Synchronous Esophageal and Lung Cancers-Is Combined Anatomic Resection Appropriate?

BACKGROUND: This study evaluated the safety and feasibility of combined resection for patients with synchronous pulmonary and esophageal cancer. METHODS: Patients undergoing esophagectomy between 1997 and 2019 were identified from prospectively collected databases at 3 tertiary referral centers, and those with combined anatomic lung resection at the same setting were matched in a 1:3 ratio to esophagectomy-alone patients, based on age, sex, pathologic stage, neoadjuvant therapy, and surgical procedure. Demographic data, perioperative data, and postoperative complications were compared. Statistical analysis included the unpaired t test, Fisher exact, or χ2 test and Gehan-Breslow analysis. RESULTS: Of 4729 esophagectomies, combined anatomic lung resection was performed in 18 patients with discrete pulmonary lesions. Matching yielded 49 patients who underwent esophagectomy only and were statistically similar compared with patients undergoing combined resections. Ivor Lewis esophagectomy and lobectomy were the most frequent procedures. Combined resections did not have a higher overall complication rate than esophagectomy alone; rather, these patients had fewer overall complications (56% vs 84%; P = .02). Specifically, there were no differences in anastomotic leak (17% vs 18%) or pulmonary complications (39% vs 33%) between combined resection and esophagectomy alone. No postoperative mortality were identified, and median overall survival was 4.1 years vs 6.5 years (P = .10). CONCLUSIONS: Patients with synchronous localized lung and esophageal cancer, although rare, should not be biased toward nonsurgical therapy, because the morbidity associated with combined esophagectomy and anatomic lung resection does not differ significantly from esophagectomy alone in this highly selected group of patients.

Same day discharge for benign laparoscopic hiatal surgery: a feasibility analysis.

BACKGROUND: Advances in minimally invasive surgery and the development of enhanced recovery pathways have favored the spread of day-surgery programs. Despite laparoscopic approaches being accepted as the standard of care for benign hiatal diseases, safety and feasibility of same day discharges for laparoscopic hiatal surgeries other than fundoplication has yet to be established. OBJECTIVE: This study aimed to assess the feasibility of same day discharge for primary and revisional laparoscopic hiatal surgeries including paraesophageal hernia repairs (PEHR), fundoplication for reflux, and Heller myotomy (±diverticulectomy). METHODS: A retrospective cohort study including all patients undergoing elective laparoscopic hiatal procedures in the division of Thoracic surgery between 2011 and 2016 at McGill University Health Centre was performed. Planned day-surgery (DAYCASE) was compared to planned inpatient (INPATIENT) cohorts with respect to operative and postoperative outcomes, length of stay, readmission, and emergency room visits. RESULTS: A total of 261 patients were identified, 161 female (62%); median age 62 (20). The case distribution was: PEHR (123; 47.1%), Heller myotomy (94;36%, 7 diverticulectomy), and fundoplication (44; 16.9%). Twenty patients had revisional procedures (7.7%). Same day discharge was planned in 98 cases (38%) and was successful in 80 (81.6%). Proportion of DAYCASE increased form 12% prior to 2013 to 67% in 2016. INPATIENTs were older (median 66 vs. 60 years), and had a higher proportion of PEHR (55 vs. 34%), p < 0.05. Both cohorts were comparable in gender proportion, ASA classification, and length of surgery. Complications, readmission, and emergency visits did not differ between the two cohorts. On multivariate analysis, female gender (OR 37, 95% CI 1.46-936, p = 0.028), surgery beginning after noon (OR 5.4, 95% CI 1.1-26.9, p = 0.038), intraoperative complications (OR 20.4 95% CI 1.5-286, p = 0.025), and postoperative complications (OR 52.1, 95% CI 4.5-602, p = 0.002) were independently associated with unplanned admission. CONCLUSIONS: Day-case surgery for complex laparoscopic hiatal procedures is feasible and can be achieved in a significant number of patients without compromising safety.