Univariate analysis results of early and delayed postoperative complications and mortality stratified by body mass index (BMI) status

Surgical complication(s) Normal weight BMI 18.5-24.99 N=28, N (%)

Overweight BMI 25-29.99 N=56, N (%)

Obese BMI ≥ 30 N=45, N (%)

p Value

Wound infection 0(0) 0(0) 1(1.2) 0.390 Anastomotic leak 0(0) 1(1.8) 4(8.9) 0.090 Pulmonary Embolism/DVT* 0(0) 2(3.6) 0(0) 0.266 Pneumonia 0(0) 2(3.6) 4(8.9) 0.189 Cardiovascular 3(10.7) 9(16.1) 7(15.6) 0.793 Any complication(s)† 3(10.3) 12(41.4) 14(48.3) 0.123 30 days Mortality 1(3.6) 0(0) 1(2.2) 0.414 *Deep Venous Thrombosis; †Defined as the presence of one or more of the complications listed above in a single patient.

Effect of Body Mass Index on Operative Outcome after Robotic-Assisted Ivor-Lewis Esophagectomy (RAIL): Retrospective Analysis of 129 Cases

at a Single High-Volume Tertiary Care CenterAhmed I. Salem, M.D., Matthew R Thau, M.S., Tobin Joel Crill Strom, M.D., AM Abbott M.D., M.S.c, Nadia Saeed Khaldoun Almhanna,

M.D., M.S.c., Sarah E Hoffe, M.D., Ravi Shridhar, M.D., PhD, Richard C. Karl, M.D., Kenneth L. Meredith, M.D., FACS

Section of Surgical Oncology – Division of General Surgery University of Wisconsin School of Medicine and Public Health

Introduction:

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 (BMI) following robotic-assisted Ivor-Lewis esophagectomy (RAIL) at a high-volume tertiary-care referral cancer center and evaluated the safety of robotic surgery in patients with an elevated BMI.

Methods:

A retrospective review of all patients who underwent RAIL for pathologically confirmed distal esophageal cancer was conducted. Patient demographics, clinicopathologic data, and operative outcomes were collected. We stratified BMI according to WHO criteria; normal range is defined as a BMI range of 18.5 to 24.9 kg/m². Overweight is defined as a BMI range of 25.0 to 29.9 kg/m² and obesity is defined as a BMI of 30 kg/m² and above. Statistics were calculated using Wilcoxon Rank-Sum and Spearman Coefficient tests with a p-value of 0.05 for significance.

Results:

129 patients (103 men, 26 women) with median age of 67 (30-84) years were included. The majority of patients, 76% (N=98) received neoadjuvant therapy. When stratified by BMI twenty-eight (22%) were normal weight, fifty-six (43%) were overweight and forty-five (35%) were obese. All patients had R0 resection. Median operating room (OR) time was 407 (239-694) minutes. When stratified by BMI, medians of OR time across the normal weight, overweight and obese groups were 387 (254-660) minutes, 395 (310-645) minutes and 445 (239-694) minutes respectively. Median estimated blood loss (EBL) was 150 (25-600) cc. When stratified by BMI, medians of EBL across the normal weight, overweight and obese groups were 100 (50-500) cc, 150 (25-600) cc and 150 (25-600) cc respectively. Obesity significantly correlated with longer OR time (p=0.05) but without significant increased EBL (p=0.348). Among the three BMI groups there was no difference in postoperative complications including thrombotic events (pulmonary embolism and deep venous thrombosis) (p=0.266), pneumonia (p=0.189), anastomotic leak (p=0.090), wound infection (p=0.390), any cardiac events (p=0.793) or 30 days mortality (p=0.414).

Conclusion:

Our data study demonstrates that patients with esophageal cancer and an elevated BMI undergoing RAIL have increased operative times but no significantly increased EBL during the procedure. Other potential morbidities did not differ with the robotic approach.

Introduction of the base of the EEA (End-to-End Anastomosis) Stapler into the gastric conduit