Thoracic Portal Survey Results – Minimally Invasive Esophagectomy

For purposes of this survey, respondents were asked to assume they had recommended surgical therapy for a 63 year old man who had been diagnosed with a distal esophageal adenocarcinoma, clinically staged as T2N0 via EUS, CT, and PET. His general health was good. He had no prior abdominal or thoracic surgery, and he had no important comorbidities.

For purposes of this survey, MIE was defined as a totally minimally invasive approach or a hybrid approach with either the abdominal or thoracic portion done open. Hand-assisted surgery was not included. MIE transhiatal resection was included. Either an intrathoracic or a cervical anastomosis was included.

A relatively small number of respondents participated in this survey, which perhaps reflects the small amount of penetration of MIE in the thoracic surgery community and the small amount of interest in esophageal surgery among thoracic surgeons in some regions. Of those who did participate, 75% had some familiarity with MIE, whereas 20% did only open resections.

Of surgeons who currently perform MIE, 45% learned it during training and 33% learned it after completing their formal training. Twenty percent of respondents indicated that they were currently learning MIE techniques.

Among surgeons who don’t currently perform MIE, two-thirds indicated an intention to learn MIE techniques, and over 10% had tried MIE and abandoned the technique. Those who perform MIE most often use a totally minimally invasive approach with an intrathoracic anastomosis.

Two-thirds of respondents believed that MIE has a similar or lower rate of complications compared to open esophagectomy. Almost 60% felt that oncologic outcomes were similar between MIE and open esophagectomy.

In contrast to prior surveys, the vast majority of respondents were from North America, which perhaps correlates with the lack of esophageal experience/training/expertise among thoracic surgeons on other continents.

1. Have you had any experience performing MIE?
	answered question		102
	skipped question		1
		Response Percent	Response Count
Yes, only as a trainee		16.7%	17
Yes, only after training		20.6%	21
Yes, during and after training		36.3%	37
No, I perform such operations using open techniques		19.6%	20
No, I don’t perform esophagectomies		6.9%	7

2. If you are NOT currently performing MIE, what is your current status regarding it?
	answered question		52
	skipped question		51
		Response Percent	Response Count
I plan to learn it.		65.4%	34
I don’t plan to learn it.		9.6%	5
I learned it in training but don’t plan to use it.		5.8%	3
I have tried it but abandoned it.		11.5%	6
I don’t perform esophagectomies.		7.7%	4

3. If you are currently performing MIE, what is your background?
	answered question		100
	skipped question		3
		Response Percent	Response Count
I learned it during training and have performed it since.		32.0%	32
I learned it subsequent to my training and am happy enough with it that I use it routinely.		24.0%	24
I am currently learning how to perform it and am uncertain as to whether it will become routine.		15.0%	15
I don’t perform MIE.		22.0%	22
I don’t perform esophagectomies		7.0%	7

4. What technique do you use for MIE?
	answered question		99
	skipped question		4
		Response Percent	Response Count
Totally minimally invasive, most often with cervical anastomosis		12.1%	12
Totally minimally invasive, most often with intrathoracic anastomosis		35.4%	35
Totally minimally invasive transhiatal		5.1%	5
Hybrid with laparoscopy and thoracotomy		4.0%	4
Hybrid with laparotomy and thoracoscopy		15.2%	15
I don’t perform MIE		23.2%	23
I don’t perform esophagectomies		5.1%	5

5. Based on your experience with MIE, what is your opinion of the utility of MIE with regards to complications?
	answered question		100
	skipped question		3
		Response Percent	Response Count
The complication rate is lower compared to open operations.		38.0%	38
The complication rate is higher compared to open operations.		9.0%	9
The complication rate is similar to that of open operations.		27.0%	27
I don’t perform MIE.		22.0%	22
I don’t perform esophagectomies.		4.0%	4

6. Based on your experience with MIE, what is your opinion of the utility of MIE with regards to oncologic outcomes?
	answered question		100
	skipped question		3
		Response Percent	Response Count
The cancer-related survival is better compared to open operations.		10.0%	10
The cancer-related survival is worse compared to open operations.		6.0%	6
The cancer-related survival is similar to that of open operations.		58.0%	58
I don’t perform MIE.		21.0%	21
I don’t perform esophagectomies.		5.0%	5

7. In what region do you practice or train?
	answered question		102
	skipped question		1
		Response Percent	Response Count
North America		64.7%	66
Europe		11.8%	12
Asia		17.6%	18
Africa		1.0%	1
Central or South America		4.9%	5
Australia/New Zealand		0.0%	0