Long-term oncological outcomes following completely minimally invasive esophagectomy versus open esophagectomy

Summary Open esophagectomy (OE) for esophageal and gastroesophageal junctional cancers is associated with high morbidity. Completely minimally invasive esophagectomy (CMIE) techniques have evolved over the last two decades and significantly reduce surgical trauma compared to open surgery. Despite this, long-term oncological outcomes following CMIE compared to OE remain unclear. This systematic review and meta-analysis aimed to compare overall 5-year survival (OFS) and disease-free 5-year survival (DFFS) between CMIE and OE. It was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive electronic literature search from MEDLINE, EMBASE, Web of Science, Scopus and the Cochrane Central Register of Controlled Trials was conducted. The PROSPERO database was also searched for studies comparing OFS and DFFS between CMIE and OE. The Newcastle Ottawa Scale was used to assess study quality for included studies. Overall, seven studies (containing 949 patients: 527 OE and 422 CMIE) were identified from screening. On pooled meta-analysis, there was no significant difference in OFS or DFFS between CMIE and OE cohorts ([odds ratio 1.12; 95% CI: 0.85 to 1.48; P = 0.41] and [odds ratio 1.34; 95% CI: 0.81–2.22; P = 0.25] respectively). Sensitivity and subgroup analysis with high-quality studies, three highest sample sized studies, and three most recent studies also revealed no difference in long-term oncological outcomes between the two operative groups. This review demonstrates long-term oncological outcomes following CMIE appear equivalent to OE based on amalgamation of existing published literature. Limited high-level evidence comparing OFS and DFFS between CMIE and OE exists. Further research with a randomized controlled trial is required to clinically validate these findings.

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696 LONG-TERM OUTCOMES OF MINIMALLY INVASIVE ESOPHAGECTOMY COMPARED TO OPEN ESOPHAGECTOMY: A RETROSPECTIVE ANALYSIS OF 2958 CASES IN SINGLE CANCER CENTER

Diseases of the Esophagus ◽

10.1093/dote/doab052.696 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Xue-feng Leng ◽

Kexun Li ◽

Qifeng Wang ◽

Wenwu He ◽

Kun Liu ◽

...

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Cancer Center ◽

Term Survival ◽

Invasive Esophagectomy ◽

Open Esophagectomy ◽

Single Cancer

Abstract Esophageal cancer is the fourth primary cause of cancer-related death in the male in China.The cornerstone of treatment for resectable esophageal cancer is surgery. With the development of minimally invasive esophagectomy (MIE), it is gradually adopted as an alternative to open esophagectomy (OE) in real-world practice. The purpose of this study is to explore whether MIE vs. OE will bring survival benefits to patients with the advancement of treatment techniques and concepts. Methods Data were obtained from the Sichuan Cancer Hospital & Institute Esophageal Cancer Case Management Database (SCH-ECCM Database). We retrospective analyzed esophageal cancer patients who underwent esophagectomy from Jan. 2010 to Nov. 2017. Patients were divided into two groups: MIE and OE groups. Clinical outcome and survival data were compared using TNM stages of AJCC 8th edition. Results After 65.3 months of median follow-up time, 2958 patients who received esophagectomy were included. 1106 of 2958 patients (37.4%) were underwent MIE, 1533 of 2958 patients (51.8%) were underwent OE. More than half of the patients (56.7%, 1673/2958) were above stage III. The median overall survival (OS) of 2958 patients was 51.6 months (95% CI 45.2–58.1). The MIE group's median OS was 74.6 months compared to 42.4 months in the OE group (95% CI 1.23–1.54, P < 0.001). The OS at 1, 3, and 5 years were 90%, 68%, 58% in the MIE group; 85%, 54%, 42% in the OE group,respectively (P<0.001). Conclusion The nearly 8-year follow-up data from this single cancer center suggests that with the advancement of minimally invasive surgical technology, MIE can bring significant benefits to patients' long-term survival compared with OE. Following the continuous progression of minimally invasive surgery and establishing a mature surgical team, MIE should be encouraged.

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Long-term survival in esophageal cancer after minimally invasive esophagectomy compared to open esophagectomy

Annals of Surgery ◽

10.1097/sla.0000000000004645 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Eivind Gottlieb-Vedi ◽

Joonas H. Kauppila ◽

Fredrik Mattsson ◽

Mats Lindblad ◽

Magnus Nilsson ◽

...

