Rib resection versus rib division in two-stage oesophagectomies: a retrospective cohort study

Alexander Yuen; Jessica Ng; Leigh Rutherford; David Parker; Philip Townend

doi:10.18203/2349-2902.isj20240162

Authors

Alexander Yuen Department of Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia https://orcid.org/0000-0001-8469-6188
Jessica Ng Department of Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia https://orcid.org/0000-0002-9538-4435
Leigh Rutherford Department of Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia https://orcid.org/0000-0001-5597-4847
David Parker Department of Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
Philip Townend Department of Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia https://orcid.org/0000-0001-7800-9660

DOI:

https://doi.org/10.18203/2349-2902.isj20240162

Keywords:

Oesophagectomy, Rib resection, Rib division, Oesophageal carcinoma, Two-stage oesophagectomy, Analgesic requirement

Abstract

Background: Rib resection (removal of a portion of one rib) and rib division are different approaches used to gain exposure and access to the thoracic cavity in the two-stage oesophagectomy. The analgesic requirement, respiratory complications and physiotherapy and rehabilitation requirements of rib resection and rib division in two-stage oesophagectomy procedures for oesophageal carcinoma were compared.

Methods: Patients who underwent two-stage oesophagectomy between 2017 and 2022 were retrospectively identified. The patients were analysed in a rib resection group (n=14) and a rib division group (n=14) with regards to patient demographics, engagement with the institution’s acute pain service, analgesic requirement, incidence of pneumonia, physiotherapy and rehabilitation requirements.

Results: The overall amount of opioid analgesia used was greater in the rib division group compared to the rib resection group (674.6 versus 528.0 mg, p=0.3799). There were no significant differences in the incidence of pneumonia between the two groups (n=4 versus 1, p=0.3259). There was a trend towards longer ventilation times (0.643 versus 0.357 days, p=0.3333), increased physiotherapy (9.93 versus 9.71 days, p=0.4700), rehabilitation requirements (n=0 versus 2, p=0.1422) within the rib division compared to the rib resection group.

Conclusions: The differences in outcomes between the rib resection and rib division groups are not statistically significant and have been shown to be non-inferior in this dataset. The choice of approach should be based on individual patient factors and the surgeon's preference.

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