Outcomes of Minimally Invasive Versus Open Esophagectomy

Minimally invasive esophagectomy (MIE) is increasingly utilized for early-stage esophageal cancer, yet its long-term survival benefit compared to open esophagectomy (OE) remains debated. This study evaluates perioperative and survival outcomes between MIE and OE.

The National Cancer Database was queried from 2016 to 2021 for all esophageal cancer patients that underwent esophagectomy. Patients were categorized as MIE if the surgery was started and ended minimally invasive, and OE if the approach was open. Demographics, clinical characteristics, and clinical outcomes including length of stay (LOS), overall survival, and perioperative mortality were evaluated using multivariable regression and Kaplan-Meier analysis.

There were 2702 patients who met inclusion criteria, (1624 (60%) MIE and 1078 (40%) OE). MIE had a higher lymph node harvest rate compared to OE, 18 versus 15 (P < 0.001), and reduced hospital LOS (P = 0.045). Thirty-d readmission rate did not differ between MIE and OE. Unadjusted analysis favored MIE for overall survival (hazard ratio = 1.27, P = 0.02), but significance dissipated after adjustment (hazard ratio = 1.07, P = 0.77). Perioperative outcomes (LOS, readmission rates) were comparable.

MIE was associated with higher lymph node retrieval, staging accuracy, and reduced hospital LOS but does not independently enhance survival when accounting for pathological stage and adjuvant therapies. Perioperative advantages and staging precision support MIE as a preferred approach, though survival is contingent on multimodal management.