Patient reported outcomes (PROs) after minimally invasive and open esophagectomy.

Esophagectomy for esophageal malignancies remains an operation with significant potential morbidity and mortality. However, surgical outcomes continue to improve over time and focus has shifted toward not just good outcomes, but quality of life post operatively. Patient reported outcomes (PROs) focus of quality of life measures via validated patient surveys has increasingly become a significant focus. While PROs do have their limitations, they represent a glimpse into the symptomatology, quality of life, and well-being of a patient undergoing a procedure with inherent morbidity. Working to improve outcomes from the perspective of the patient is not a new concept, but has becoming increasingly relevant as surgical quality for all procedures improves. The optimal approach to esophagectomy is controversial. Minimally invasive approaches attempt to avoid laparotomy and thoracotomy with the thought of improving post-operative quality of life by mitigating complications related to those open surgical approaches. The data in favor of laparoscopy and thoracoscopy is quite strong and multiple randomized controlled trials exist in this realm supporting minimally invasive approaches with regards to quality of life outcomes and more rapid return to patient's preoperative baseline. The data in favor of a robotic approach for esophagectomy is not quite as robust, but more studies show that these approaches mirror the benefits of the laparoscopic and thoracoscopic approaches without robotic assistance.
Competing Interests: Conflicts of Interest: The authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-2019-pro-09). The series “Patient reported Outcomes in Thoracic Surgery: A new Frontier” was commissioned by the editorial office without any funding or sponsorship. Dr. JDL reports and owns stock in: Intuitive Surgical, Inc., Cigna Corp, and Proctor and Gamble. ISS serves as an unpaid editorial board member of Journal of Thoracic Disease from Sept 2018 to Aug 2020. Dr. ISS reports honoraria and/or grants for research/education/training, and/or consulting for Intuitive Surgical, Inc., On Target Laboratories, Cambridge Medical Robotics, and Auris Medical, all outside the scope of the submitted work. The authors have no other conflicts of interest to declare.
(2020 Journal of Thoracic Disease. All rights reserved.)