Utilising Benchmarking Standards to Evaluate Transition to Minimally Invasive Esophagectomy.

Minimally Invasive Esophagectomy (MIE) is performed in nearly 50% of cases worldwide. The effectiveness of the technique arises from a single randomised control trial and multiple single series cohorts. Consistent reporting of complications is varied. We describe our experience of transitioning to MIE compared to Open Esophagectomy (OE) using ECCG standardised complication benchmark definitions.Between 2007-2017, all patients undergoing esophagectomy were identified using a prospectively curated database. Complications were defined by the Esophageal Complications Consensus Group (ECCG) and graded using the Clavien-Dindo(CD-most severe complication) and Comprehensive Complication Index (CCI-complexity of complications during hospital stay).Of 383 patients, 299 (76%) were male with a median age of 64.5 (56-72). MIE was performed in 49.6%. There were no differences in age, histology (p=0.222), pT Stage (p=0.136) or nodal positivity (p=0.918). Stage 3 cancers accounted for 42.0% of OE and 47.9% of MIE. A thoracic anastomosis was more frequently in MIE (156/190,82.1%) compared to OE (113/193,58.5%), p=0.001. Frequency, severity(CD) and complexity(CCI) of complications were better in the MIE group, without compromising operative outcomes. No differences were identified in individual complication groupings or grade in MIE compared to OE: Pneumonia 19.5% vs 26.9%,( p=0.09); ICU readmission 7.4% vs 9.3%,( p=0.519); Atrial Fibrillation 11.1% vs 6.7%,( p=0.082) or grade of leak, ( p=0.99).These results compare favourably to those reported by ECCG. Minimally Invasive esophagectomy can be the standard approach for surgical management of esophageal cancer. Introduction of the approach in each surgeon's practice should be benchmarked to international standards.