Minimally Invasive Versus Open Esophagectomy for Malignancy: Pathological and Long-Term Oncological Outcomes

Area of Science:

• Surgical Oncology
• Thoracic Surgery
• Gastrointestinal Surgery

Background:

• Minimally invasive esophagectomy (MIE) is increasingly adopted globally.
• Data comparing MIE with open esophagectomy (OE) from India are limited.
• This study addresses the need for comparative outcomes in the Indian subcontinent.

Purpose of the Study:

• To compare early postoperative outcomes between MIE and OE.
• To evaluate long-term oncological results, including survival and disease-free survival.
• To provide evidence for surgical approach selection in esophageal cancer treatment.

Main Methods:

• Retrospective analysis of 313 patients undergoing esophagectomy (194 OE, 119 MIE).
• Comparison of complication rates (Clavien-Dindo grade III+), specific complications (pneumonitis, anastomotic leak), hospital/ICU stay, and blood loss.
• Assessment of long-term outcomes: 3-year mortality, disease-free survival (DFS), and overall survival (OS).

Main Results:

• MIE group had significantly lower overall morbidity (17.6% vs 27.83%, p=0.043), pneumonitis (3.36% vs 7.21%, p=0.039), and anastomotic leak (4.20% vs 9.28%, p=0.030) compared to OE.
• MIE resulted in significantly shorter hospital stays (p=0.0035), ICU stays (p=0.002), and less blood loss (p=0.001).
• No significant differences were observed in 3-year mortality (37.2% MIE vs 32.6% OE, p=0.621), DFS (73.6% MIE vs 62.2% OE, p=0.221), or OS (80.9% MIE vs 78.8% OE, p=0.727).

Conclusions:

• Minimally invasive esophagectomy offers significant advantages in reducing early postoperative complications and improving short-term recovery metrics compared to open esophagectomy.
• For esophageal cancer patients in India, MIE demonstrates comparable long-term oncological efficacy to OE.
• MIE should be considered a viable and potentially superior alternative to OE, particularly regarding patient recovery and safety.