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
Observational Study
. 2024 Aug 1;280(2):267-273.
doi: 10.1097/SLA.0000000000006280. Epub 2024 Apr 5.

Recurrence and Survival After Minimally Invasive and Open Esophagectomy for Esophageal Cancer: A Post Hoc Analysis of the Ensure Study

Sofie P G Henckens  1   2   3 , Nannet Schuring  1   2   3 , Jessie A Elliott  4 , Asif Johar  5 , Sheraz R Markar  6 , Amaia Gantxegi  7 , Pernilla Lagergren  5   8 , George B Hanna  8 , Manuel Pera  9 , John V Reynolds  4 , Mark I van Berge Henegouwen  1   2   3 , Suzanne S Gisbertz  1   2   3 ; ENSURE study group
Collaborators, Affiliations
Observational Study

Recurrence and Survival After Minimally Invasive and Open Esophagectomy for Esophageal Cancer: A Post Hoc Analysis of the Ensure Study

Sofie P G Henckens et al. Ann Surg. .

Abstract

Objective: To determine the impact of operative approach [open (OE), hybrid minimally invasive (HMIE), and total minimally invasive (TMIE) esophagectomy] on operative and oncologic outcomes for patients treated with curative intent for esophageal and junctional cancer.

Background: The optimum oncologic surgical approach to esophageal and junctional cancer is unclear.

Methods: This secondary analysis of the European multicenter ENSURE study includes patients undergoing curative-intent esophagectomy for cancer between 2009 and 2015 across 20 high-volume centers. Primary endpoints were disease-free survival (DFS) and the incidence and location of disease recurrence. Secondary endpoints included among others R0 resection rate, lymph node yield, and overall survival (OS).

Results: In total, 3199 patients were included. Of these, 55% underwent OE, 17% HMIE, and 29% TMIE. DFS was independently increased post-TMIE [hazard ratio (HR): 0.86 (95% CI: 0.76-0.98), P = 0.022] compared with OE. Multivariable regression demonstrated no difference in absolute locoregional recurrence risk according to the operative approach [HMIE vs OE, odds ratio (OR): 0.79, P = 0.257; TMIE vs OE, OR: 0.84, P = 0.243]. The probability of systemic recurrence was independently increased post-HMIE (OR: 2.07, P = 0.031), but not TMIE (OR: 0.86, P = 0.508). R0 resection rates ( P = 0.005) and nodal yield ( P < 0.001) were independently increased after TMIE, but not HMIE ( P = 0.424; P = 0.512) compared with OE. OS was independently improved following both HMIE (HR: 0.79, P = 0.009) and TMIE (HR: 0.82, P = 0.003) as compared with OE.

Conclusion: In this European multicenter study, TMIE was associated with improved surgical quality and DFS, whereas both TMIE and HMIE were associated with improved OS as compared with OE for esophageal cancer.

PubMed Disclaimer

Conflict of interest statement

M.I.v.B.H. is a consultant for Alesi Surgical, BBraun, Johnson & Johnson, Medtronic and Viatris, and received research grants from Stryker (all fees paid to the institution). The remaining authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
OS curves, specified for surgical approach; P = 0.024.
FIGURE 2
FIGURE 2
PRS curves, specified for surgical approach; P = 0.047.
See this image and copyright information in PMC

References

    1. Kuppusamy MK, Low DE. Evaluation of international contemporary operative outcomes and management trends associated with esophagectomy: a 4-year study of >6000 patients using ECCG definitions and the online esodata database. Ann Surg. 2022;275:515–525. - PubMed
    1. Low DE, Allum W, De Manzoni G, et al. . Guidelines for perioperative care in esophagectomy: enhanced recovery after surgery (ERAS) society recommendations. World J Surg. 2019;43:299–330. - PubMed
    1. Sakamoto T, Fujiogi M, Matsui H, et al. . Comparing perioperative mortality and morbidity of minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: a nationwide retrospective analysis. Ann Surg. 2021;274:324–330. - PubMed
    1. Yibulayin W, Abulizi S, Lv H, et al. . Minimally invasive oesophagectomy versus open esophagectomy for resectable esophageal cancer: a meta-analysis. World J Surg Oncol. 2016;14:304. - PMC - PubMed
    1. Biere SS, Van Berge Henegouwen MI, Maas KW, et al. . Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379:1887–1892. - PubMed

Publication types