Recommended Citation
Armstrong R, Kolberg K, Wankowski D, Bellini G, Papenfuss W. Oncologic and Surgical Outcomes for a Novel Approach to Esophagectomy: A Retrospective Analysis at a Large Community Health System. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Esophagectomy is a cornerstone of esophageal cancer treatment. Open esophagectomy has potential for complications and difficult recovery. Transhiatal Endoscopic Esophageal Mobilization (TEEM) is a novel minimally invasive method of esophagectomy that decreases morbidity and length of procedure via a dual-team approach from the abdomen and neck.
Purpose:
The objective of this study was to evaluate the oncologic and perioperative outcomes of TEEM esophagectomy over a 10-year period.
Methods:
We retrospectively reviewed patients who underwent TEEM esophagectomy between January 1, 2015- December 31, 2024 at our institution using the STS database. Patients without esophageal cancer were excluded. Demographics, intraoperative data, post-operative, and pathologic results were collected for descriptive analysis.
Results:
Overall, 146 patients received TEEM. Mean age was 65.3 years (range 36-84). Average procedure time was 202 minutes. Procedure time trended lower over time with average OR time during the first 3.5 years of 244 minutes, OR time during the middle 3 years of 192 minutes, and OR time during the final 3.5 years of 188 minutes. Initially all patients were admitted to ICU after surgery, but at the end of data collection patients were admitted to the floor after surgery in most cases. Esophageal tumors were located in the lower third (57%, n=83), the gastroesophageal junction (35%, n=51), and middle third (8%, n=12). Mena lymphadenectomy included 15 LN (15.43 ± 5.47 SD). 95.2% of patients had R0 resection (n=139). 30-day and 90-day mortality were equivalent at 1.3% (n=2). One year mortality was 15%. 54 patients experienced post-operative events. The most frequent complications were pulmonary (pulmonary embolism, respiratory failure, pneumonia, pleural effusion, pneumothorax, acute respiratory distress syndrome, reintubation, trach, atelectasis, n=47). Additional complications included cardiac (arrythmias/myocardial infraction, n=24), recurrent laryngeal nerve injury (n=13), anastomotic leak (n=9), surgical site infection (n=3). 14.38% (n=21) of patients were readmitted within 30 days.
Conclusion:
TEEM esophagectomy is a feasible approach for surgical resection of esophageal cancers from mid esophagus to gastroesophageal junction. This technique is efficient and provides adequate lymphadenectomy and R0 resection rates. Further study is needed to compare TEEM approach to standard esophagectomy to discern any approach specific benefit.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
Oncologic and Surgical Outcomes for a Novel Approach to Esophagectomy: A Retrospective Analysis at a Large Community Health System
Background/Significance:
Esophagectomy is a cornerstone of esophageal cancer treatment. Open esophagectomy has potential for complications and difficult recovery. Transhiatal Endoscopic Esophageal Mobilization (TEEM) is a novel minimally invasive method of esophagectomy that decreases morbidity and length of procedure via a dual-team approach from the abdomen and neck.
Purpose:
The objective of this study was to evaluate the oncologic and perioperative outcomes of TEEM esophagectomy over a 10-year period.
Methods:
We retrospectively reviewed patients who underwent TEEM esophagectomy between January 1, 2015- December 31, 2024 at our institution using the STS database. Patients without esophageal cancer were excluded. Demographics, intraoperative data, post-operative, and pathologic results were collected for descriptive analysis.
Results:
Overall, 146 patients received TEEM. Mean age was 65.3 years (range 36-84). Average procedure time was 202 minutes. Procedure time trended lower over time with average OR time during the first 3.5 years of 244 minutes, OR time during the middle 3 years of 192 minutes, and OR time during the final 3.5 years of 188 minutes. Initially all patients were admitted to ICU after surgery, but at the end of data collection patients were admitted to the floor after surgery in most cases. Esophageal tumors were located in the lower third (57%, n=83), the gastroesophageal junction (35%, n=51), and middle third (8%, n=12). Mena lymphadenectomy included 15 LN (15.43 ± 5.47 SD). 95.2% of patients had R0 resection (n=139). 30-day and 90-day mortality were equivalent at 1.3% (n=2). One year mortality was 15%. 54 patients experienced post-operative events. The most frequent complications were pulmonary (pulmonary embolism, respiratory failure, pneumonia, pleural effusion, pneumothorax, acute respiratory distress syndrome, reintubation, trach, atelectasis, n=47). Additional complications included cardiac (arrythmias/myocardial infraction, n=24), recurrent laryngeal nerve injury (n=13), anastomotic leak (n=9), surgical site infection (n=3). 14.38% (n=21) of patients were readmitted within 30 days.
Conclusion:
TEEM esophagectomy is a feasible approach for surgical resection of esophageal cancers from mid esophagus to gastroesophageal junction. This technique is efficient and provides adequate lymphadenectomy and R0 resection rates. Further study is needed to compare TEEM approach to standard esophagectomy to discern any approach specific benefit.
Affiliations
Aurora St. Luke’s Medical Center, Aurora UW Medical Group, Aurora Sinai Medical Center