Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 1;276(6):e749-e757.
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

Marianne C Kalff  1 , Laura F C Fransen  2 , Eline M de Groot  3 , Suzanne S Gisbertz  1 , Grard A P Nieuwenhuijzen  2 , Jelle P Ruurda  3 , Rob H A Verhoeven  4 , Misha D P Luyer  2 , Richard van Hillegersberg  3 , Mark I van Berge Henegouwen  1 ; Dutch Upper Gastrointestinal Cancer Audit group
Affiliations

Long-term Survival After Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer: A Nationwide Propensity-score Matched Analysis

Marianne C Kalff et al. Ann Surg. .

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.

PubMed Disclaimer

Conflict of interest statement

Verhoeven has received unrestricted research grants from BMS and Roche. Van Berge Henegouwen reports research grants from Olympus and Stryker, in addition to consulting fees from Medtronic, Mylan, and Johnson and Johnson. Luyer and Nieuwenhuijzen report a research grant and consulting fees from Medtronic. Gisbertz reports a research grant from Olympus and consulting fees from Medtronic. The remaining authors have no conflict of interest to report. No funding was received for this study. The authors report no conflicts of interest.

References

    1. Haverkamp L, Seesing MFJ, Ruurda JP, et al. Worldwide trends in surgical techniques in the treatment of esophageal and gastroesophageal junction cancer. Dis Esophagus. 2017;30:1–7.
    1. Dutch Institute for Clinical Auditing. DICA jaarrapportage 2018. DICA-jaarrapportage-2018. Available at: https://dica.nl/jaarrapportage-2018/duca. Accessed July 24, 2020.
    1. Boshier PR, Anderson O, Hanna GB. Transthoracic versus transhiatal esoph-agectomy for the treatment of esophagogastric cancer: a meta-analysis. Ann Surg. 2011;254:894–906.
    1. Donohoe CL, et al. Evidence-based selective application of transhiatal esophagectomy in a high-volume esophageal center. World J Surg. 2012;36:98–103.
    1. Straatman J, et al. Minimally invasive versus open esophageal resection: three-year follow-up of the previously reported randomized controlled trial: the TIME Trial. Ann Surg. 2017;266:232–236.

Publication types