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Long-Term Survival After Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer: A Nationwide Propensity-Score Matched Analysis.

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.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Kalff MC,Fransen LFC,de Groot EM,Gisbertz SS,Nieuwenhuijzen GAP,Ruurda JP,Verhoeven RHA,Luyer MDP,van Hillegersberg R,van Berge Henegouwen MI,Dutch Upper Gastrointestinal Cancer Audit group.

doi

10.1097/SLA.0000000000004708

subject

Has Abstract

pub_date

2020-12-23 00:00:00

eissn

0003-4932

issn

1528-1140

pii

00000658-900000000-93822

journal_volume

Publish Ahead of Print

pub_type

杂志文章

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Long-Term Survival After Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer: A Nationwide Propensity-Score Matched Analysis.