempts in healthcare to mimic programs that have been credited for the safety of commercial aviation have met with varying results.

Outcomes following resection of pancreatic adenocarcinoma: 20-year experience at a single institution.

Background: Pancreatectomy for ductal adenocarcinoma has been performed with increasing frequency since the late 1980s as postoperative mortality decreased and long-term survival became more common. However, the belief persists among some clinicians that pancreatectomy offers little survival benefit. This report reviews our institutional experience with pancreatectomy for pancreatic adenocarcinoma and provides a critical overview of the controversies regarding the benefits of surgical intervention for patients who are candidates for curative resection.