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
. 2023 May 12:13:1104109.
doi: 10.3389/fonc.2023.1104109. eCollection 2023.

Minimally invasive Ivor Lewis esophagectomy in the elderly patient: a multicenter retrospective matched-cohort study

Giovanni Capovilla  1 , Eren Uzun  2 , Alessia Scarton  1 , Lucia Moletta  1 , Edin Hadzijusufovic  2 , Luca Provenzano  1 , Renato Salvador  1 , Elisa Sefora Pierobon  1 , Gianpietro Zanchettin  1 , Evangelos Tagkalos  2 , Felix Berlth  2 , Hauke Lang  2 , Michele Valmasoni  1 , Peter P Grimminger  2
Affiliations

Minimally invasive Ivor Lewis esophagectomy in the elderly patient: a multicenter retrospective matched-cohort study

Giovanni Capovilla et al. Front Oncol. .

Abstract

Introduction: Several studies reported the advantages of minimally invasive esophagectomy over the conventional open approach, particularly in terms of postoperative morbidity and mortality. The literature regarding the elderly population is however scarce and it is still not clear whether elderly patients may benefit from a minimally invasive approach as the general population. We sought to evaluate whether thoracoscopic/ laparoscopic (MIE) or fully robotic (RAMIE) Ivor-Lewis esophagectomy significantly reduces postoperative morbidity in the elderly population.

Methods: We analyzed data of patients who underwent open esophagectomy or MIE/RAMIE at Mainz University Hospital and at Padova University Hospital between 2016 and 2021. Elderly patients were defined as those ≥ 75 years old. Clinical characteristics and the postoperative outcomes were compared between elderly patients who underwent open esophagectomy or MIE/RAMIE. A 1-to-1 matched comparison was also performed. Patients < 75 years old were evaluated as a control group.

Results: Among elderly patients MIE/RAMIE were associated with a lower overall morbidity (39.7% vs. 62.7%, p=0.005), less pulmonary complications (32.8 vs. 56.9%, p=0.003) and a shorter hospital stay (13 vs. 18 days, p=0.03). Comparable findings were obtained after matching. Similarly, among < 75 years-old patients, a reduced morbidity (31.2% vs. 43.5%, p=0.01) and less pulmonary complications (22% vs. 36%, p=0.001) were detected in the minimally invasive group.

Discussion: Minimally invasive esophagectomy improves the postoperative course of elderly patients reducing the overall incidence of postoperative complications, particularly of pulmonary complications.

Keywords: MIE; RAMIE; esophageal cancer; esophagectomy; laparoscopy; thoracoscopy.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Overall survival (A) and disease free survival (B) of the < 75y MI group vs. the < 75y open group. Whole cohort.
Figure 2
Figure 2
Overall survival (A) and disease free survival (B) of the ≥ 75y MI group vs. the ≥ 75y open group. Whole cohort.
See this image and copyright information in PMC

References

    1. Raymond DP, Seder CW, Wright CD, Magee MJ, Kosinski AS, Cassivi SD, et al. . Predictors of major morbidity or mortality after resection for esophageal cancer: a society of thoracic surgeons general thoracic surgery database risk adjustment model. Ann Thorac Surg (2016) 102(1):207. doi: 10.1016/j.athoracsur.2016.04.055 - DOI - PMC - PubMed
    1. Morita M, Nakanoko T, Fujinaka Y, Kubo N, Yamashita N, Yoshinaga K, et al. . In-hospital mortality after a surgical resection for esophageal cancer: analyses of the associated factors and historical changes. Ann Surg Oncol (2011) 18(6):1757–65. doi: 10.1245/s10434-010-1502-5 - DOI - PubMed
    1. Markar SR, Karthikesalingam A, Thrumurthy S, Low DE. Volume-outcome relationship in surgery for esophageal malignancy: systematic review and meta-analysis 2000-2011. J Gastrointest Surg (2012) 16(5):1055–63. doi: 10.1007/s11605-011-1731-3 - DOI - PubMed
    1. Biere SSAY, Van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, et al. . Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet (2012) 379(9829):1887–92. doi: 10.1016/S0140-6736(12)60516-9 - DOI - PubMed
    1. van der Sluis PC, van der Horst S, May AM, Schippers C, Brosens LAA, Joore HCA, et al. . Robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer: a randomized controlled trial. Ann Surg (2019) 269(4):621–30. doi: 10.1097/SLA.0000000000003031 - DOI - PubMed

LinkOut - more resources