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Term Survival ◽

Long Term Survival ◽

Invasive Esophagectomy ◽

Open Esophagectomy

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623 MINIMALLY INVASIVE VERSUS OPEN MCKEOWN FOR PATIENTS WITH ESOPHAGEAL CANCER: A RETROSPECTIVE STUDY

Diseases of the Esophagus ◽

10.1093/dote/doab052.623 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Yan Zheng ◽

Wenqun Xing ◽

Xianben Liu ◽

Haibo Sun

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Group 14 ◽

Term Survival ◽

Long Term Survival ◽

Invasive Esophagectomy ◽

Open Esophagectomy ◽

Surgery Department

Abstract McKeown Minimally invasive esophagectomy(McKeown-MIE) offers advantages in short-term outcomes compared with McKeown open esophagectomy(McKeown-OE). However, debate as to whether MIE is equivalent or better than OE regarding survival outcomes is ongoing. The aim of this study was to compare long-term survival between McKeown-MIE and McKeown-OE in a large cohort of esophageal cancer(EC) patients. Methods We used a prospective database of the Thoracic Surgery Department at our Cancer Hospital and included patients who underwent McKeown-MIE and McKeown-OE for EC during January 1, 2015, to January 6, 2018. The perioperative data and overall survival(OS) rate in the two groups were retrospectively compared. Results We included 502 patients who underwent McKeown-MIE (n = 306) or McKeown-OE (n = 196) for EC. The median age was 63 years. All baseline characteristics were well-balanced between two groups. There was a significantly shorter mean operative time (269.76 min vs. 321.14 min, P < 0.001) in OE group. The 30-day and in hospital mortality were 0 and no difference for 90-day mortality (P = 0.116). The postoperative stay was shorter in MIE group, 14 days and 18 days in the MIE and OE groups(P < 0.001). The OS at 32 months was 76.82% and 64.31% in the MIE and OE groups (P = 0.001); hazard ratio(HR) (95% CI): 2.333 (1.384–3.913). Conclusion These results showed the McKeown-MIE group was associated with a better long-term survival, compared with open-MIE for patients with resectable EC.

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Minimally invasive esophagectomy versus open esophagectomy: A systematic review and meta-analysis

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2021.06.012 ◽

2021 ◽

Author(s):

Francisca dos S. Coelho ◽

Diana E. Barros ◽

Filipa A. Santos ◽

Flávia C. Meireles ◽

Francisca C. Maia ◽

...

Keyword(s):

Systematic Review ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Meta Analysis ◽

Invasive Esophagectomy ◽

Open Esophagectomy

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Minimally invasive esophagectomy is associated with superior survival, lymphadenectomy and surgical margins: propensity matched analysis of the National Cancer Database

Diseases of the Esophagus ◽

10.1093/dote/doaa017 ◽

2020 ◽

Vol 33 (10) ◽

Cited By ~ 2

Author(s):

Stephanie G Worrell ◽

Katelynn C Bachman ◽

Anuja L Sarode ◽

Yaron Perry ◽

Philip A Linden ◽

...

Keyword(s):

Overall Survival ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Rank Test ◽

National Cancer Database ◽

Long Term Outcomes ◽

Short Term ◽

Invasive Esophagectomy ◽

Open Esophagectomy

Abstract Despite excellent short-term outcomes of minimally invasive esophagectomy (MIE), there is minimal data on long-term outcomes compared to open esophagectomy. MIE’s superior visualization may have improved lymphadenectomy and complete resection rate and therefore improved long-term outcomes. We hypothesized that MIE would have superior long-term survival. Patients undergoing an esophagectomy for cancer between 2010 and 2016 were identified in the National Cancer Database. MIE included laparoscopic/robotic approach, and conversions were categorized as open. A 1:1 propensity match was performed. Lymphadenectomy and margin status were compared between MIE and open using Stuart Maxwell marginal homogeneity and Wilcoxon matched-pair signed-rank test. Survival was compared using log-rank test. 13,083 patients were identified: 8,906 (68%) open and 4,177 (32%) MIE. Propensity matching identified 3,659 ‘pairs’ of MIE and open esophagectomy patients. Among them, MIE was associated with higher number lymph nodes examined (16 vs. 14, P < 0.001) and similar number of positive lymph nodes (0 vs. 0, P = 0.33). MIE had higher rate of negative pathologic margin (95 vs. 93.5%, P < 0.001). MIE was also associated with shorter hospitalization (9 vs. 10 days, P < 0.001). Survival was improved among MIE patients (46.6 vs. 41.4 months for open, P = 0.003) and among pathologic node-negative patients (71.4 vs. 61.5 months, P = 0.005). These data suggest that MIE has improved short-term outcomes (improved lymphadenectomy, pathologic margins, and length of stay) and also associated improved overall survival. The etiology of superior overall survival is likely secondary to many factors related and unrelated to surgical approach.

