Ann Surg. 2021 Nov 11. doi: 10.1097/SLA.0000000000005296. Online ahead of print.
ABSTRACT
OBJECTIVE: To evaluate the long-term and short-term outcomes of minimally invasive esophagectomy (MIE) compared with open esophagectomy (OE) in localized esophageal squamous cell carcinoma (ESCC) patients in real-world settings.
BACKGROUND: MIE is an alternative to OE, despite the limited evidence regarding its effect on long-term survival.
METHODS: We recruited 5822 consecutive patients with resectable ESCC in two typical high-volume centers in southern and northern China, 1453 of whom underwent MIE. Propensity score-based overlap weighted regression adjusted for multifaceted confounding factors was used to compare outcomes in the MIE and OE groups.
RESULTS: Five-year overall survival (OS) was 62.7% in the MIE group and 57.7% in the OE group. The overlap weighted Cox regression showed slightly better OS in the MIE group (HR 0.93, 95% CI: 0.82-1.06). Although duration of surgery was longer and treatment cost higher in the MIE group than in the OE group, the number of lymph nodes harvested was larger, the proportion of intraoperative blood transfusions lower, and postoperative complications less in the MIE group. 30-day (RR 0.77, 0.38-1.55) and 90-day (RR 0.79, 0.46-1.35) mortality were lower in the MIE group versus the OE group, although not statistically significant. These findings were consistent across different analytic approaches and subgroups, notably in the subset of ESCC patients with large tumors.
CONCLUSIONS: MIE can be performed safely with OS comparable to OE for patients with localized ESCC, indicating MIE may be recommended as the primary surgical approach for resectable ESCC in health facilities with requisite technical capacity.
PMID:35129490 | DOI:10.1097/SLA.0000000000005296
