Naoya Yoshida1,2, Hiroyuki Yamamoto3,4, Hideo Baba1,5, Hiroaki Miyata3,4, Masayuki Watanabe6, Yasushi Toh6, Hisahiro Matsubara7, Yoshihiro Kakeji8, Yasuyuki Seto9. 1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan. 2. Division of Translational Research and Advanced Treatment Against Gastrointestinal Cancer, Kumamoto University, Chuoku, Kumamoto, Japan. 3. Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan. 4. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 5. Center for Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan. 6. Database Committee, The Japan Esophageal Society, Japan. 7. The Japan Esophageal Society, Japan. 8. Database Committee, The Japanese Society of Gastroenterological Surgery, Japan. 9. The Japanese Society of Gastroenterological Surgery, Japan.
Abstract
OBJECTIVE: We aimed to elucidate whether minimally invasive esophagectomy (MIE) can be safely performed by reviewing the Japanese National Clinical Database. SUMMARY OF BACKGROUND DATA: MIE is being increasingly adopted, even for advanced esophageal cancer that requires various preoperative treatments. However, the superiority of MIE's short-term outcomes compared with those of open esophagectomy (OE) has not been definitively established in general clinical practice. METHODS: This study included 24,233 esophagectomies for esophageal cancer conducted between 2012 and 2016. Esophagectomy for clinical T4 and M1 stages, urgent esophagectomy, 2-stage esophagectomy, and R2 resection were excluded. The effects of preoperative treatment and surgery on short-term outcomes were analyzed using generalized estimating equations logistic regression analysis. RESULTS: MIE was superior or equivalent to OE in terms of the incidence of most postoperative morbidities and surgery-related mortality, regardless of the type of preoperative treatment. Notably, MIE performed with no preoperative treatment was associated with significantly less incidence of any pulmonary morbidities, prolonged ventilation ≥48 hours, unplanned intubation, surgical site infection, and sepsis. However, reoperation within 30 days in patients with no preoperative treatment was frequently observed after MIE. The total surgery-related mortality rates of MIE and OE were 1.7% and 2.4%, respectively (P < 0.001). Increasing age, low preoperative activities of daily living, American Society of Anesthesiologists physical status ≥3, diabetes mellitus requiring insulin use, chronic obstructive pulmonary disease, congestive heart failure, creatinine ≥1.2 mg/dL, and lower hospital case volume were identified as independent risk factors for surgery-related mortality. CONCLUSIONS: The results suggest that MIE can replace OE in various situations from the perspective of short-term outcome.
OBJECTIVE: We aimed to elucidate whether minimally invasive esophagectomy (MIE) can be safely performed by reviewing the Japanese National Clinical Database. SUMMARY OF BACKGROUND DATA: MIE is being increasingly adopted, even for advanced esophageal cancer that requires various preoperative treatments. However, the superiority of MIE's short-term outcomes compared with those of open esophagectomy (OE) has not been definitively established in general clinical practice. METHODS: This study included 24,233 esophagectomies for esophageal cancer conducted between 2012 and 2016. Esophagectomy for clinical T4 and M1 stages, urgent esophagectomy, 2-stage esophagectomy, and R2 resection were excluded. The effects of preoperative treatment and surgery on short-term outcomes were analyzed using generalized estimating equations logistic regression analysis. RESULTS:MIE was superior or equivalent to OE in terms of the incidence of most postoperative morbidities and surgery-related mortality, regardless of the type of preoperative treatment. Notably, MIE performed with no preoperative treatment was associated with significantly less incidence of any pulmonary morbidities, prolonged ventilation ≥48 hours, unplanned intubation, surgical site infection, and sepsis. However, reoperation within 30 days in patients with no preoperative treatment was frequently observed after MIE. The total surgery-related mortality rates of MIE and OE were 1.7% and 2.4%, respectively (P < 0.001). Increasing age, low preoperative activities of daily living, American Society of Anesthesiologists physical status ≥3, diabetes mellitus requiring insulin use, chronic obstructive pulmonary disease, congestive heart failure, creatinine ≥1.2 mg/dL, and lower hospital case volume were identified as independent risk factors for surgery-related mortality. CONCLUSIONS: The results suggest that MIE can replace OE in various situations from the perspective of short-term outcome.