Long-term Survival After Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer
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 Luyer, Richard van Hillegersberg, Mark I. van Berge Henegouwen, on behalf of the Dutch Upper Gastrointestinal Cancer Audit group
Abstract
OBJECTIVES: This study aimed to compare long-term survival following MIE versus OE for esophageal cancer using a nationwide propensity-score matched cohort. SUMMARY OF 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 and 2015 were included. A propensity-score matching analysis for MIE versus OE was performed separately for transthoracic and transhiatal esoph-agectomies. 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). Postoperative 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 MIE was equivalent to open in both propensity-score matched cohorts of patients undergoing transthoracic or transhiatal esophageal resections. Transhiatal MIE was accompanied withmore postoperative morbidity. Both transthoracic and transhiatal MIE resulted in a more extended lymphadenectomy.