ArticleAnnals of surgery2019
Learning Curve and Associated Morbidity of Minimally Invasive Esophagectomy: A Retrospective Multicenter Study.
Article in Annals of surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 125 papers, 6 of them syntheses that pooled it.
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Who cites it
125 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- The "Textbook Outcome" Isn't Textbook: Significant Variation in "Textbook Outcome" Definitions following a Systematic Review of the Surgical Oncology Literature.Annals of surgical oncology · 2026Pooled it
- Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy for esophageal cancer: a systematic review and meta-analysis of 18,187 patients.Journal of robotic surgery · 2024Pooled it
- Effect of gastric ischemic conditioning prior to esophagectomy: systematic review and meta-analysis.Updates in surgery · 2023Pooled it
- Effect of Anastomotic Leak on Long-Term Survival After Esophagectomy: Multivariate Meta-analysis and Restricted Mean Survival Times Examination.Annals of surgical oncology · 2023Pooled it
- Totally minimally invasive esophagectomy versus hybrid minimally invasive esophagectomy: systematic review and meta-analysis.Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus · 2020Pooled it
- Indocyanine green for the prevention of anastomotic leaks following esophagectomy: a meta-analysis.Surgical endoscopy · 2019Pooled it
- A single blinded randomized controlled trial comparing semi-mechanical with hand-sewn cervical anastomosis after esophagectomy for cancer (SHARE-study).Journal of surgical oncology · 2020Trial
- Implementation of Minimally Invasive Esophagectomy From a Randomized Controlled Trial Setting to National Practice.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2020Trial
- The Impact of Best Practice Meetings on Outcomes of Esophageal Cancer Surgery in the Netherlands.Annals of surgical oncology · 2026Article
- Robotic Ivor Lewis esophagectomy experience and outcomes from a high-volume cancer center with propensity-matched comparative assessment to the ACS-NSQIP database.Surgical endoscopy · 2026Article
- Routine Intraoperative ICG Perfusion Assessment and Anastomotic Leak After Esophagectomy: A Before-After Cohort Study.Journal of clinical medicine · 2026Article
- Postoperative complications after Minimally Invasive transCervical oEsophagectomy (MICE) versus Transthoracic Minimally Invasive oEsophagectomy (TMIE): an inverse probability of treatment weighted analysis.Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus · 2026Article
- Learning curve-associated safety in minimally invasive esophagectomy using a time-based supervisory takeover strategy: a propensity score-weighted analysis of 603 VATS procedures.Surgical endoscopy · 2026Article
- Article
- Evolution and refinements in minimally invasive esophagectomy: a narrative review.Journal of thoracic disease · 2026Review
- Cervical Anastomotic Leakage After Minimally Invasive McKeown Esophagectomy in the SAFER Surgical System: Clinical Course and Predictors of Delayed Healing.Thoracic cancer · 2026Article
- Textbook outcome can be reached in the learning curve for hybrid robot-assisted esophagectomy-experience from a German high-volume center.Journal of robotic surgery · 2026Article
- Impact of hospital volume on outcomes of esophagectomy for esophageal cancer: analysis of a prospective multicenter database.Surgical endoscopy · 2026Article
- Comparable outcomes after McKeown and Ivor-Lewis minimally invasive esophagectomy with standardized two-field lymphadenectomy: a propensity score-matched study.Frontiers in oncology · 2026Article
- Single-incision versus multi-incision minimally invasive esophagectomy with different reconstruction routes for esophageal cancer: a retrospective propensity-weighted analysis.Journal of thoracic disease · 2025Article
65 more citing papers are in PubMed but not listed here.
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Authors and funding
16 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo investigate the morbidity that is associated with the learning curve of minimally invasive esophagectomy.
backgroundAlthough learning curves have been described, it is currently unknown how much extra morbidity is associated with the learning curve of technically challenging surgical procedures.
methodsProspectively collected data were retrospectively analyzed of all consecutive patients undergoing minimally invasive Ivor Lewis esophagectomy in 4 European expert centers. The primary outcome parameter was anastomotic leakage. Secondary outcome parameters were operative time and textbook outcome ("optimal outcome"). Learning curves were plotted using weighted moving average and CUSUM analysis was used to determine after how many cases the plateau was reached. Learning associated morbidity was calculated with area under the curve analysis.
resultsThis study included 646 patients. Three of the 4 hospitals reached the plateau of 8% anastomotic leakage. The length of the learning curve was 119 cases. The mean incidence of anastomotic leakage decreased from 18.8% during the learning phase to 4.5% after the plateau had been reached (P < 0.001). Thirty-six extra patients (10.1% of all patients operated on during the learning curve) experienced learning associated anastomotic leakage, that could have been avoided if patients were operated by surgeons who had completed the learning curve. The incidence of textbook outcome increased from 28% to 53% and the mean operative time decreased from 344 minutes to 270 minutes.
conclusionsA considerable number of 36 extra patients (10.1%) experienced learning associated anastomotic leakage. More research is urgently needed to investigate how learning associated morbidity can be reduced to increase patient safety during learning curves.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.