Ann Surg. 2020 Dec 23; doi: 10.1097/SLA.0000000000004708. Epub 2020 Dec 23.
Long-Term Survival After Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer: A Nationwide Propensity-Score Matched Analysis.
Annals of surgery
Marianne C Kalff, Laura F C Fransen, Eline M de Groot, Suzanne S Gisbertz, Grard A P Nieuwenhuijzen, Jelle P Ruurda, Rob H A Verhoeven, Misha D P Luyer, Richard van Hillegersberg, Mark I van Berge Henegouwen,
Affiliations
Affiliations
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands Department of Surgery, UMC Utrecht, Utrecht, the Netherlands Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands.
PMID: 33378310
DOI: 10.1097/SLA.0000000000004708
Abstract
OBJECTIVES: This study aimed to compare long-term survival following minimally invasive esophagectomy (MIE) versus open esophagectomy (OE) for esophageal cancer using a nationwide propensity-score matched cohort.
SUMMARY BACKGROUND DATA: MIE provides lower postoperative morbidity and mortality, and similar short-term oncological quality compared to OE.
METHODS: Data was acquired from the Dutch Upper Gastrointestinal Cancer Audit. Patients undergoing minimally invasive or open, transthoracic or transhiatal esophagectomy for primary esophageal cancer between 2011-2015 were included. A propensity-score matching analysis for MIE versus OE was performed separately for transthoracic and transhiatal esophagectomies.
RESULTS: A total of 1036 transthoracic MIE and OE patients, and 582 transhiatal MIE and OE patients were matched. Long-term survival was comparable for MIE and OE for both transthoracic and transhiatal procedures (5-year overall survival: transthoracic MIE 49.2% vs. OE 51.1%, p 0.695; transhiatal MIE 48.4% vs. OE 50.7%, p 0.832). For both procedures, MIE yielded more lymph nodes (transthoracic median 21 vs. 18, p < 0.001; transhiatal 15 vs. 13, p 0.007). Post-operative morbidity was comparable after transthoracic MIE and OE (60.8% vs. 64.9%, p 0.177), with a reduced length of stay after transthoracic MIE (median 12 vs. 15 days, p < 0.001). After transhiatal MIE, more postoperative complications (64.9% vs. 56.4%, p 0.034) were observed, without subsequent difference in length of stay.
CONCLUSION: Long-term survival after minimally invasive esophagectomy was equivalent to open in both propensity-score matched cohorts of patients undergoing transthoracic or transhiatal esophageal resections. Transhiatal minimally invasive esophagectomy was accompanied with more post-operative morbidity. Both transthoracic and transhiatal minimally invasive esophagectomy resulted in a more extended lymphadenectomy.
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Conflict of interest statement
Conflict of interest and source of funding: Verhoeven has received unrestricted research grants from BMS and Roche. Van Berge Henegouwen reports research grants from Olympus and Stryker, in addition t
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