General Thoracic Surgery: Esophagus
Outcomes, quality of life, and survival after esophagectomy for squamous cell carcinoma: A propensity score–matched comparison of operative approaches

Read at the 94th Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 26-30, 2014.
https://doi.org/10.1016/j.jtcvs.2014.12.063Get rights and content
Under an Elsevier user license
open archive

Background

Minimally invasive esophagectomy (MIE) theoretically offers advantages compared with open esophagectomy (OE). However, the long-term outcomes have not been well studied, especially for esophageal squamous cell carcinoma. We retrospectively compared postoperative outcomes, quality of life (QOL), and survival in a matched population of patients undergoing MIE, with a control (OE) group.

Methods

From May 2004 to August 2013, MIE was performed for a group of 735 patients, which was compared with a group of 652 cases of OE. Eventually, 444 paired cases, matched using propensity-score matching, were selected for further statistical analysis.

Results

Compared with the OE group, the MIE group had shorter operation duration (191 ± 47 minutes vs 211 ± 44 minutes, P < .001); less blood loss (135 ± 74 ml vs 163 ± 84 ml, P < .001); similar lymph node harvest (24.1 ± 6.2 vs 24.3 ± 6.0, P = .607); shorter postoperative hospital stay (11 days [range: 7-90 days] vs 12 days [range: 8-112 days], P < .001); fewer major complications (30.4% vs 36.9%, P = .039); a lower readmission rate to the intensive-care unit (5.6% vs 9.7%, P = .023); and similar perioperative mortality (1.1% vs 2.0%, P = .281). At a median follow-up of 27 months, the 2-year overall survival rates in the MIE and OE group were: (1) stage 0 and I: 92% versus 90% (P = .864); (2) stage II: 83% versus 82% (P = .725); (3) stage III: 59% versus 55% (P = .592); (4) stage IV: 43% versus 43% (P = .802). The generalized estimating equation analysis showed that MIE had an independently positive impact on patients' postoperative QOL.

Conclusions

In our experience, MIE is a safe and effective procedure for the treatment of esophageal squamous cell carcinoma. It may offer better perioperative outcomes, better postoperative QOL, and equal oncologic survival, compared with OE.

Abbreviations and Acronyms

cTis
Clinical Trials Information System
cTNM
clinical tumor-node-metastasis
ESCC
esophageal squamous cell carcinoma
MIE
minimally invasive esophagectomy
OE
open esophagectomy
pTNM
pathologic tumor-node-metastasis
QOL
quality of life

CTSNet classification

7
8.7

Cited by (0)

Disclosures: Authors have nothing to disclose with regard to commercial support.

Y. Shen contributed equally to this work.