Hiroya Takeuchi1,2, Hiroaki Miyata3,4, Soji Ozawa5, Harushi Udagawa5, Harushi Osugi5, Hisahiro Matsubara5, Hiroyuki Konno6, Yasuyuki Seto6, Yuko Kitagawa7,5. 1. Department of Surgery, Keio University School of Medicine, Tokyo, Japan. htakeuchi@a6.keio.jp. 2. The Japan Esophageal Society, Tokyo, Japan. htakeuchi@a6.keio.jp. 3. Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan. 4. National Clinical Database, Tokyo, Japan. 5. The Japan Esophageal Society, Tokyo, Japan. 6. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan. 7. Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Abstract
PURPOSE: This study aimed to compare short-term outcomes of minimally invasive esophagectomy (MIE) with those of open esophagectomy (OE) for thoracic esophageal cancer using a nationwide Japanese database. METHODS: Overall, 9584 patients with thoracic esophageal cancer who underwent esophagectomy at 864 hospitals in 2011-2012 were evaluated. We performed one-to-one matching between the MIE and OE groups on the basis of estimated propensity scores for each patient. RESULTS: After propensity score matching, operative time was significantly longer in the MIE group (n = 3515) than in the OE group (n = 3515) [526 ± 149 vs. 461 ± 156 min, p < 0.001], whereas blood loss was markedly less in the MIE group than in the OE group (442 ± 612l vs. 608 ± 591 ml, p < 0.001). The populations of patients who required more than 48 h of postoperative respiratory ventilation was significantly less in the MIE group than in the OE group (8.9 vs. 10.9%, p = 0.006); however, reoperation rate within 30 days was significantly higher in the MIE group than in the OE group (7.0 vs. 5.3%, p = 0.004). There were no significant differences between the MIE and OE groups in 30-day mortality rates (0.9 vs. 1.1%) and operative mortality rates (2.5 vs. 2.8%, respectively). CONCLUSIONS: MIE was comparable with conventional OE in terms of short-term outcome after esophagectomy. It was particularly beneficial in reducing postoperative respiratory complications, but may be associated with higher reoperation rates.
PURPOSE: This study aimed to compare short-term outcomes of minimally invasive esophagectomy (MIE) with those of open esophagectomy (OE) for thoracic esophageal cancer using a nationwide Japanese database. METHODS: Overall, 9584 patients with thoracic esophageal cancer who underwent esophagectomy at 864 hospitals in 2011-2012 were evaluated. We performed one-to-one matching between the MIE and OE groups on the basis of estimated propensity scores for each patient. RESULTS: After propensity score matching, operative time was significantly longer in the MIE group (n = 3515) than in the OE group (n = 3515) [526 ± 149 vs. 461 ± 156 min, p < 0.001], whereas blood loss was markedly less in the MIE group than in the OE group (442 ± 612l vs. 608 ± 591 ml, p < 0.001). The populations of patients who required more than 48 h of postoperative respiratory ventilation was significantly less in the MIE group than in the OE group (8.9 vs. 10.9%, p = 0.006); however, reoperation rate within 30 days was significantly higher in the MIE group than in the OE group (7.0 vs. 5.3%, p = 0.004). There were no significant differences between the MIE and OE groups in 30-day mortality rates (0.9 vs. 1.1%) and operative mortality rates (2.5 vs. 2.8%, respectively). CONCLUSIONS:MIE was comparable with conventional OE in terms of short-term outcome after esophagectomy. It was particularly beneficial in reducing postoperative respiratory complications, but may be associated with higher reoperation rates.
Authors: Gijsbert I van Boxel; B Feike Kingma; Frank J Voskens; Jelle P Ruurda; Richard van Hillegersberg Journal: J Thorac Dis Date: 2020-02 Impact factor: 2.895