Comparing Perioperative Mortality and Morbidity of Minimally Invasive Esophagectomy Versus Open Esophagectomy for Esophageal Cancer

Abstract Aim To compare postoperative outcome in elderly undergoing either open or minimally invasive esophagectomy. Background & Methods Randomized controlled trials have shown improved short term outcome in patients undergoing minimally invasive compared with open esophagectomy. However, all of them have excluded patients aged 75 years or older. Evidence regarding this patient group, therefore, remains scarce. A propensity score matched retrospective cohort study was performed in a Dutch nationwide cohort from the period of april 2011 to april 2016 of patients aged ≥75 years diagnosed with local and locally advanced esophageal cancer who underwent either minimally invasive or open esophagectomy. Primary outcomes consisted of anastomotic leakage and perioperative mortality. Secondary outcomes were the rate of other complications, reintervention and hospital/ICU readmission. Results After matching, 322 patients were included, 161 in the open esophagectomy and 161 in the minimally invasive esophagectomy group. In the minimally invasive group, a significantly higher incidence occurend of Clavien-Dindo ≥3 complications (RR 1.63, CI-95% 1.24—2.13), anastomotic leaks (RR 1.60, CI-95% 1.12—2.29) and reinterventions (RR 1.70, CI-95% 1.19—2.42). There were no significant differences regarding perioperative mortality, other complications and readmission rate. Conclusion Elderly patients diagnosed with locally advanced esophageal cancer should undergo minimally invasive esophagectomy in favor of open esophagectomy. Keywords Elderly, minimally invasive esophagectomy, open esophagectomy, esophageal cancer, clinical outcome, perioperative mortality.

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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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Costs and benefits of different methods of esophagectomy for esophageal cancer

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492317731389 ◽

2017 ◽

Vol 25 (7-8) ◽

pp. 513-517 ◽

Cited By ~ 8

Author(s):

Alongkorn Yanasoot ◽

Kamtorn Yolsuriyanwong ◽

Sakchai Ruangsin ◽

Supparerk Laohawiriyakamol ◽

Somkiat Sunpaweravong

Keyword(s):

Esophageal Cancer ◽

Postoperative Pain ◽

Minimally Invasive ◽

Operative Time ◽

Minimally Invasive Esophagectomy ◽

Laparoscopic Approach ◽

Costs And Benefits ◽

Invasive Approach ◽

Invasive Esophagectomy ◽

Open Esophagectomy

Background A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of the costs and benefits of minimally invasive, hybrid, and open esophagectomy approaches for esophageal cancer surgery. Methods The data of 83 consecutive patients who underwent a McKeown’s esophagectomy at Prince of Songkla University Hospital between January 2008 and December 2014 were analyzed. Open esophagectomy was performed in 54 patients, minimally invasive esophagectomy in 13, and hybrid esophagectomy in 16. There were no differences in patient characteristics among the 3 groups Minimally invasive esophagectomy was undertaken via a thoracoscopic-laparoscopic approach, hybrid esophagectomy via a thoracoscopic-laparotomy approach, and open esophagectomy by a thoracotomy-laparotomy approach. Results Minimally invasive esophagectomy required a longer operative time than hybrid or open esophagectomy ( p = 0.02), but these patients reported less postoperative pain ( p = 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 3 groups. Minimally invasive esophagectomy incurred higher operative and surgical material costs than hybrid or open esophagectomy ( p = 0.01), but there were no significant differences in inpatient care and total hospital costs. Conclusion Minimally invasive esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain. Hybrid esophagectomy had a shorter learning curve while sharing the advantages of minimally invasive esophagectomy.

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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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