University of Oulu

Helminen O, Kauppila JH, Saviaro H, Yannopoulos F, Meriläinen S, Koivukangas V, Huhta H, Mrena J, Saarnio J, Sihvo E. Minimally invasive esophagectomy learning curves with different types of background experience. J Thorac Dis 2021;13(11):6261-6271. doi: 10.21037/jtd-21-1063

Minimally invasive esophagectomy learning curves with different types of background experience

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Author: Helminen, Olli1,2; Kauppila, Joonas H.1,3; Saviaro, Henna1;
Organizations: 1Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
2Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
3Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
4Department of Cardiothoracic Surgery, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
Persistent link:
Language: English
Published: AME Publishing Company, 2021
Publish Date: 2022-02-24


Background: Minimally invasive esophagectomy (MIE) is a complex procedure with learning associated morbidity. The aim was to evaluate the learning curve for MIE focusing on short-term outcomes in two settings: (I) experienced MIE surgeon in new hospital (Hospital 1); (II) surgeons experienced with open esophagectomy and minimally invasive surrogate surgery (Hospital 2).

Methods: In Hospital 1 and Hospital 2, on intent-to-treat basis number of MIEs were 132 and 57, respectively. The primary outcomes were major complications and anastomosis leaks. Secondary outcomes were operative time, blood loss, lymph node yield, hospital stay and 1-year mortality. Length of learning curves were analyzed with risk-adjusted cumulative sum (RA-CUSUM) method.

Results: In Hospital 1, major complication and anastomosis leak rates were 9.8% and 4.5%, 22.8% and 12.3% in Hospital 2, respectively. In Hospital 1, complication and leak rates remained stable. In Hospital 2, improvement occurred after 34 cases in major complications and 29 cases in leaks. Of secondary outcomes, improvements were seen in Hospital 1 in operative time after 61, blood loss after 86, lymph node yield after 52, hospital stay after 19 and 1-year mortality after 24 cases. In Hospital 2, improvement occurred in operative time after 30, blood loss after 15, lymph node yield after 45, hospital stay after 50 and 1-year mortality after 15 cases.

Conclusions: According to this study, learning phase of the individual surgeon determines the outcomes of MIE, not the institutional learning phase.

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Series: Journal of thoracic disease
ISSN: 2072-1439
ISSN-E: 2077-6624
ISSN-L: 2072-1439
Volume: 13
Issue: 11
Pages: 6261 - 6271
DOI: 10.21037/jtd-21-1063
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3122 Cancers
Funding: Instrumentarium Science Foundation (OH), Mary and Georg C. Ehrnrooth Foundation (OH) and Finnish State Research Funding (OH, HH), Finnish Cultural Foundation (HH), Vieno, Alli Suorsa’s Healthcare Foundation (HH), The Finnish Cancer Foundation (JHK), Sigrid Juselius Foundation (JHK) and Päivikki and Sakari Sohlberg Foundation (JHK).
Copyright information: © Journal of Thoracic Disease. This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: