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Open versus minimally invasive esophagectomy: a single-center case controlled study

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Abstract

Background

Recent advances in laparoscopic and thoracoscopic surgery have made it possible to perform esophagectomy using minimally invasive techniques. Although technically complex, recent case studies showed that minimally invasive approaches to esophagectomy are feasible and have the potential to improve mortality, hospital stay, and functional outcome.

Methods

We have performed a case controlled pair-matched study comparing 62 patients who had undergone either minimally invasive (MIE) or open esophagectomy (OE) between 2004 and 2007. Patients were matched by tumor stage and localization, sex, age, and preoperative ASA score. Pathologic stage, operative time, blood loss, transfusion requirements, hospital length of stay, postoperative morbidity, and mortality were recorded.

Results

Statistically significant differences were seen in the overall number of patients with surgical morbidity (MIE: 25% vs. OE: 74%, p = 0.014), the transfusion rate (MIE: 12.9% vs. OE: 41.9%, p = 0.001), and the rate of postoperative respiratory complications (MIE: 9.7% vs. OE: 38.7%, p = 0.008). There was no difference with respect to the duration of surgery. The number of resected lymph nodes and rate of pathologic complete resection were comparable. ICU stay [MIE: 3 days (range = 0–15) vs. OE: 6 days (range = 1–40), p = 0.03] and hospital stay [MIE: 12 days (range = 8–46) vs. OE: 24 days (range = 10–79), p = 0.001] were significantly shorter in the MIE group.

Conclusion

The results of this case-controlled study provide further evidence for the feasibility and possible improvements in the postoperative morbidity of minimally invasive esophagectomy. Our data are comparable to those from other centers and lead us to initiate the first prospectively randomized study comparing the morbidity of total minimally invasive esophagectomy with the open technique.

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Disclosures

Drs. Sebastian F. Schoppmann, Gerhard Prager, Felix B. Langer, Franz M. Riegler, Barbara Kabon, Edith Fleischmann, and Johannes Zacherl have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Medical University of Vienna (MUV), Waehringer Guertel 18-20, 1090, Vienna, Austria

    Sebastian F. Schoppmann, Gerhard Prager, Felix B. Langer, Franz M. Riegler & Johannes Zacherl

  2. Department of Anesthesiology, Medical University of Vienna (MUV), Waehringer Guertel 18-20, 1090, Vienna, Austria

    Barbara Kabon & Edith Fleischmann

Authors
  1. Sebastian F. Schoppmann
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  2. Gerhard Prager
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  3. Felix B. Langer
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  5. Barbara Kabon
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  6. Edith Fleischmann
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  7. Johannes Zacherl
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Correspondence to Sebastian F. Schoppmann or Johannes Zacherl.

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Schoppmann, S.F., Prager, G., Langer, F.B. et al. Open versus minimally invasive esophagectomy: a single-center case controlled study. Surg Endosc 24, 3044–3053 (2010). https://doi.org/10.1007/s00464-010-1083-1

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