Safe Introduction of Minimally Invasive Esophagectomy at a Medium Volume Center

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Minimally invasive esophagectomy (MIE) is increasingly adopted in high-volume centers.
• Tertiary referral centers with medium surgical volume face unique challenges in adopting new techniques.
• Evaluating the transition to MIE in a medium-volume center is crucial for understanding its feasibility and impact.

Purpose of the Study:

• To assess the surgical outcomes of introducing minimally invasive esophagectomy (MIE) at a medium-volume tertiary referral center.
• To compare MIE with open transthoracic surgery in terms of perioperative data, surgical outcomes, and complications.
• To determine if MIE can be safely implemented without compromising oncological or safety standards.

Main Methods:

• Retrospective study of 116 patients undergoing esophagectomy for esophageal or gastroesophageal junction carcinoma (Siewert I and II) between 2007 and 2016.
• Comparison of minimally invasive esophagectomy (n=51) and open transthoracic surgery (n=65) groups.
• Analysis of perioperative data, surgical outcomes, and complications using multivariate regression models.

Main Results:

• MIE was associated with significantly less peroperative bleeding (384 vs 607 mL) and a shorter length of stay (14 vs 15 days).
• Lymph node yield was significantly higher in the MIE group (18 vs 12), confirmed by multivariate analysis (aOR 3.15).
• No significant differences were observed in duration of surgery, radical resection rates, or postoperative complication rates between the groups.

Conclusions:

• Introduction of MIE in a medium-volume center yielded superior lymph node retrieval.
• MIE demonstrated reduced peroperative blood loss and shorter hospital stay compared to open surgery.
• The transition to MIE was successful, achieving comparable radical resection rates and complication profiles.