Recommended Citation
Armstrong R, Kriley I, Kolberg K, Riutta S, Bellini G, Papenfuss W. Assessing the Learning Curve for a Novel Approach to Esophagectomy within a Large Community Health System. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Transhiatal Endoscopic with Transcervical Endoscopic Esophageal Mobilization (THE TEEM) esophagectomy is a minimally invasive novel approach to treating esophageal cancers and is a technically demanding operation requiring multiple surgical specialties. This study aims to identify the learning curve for this novel approach.
Purpose:
To evaluate the learning curve for a novel approach to esophagectomy.
Methods:
A retrospective review of 154 consecutive patients who underwent THE TEEM between 2/2015 and 12/2021 was conducted. Patients were divided into chronologic quartiles by surgery date (Q1-Q4). Demographics and perioperative outcomes were compared, including length of stay (LOS), intensive care unit (ICU) disposition, ICU LOS, operative time, and lymph node yield. Continuous variables were compared using Kruskal-Wallis testing; categorical variables with chi-square testing.
Results:
Overall, 154 patients underwent THE TEEM and were divided into quartiles by date of surgery (Q1 n=39, Q2 n=38, Q3 n=38, Q4 n=39). Median age 68 years (IQR 60-74), 18.2% female, and 61.7% were treated at St. Luke’s. Tumors were primarily lower third (91.6%) and adenocarcinoma (85.1%); 84.4% received neoadjuvant therapy. Across quartiles, there were significant improvements in perioperative efficiency and resource utilization. Median operative time decreased from 231 min (IQR 208-257.5) in Q1 to 170 min (IQR 150.5-184) in Q4 (p<0.001). LOS declined from a median of 9 days (IQR 7-11) in Q1 to 5 days (IQR 4-6) in Q4 (p<0.001). ICU disposition decreased markedly, from 100% in Q1 and Q2 to 73.7% in Q3 and 23.1% in Q4. ICU length of stay decreased from 3 days (IQR 2-4) in Q1 to 0 days (IQR 0-0.5) in Q4 (p<0.001).
Conclusion:
Proficiency for THE TEEM approach to esophagectomy occurred after approximately 110 operations. Operative time, ICU admission rate, and hospital LOS decreased markedly with experience.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
wf_yes
Document Type
Oral/Podium Presentation
Assessing the Learning Curve for a Novel Approach to Esophagectomy within a Large Community Health System
Background/Significance:
Transhiatal Endoscopic with Transcervical Endoscopic Esophageal Mobilization (THE TEEM) esophagectomy is a minimally invasive novel approach to treating esophageal cancers and is a technically demanding operation requiring multiple surgical specialties. This study aims to identify the learning curve for this novel approach.
Purpose:
To evaluate the learning curve for a novel approach to esophagectomy.
Methods:
A retrospective review of 154 consecutive patients who underwent THE TEEM between 2/2015 and 12/2021 was conducted. Patients were divided into chronologic quartiles by surgery date (Q1-Q4). Demographics and perioperative outcomes were compared, including length of stay (LOS), intensive care unit (ICU) disposition, ICU LOS, operative time, and lymph node yield. Continuous variables were compared using Kruskal-Wallis testing; categorical variables with chi-square testing.
Results:
Overall, 154 patients underwent THE TEEM and were divided into quartiles by date of surgery (Q1 n=39, Q2 n=38, Q3 n=38, Q4 n=39). Median age 68 years (IQR 60-74), 18.2% female, and 61.7% were treated at St. Luke’s. Tumors were primarily lower third (91.6%) and adenocarcinoma (85.1%); 84.4% received neoadjuvant therapy. Across quartiles, there were significant improvements in perioperative efficiency and resource utilization. Median operative time decreased from 231 min (IQR 208-257.5) in Q1 to 170 min (IQR 150.5-184) in Q4 (p<0.001). LOS declined from a median of 9 days (IQR 7-11) in Q1 to 5 days (IQR 4-6) in Q4 (p<0.001). ICU disposition decreased markedly, from 100% in Q1 and Q2 to 73.7% in Q3 and 23.1% in Q4. ICU length of stay decreased from 3 days (IQR 2-4) in Q1 to 0 days (IQR 0-0.5) in Q4 (p<0.001).
Conclusion:
Proficiency for THE TEEM approach to esophagectomy occurred after approximately 110 operations. Operative time, ICU admission rate, and hospital LOS decreased markedly with experience.
Affiliations
Aurora St. Luke’s Medical Center, Aurora UW Medical Group, Aurora Sinai Medical Center