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Impact of Minimally Invasive Esophagectomy in Post-Operative Atrial Fibrillation and Long-Term Mortality in Patients Among Esophageal Cancer

Cancer Control ◽

10.1177/1073274820974013 ◽

2020 ◽

Vol 27 (1) ◽

pp. 107327482097401

Author(s):

LaiTe Chen ◽

BinBin Li ◽

ChenYang Jiang ◽

GuoSheng Fu

Keyword(s):

Atrial Fibrillation ◽

Esophageal Cancer ◽

Minimally Invasive ◽

Odds Ratio ◽

Minimally Invasive Esophagectomy ◽

Invasive Approach ◽

Invasive Esophagectomy ◽

Significant Difference ◽

Long Term Mortality

Aims: Postoperative Atrial fibrillation (POAF) after esophagectomy may prolong stay in intensive care and increase risk of perioperative complications. A minimally invasive approach is becoming the preferred option for esophagectomy, yet its implications for POAF risk remains unclear. The association between POAF and minimally invasive esophagectomy (MIE) was examined in this study. Methods: We used a dataset of 575 patients who underwent esophagectomy. Multivariate logistic regression analysis was performed to examine the association between MIE and POAF. A cox proportional hazards model was applied to assess the long-term mortality (MIE vs open esophagectomy, OE). Results: Of the 575 patients with esophageal cancer, 62 developed POAF. MIE was negatively associated with the occurrence of POAF (Odds ratio: 0.163, 95%CI: 0.033-0.801). No significant difference was observed in long-term mortality (Odds ratio: 2.144, 95%CI: 0.963-4.775). Conclusions: MIE may reduced the incidence of POAF without compromising the survival of patients with esophageal cancer. Moreover, the specific mechanism of MIE providing this possible advantage needs to be determined by larger prospective cohort studies with specific biomarker information from laboratory tests.

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232 HYBRID MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: FIVE-YEAR SURVIVAL RESULTS OF THE MIRO TRIAL.

Diseases of the Esophagus ◽

10.1093/dote/doaa087.41 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

F Nuytens ◽

S Dabakuyo-Yonli ◽

B Meunier ◽

D Pezet ◽

D Collet ◽

...

Keyword(s):

Prognostic Factors ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Disease Free Survival ◽

Disease Recurrence ◽

Pulmonary Complications ◽

Invasive Esophagectomy ◽

Open Esophagectomy

Abstract Multiple randomized controlled trials have demonstrated the short term benefits of (hybrid) minimally invasive esophagectomy (MIE) over open esophagectomy. Data regarding long term results are more conflicting with similar or even better results in the MIE arm. In this follow-up study of the MIRO-trial we evaluated the long-term 5-year outcomes including overall survival (OS), disease-free survival (DFS) as well as the pattern of disease recurrence, along with evaluation of potential prognostic factors affecting these outcomes. Methods From October 2009 till April 2012, we conducted a multicentre, open-label, prospective, randomized, controlled trial including patients who were diagnosed with thoracic esophageal cancer and eligible for curative surgical resection (Ivor-Lewis procedure). Patients were randomized between hybrid minimally invasive esophagectomy and open esophagectomy. The primary end-point of the initial MIRO trial was major intra- and postoperative complication (Clavien-Dindo ≥2) within 30 days after surgery. The primary end-points of this follow-up study were OS and DFS. Additional secondary end points were defined as site of disease recurrence and potential prognostic or mediating factors associated with DFS and OS. Results 207 patients underwent randomization. The median follow-up was 58,2 (95% CI, 56,5– 63,8) months. The 5y OS was 59% (95% CI, 48–68) and 47% (95% CI, 37–57) in the hybrid- and open-procedure group respectively (HR, 0,71, 95% CI, 0,48-1,06). The 5y DFS was 52% (95% CI, 42–61) in the hybrid-procedure group vs. 44% (95%CI, 34–53) in the open-procedure group. (HR 0.81 (95% CI, 0,55-1,17). There was no significant difference in recurrence rate (p = 0.519) or -location (p = 0.692) between groups. In a multivariate analysis, major postoperative and pulmonary complications were identified as prognostic factors of impaired OS (p < 0.0001;p = 0.005) and DFS (p = 0.002;p = 0.006). Conclusion Besides a significant reduction in postoperative overall and pulmonary complication rate, minimally invasive (hybrid) esophagectomy offers long-term oncological results that are at least equivalent to open esophagectomy. Postoperative and pulmonary complications are independent prognostic factors for impaired overall- and disease-free survival, providing additional proof that minimally invasive esophagectomy could even be associated with better long-term oncological results compared to open esophagectomy mediated by a reduction in postoperative complications.

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