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Total minimally invasive esophagectomy for esophageal adenocarcinoma reduces postoperative pain and pneumonia compared to hybrid esophagectomy

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Abstract

Background

The impact of total minimally invasive esophagectomy (MIE) on early postoperative outcome and patient’s survival is a matter of recent discussion.

Methods

We performed a 1:2 propensity score-matched comparison of 20 patients who underwent 3D-MIE and high intrathoracic esophagogastrostomy with 40 patients who underwent hybrid esophagectomy (HYBRID) with laparoscopic gastric mobilization and open transthoracic esophagectomy and the same anastomosis for esophageal adenocarcinoma in 2014 and 2015. Matching criteria were tumor localization, age, gender, and neoadjuvant treatment.

Results

Both groups did not differ regarding overall postoperative complications (MIE 55% vs. HYBRID 50%, p = 0.715) and anastomotic leakage (MIE 15% vs. HYBRID 5%, p = 0.186). A significant difference was seen regarding the rate of postoperative pneumonia (MIE 5% vs. HYBRID 27.5%; p = 0.040) and the postoperative ICU stay (MIE median 1 day vs. HYBRID median 2 days, p < 0.001). The R0-resection rate was 100% in both groups and median number of dissected lymph nodes was 32 for MIE and 35 for HYBRID (p = 0.236). Significant differences between both groups were noticed for postoperative number of patients with use of opiate demand medication and numeric rating scale for pain (NRSP maximum pain, median) both in favor of the MIE group (MIE 25%, NRSP 2 vs. HYBRID 60%, NRSP 4; p = 0.011, p < 0.001). Overall 2-year survival rate was 85% in both groups.

Conclusion

Total minimally invasive esophagectomy is superior to hybrid esophagectomy in regard of postoperative pain and rate of pneumonia. No differences exist for postoperative surgical complications or short-term prognosis.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany

    Felix Berlth, Patrick S. Plum, Seung-Hun Chon & Elfriede Bollschweiler

  2. Department of General and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland

    Christian A. Gutschow

  3. Center of Esophageal and Gastric Surgery, Agaplesion Markus Hospital, Wilhelm-Epstein-Straße 4, 60431, Frankfurt, Germany

    Arnulf H. Hölscher

Authors
  1. Felix Berlth
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  2. Patrick S. Plum
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  3. Seung-Hun Chon
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  4. Christian A. Gutschow
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  5. Elfriede Bollschweiler
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  6. Arnulf H. Hölscher
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Correspondence to Arnulf H. Hölscher.

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Disclosures

The authors of this article F. Berlth, P. Plum, S-H. Chon, C.A. Gutschow, E. Bollschweiler, and A.H. Hölscher have no conflicts of interests to declare or financial ties to disclose.

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Berlth, F., Plum, P.S., Chon, SH. et al. Total minimally invasive esophagectomy for esophageal adenocarcinoma reduces postoperative pain and pneumonia compared to hybrid esophagectomy. Surg Endosc 32, 4957–4965 (2018). https://doi.org/10.1007/s00464-018-6257-2

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  • DOI: https://doi.org/10.1007/s00464-018-6257-2

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