Original article
General thoracic
Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer: A Comparison of Early Surgical Outcomes From The Society of Thoracic Surgeons National Database

Presented at the Fifty-first Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 24–28, 2015.
https://doi.org/10.1016/j.athoracsur.2015.09.095Get rights and content

Background

Open esophagectomy results in significant morbidity and mortality. Minimally invasive esophagectomy (MIE) has become increasingly popular at specialized centers with the aim of improving perioperative outcomes. Numerous single-institution studies suggest MIE may offer lower short-term morbidity. The two approaches are compared using a large, multiinstitutional database.

Methods

The Society of Thoracic Surgeons (STS) National Database (v2.081) was queried for all resections performed for esophageal cancer between 2008 and 2011 (n = 3,780). Minimally invasive approaches included both transhiatal (n = 214) and Ivor Lewis (n = 600), and these were compared directly with open transhiatal (n = 1,065) and Ivor Lewis (n = 1,291) procedures, respectively. Thirty-day outcomes were examined using nonparametric statistical testing.

Results

Both open and MIE groups were similar in terms of preoperative risk factors. Morbidity and all-cause mortality were equivalent at 62.2% and 3.8%. MIE was associated with longer median procedure times (443.0 versus 312.0 minutes; p < 0.001), but a shorter median length of hospital stay (9.0 versus 10.0 days; p < 0.001). Patients who underwent MIE had higher rates of reoperation (9.9% versus 4.4%; p < 0.001) and empyema (4.1% versus 1.8%; p < 0.001). Open technique led to an increased rate of wound infections (6.3% versus 2.3%; p < 0.001), postoperative transfusion (18.7% versus 14.1%; p = 0.002), and ileus (4.5% versus 2.2%; p = 0.002). Propensity score-matched analysis confirmed these findings. High- and low-volume centers had similar outcomes.

Conclusions

Early results from the STS National Database indicate that MIE is safe, with comparable rates of morbidity and mortality as open technique. Longer procedure times and a higher rate of reoperation following MIE may reflect a learning curve.

Section snippets

Material and Methods

The STS General Thoracic Database (v. 2.081) was queried for all patients who underwent OE and MIE from 2008 to 2011 for esophageal cancer. These corresponded to International Classification of Disease (ICD) 9/10 diagnostic codes 150.4, 150.5, and 151.0 and procedure codes 43107, 43117, 43112, 43117, 43122, and 43XXX on the STS General Thoracic Database Data Collection Form. The comparison included the total case groups of MIE and OE, and a subgroup analysis of Ivor Lewis and transhiatal

Results

Query of the STS General Thoracic Database resulted in a total of 3,780 esophagectomies that were performed for cancer of the middle and lower esophagus between 2008 and 2011, of which 2,966 were OE and 814 were MIE. Total populations of MIE and OE, as well as subgroups, were analyzed. Excluding alternative approaches, subgroup analysis was performed such that minimally invasive approaches included both transhiatal (n = 214) and Ivor Lewis (n = 600), and these were compared directly with open

Comment

This study is one of the first to report the results of a large, multiinstitutional, national database comparison of MIE versus OE for esophageal cancer in the United States. These data suggest that MIE, in particular minimally invasive Ivor Lewis and transhiatal esophagectomy, is safe and equivalent to OE technique with respect to overall morbidity and mortality. Operative mortality was found to be low at 3.3% for MIE patients and 3.9% for OE patients. We believe this result is remarkable for

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