Outcomes of Minimally Invasive Versus Open Esophagectomy.

Area of Science:

• Surgical Oncology
• Thoracic Surgery
• Gastrointestinal Oncology

Background:

• Minimally invasive esophagectomy (MIE) is increasingly adopted for early-stage esophageal cancer.
• The comparative long-term survival benefit of MIE versus open esophagectomy (OE) remains under investigation.
• This study assesses perioperative and survival outcomes between MIE and OE.

Purpose of the Study:

• To compare perioperative outcomes and long-term survival between MIE and OE for esophageal cancer.
• To evaluate the impact of surgical approach on lymph node harvest, length of stay, and mortality.
• To determine if MIE offers an independent survival advantage over OE.

Main Methods:

• Analysis of the National Cancer Database (2016-2021) for esophageal cancer patients undergoing esophagectomy.
• Categorization of patients into MIE and OE groups based on surgical approach.
• Evaluation of demographics, clinical characteristics, length of stay, overall survival, and perioperative mortality using multivariable regression and Kaplan-Meier analysis.

Main Results:

• MIE cases (60%) showed a higher lymph node harvest (18 vs. 15) and reduced hospital length of stay (LOS) compared to OE cases (40%).
• Thirty-day readmission rates were similar between MIE and OE groups.
• Unadjusted survival favored MIE, but this benefit disappeared after adjusting for pathological stage and adjuvant therapies.

Conclusions:

• MIE is associated with improved lymph node retrieval and reduced hospital LOS, enhancing staging accuracy.
• MIE does not independently improve survival when pathological stage and adjuvant treatments are considered.
• While MIE offers perioperative and staging advantages, overall survival is dependent on comprehensive multimodal management.