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

Minimally invasive esophagectomy is gaining popularity. Comparative outcomes from open vs minimally invasive esophagectomy are reported sparsely from India. The current study is a retrospective analysis comparing early post-operative and long-term oncological outcomes among the open and minimally invasive approaches for esophagectomy. Three hundred thirteen patients were analysed, 194 from the open group (OG) and 119 in the minimally invasive group (MIE). Morbidity to the extent of Clavin Dindo level III and more among the two groups were statistically higher 52/194(27.83%) in the OG vs the MIE 21/119(17.6%), p = 0.043. Early postoperative complications, including arrhythmia, air leak from lung or bronchial injury, chyle leak, and recurrent laryngeal nerve injury, were not significantly different among the two groups. Pneumonitis and anastomotic site leak were significantly more in the OG vs the MIS group, 14 (7.21%) vs 4(3.36%) p-value of 0.039 and 18(9.28%) vs 5(4.20%) p = 0.030, respectively. Early postoperative outcomes in terms of hospital stay, ICU stay, and blood loss were significantly less in MIE vs OG, with a p-value of 0.0035, 0.002 and 0.001, respectively. The median follow-up was 47 months. Three-year mortality rates in the two groups were statistically similar (32.6%) in the OG and (37.2%) in the MIE is (P = 0.621). Three-year disease-free survival (DFS) in the OG was 62.2%, and the MIE was 73.6%. (p = 0.221). Three-year overall survival (OS) of esophagectomy in the OG was 78.8%, and the MIE was 80.9%, (p = 0.727).