BACKGROUND: In esophageal cancer, long-term outcomes of minimally invasive surgery using endoscopic surgery are currently being verified. However, most trials have compared thoracic procedures; few studies have focused on the abdominal procedures, which are important for lymph node dissection in radical esophageal cancer surgery. Hand-assisted laparoscopic surgery (HALS) is a simple and minimally invasive procedure. Although HALS superiority in short-term outcomes has been reported, its oncological safety in esophageal cancer remains unclear. Therefore, we retrospectively evaluated oncological safety of HALS compared with that of conventional open laparotomy (OL) in radical surgery for thoracic and abdominal esophageal cancer. METHODS: We retrospectively analyzed the postoperative survival in 142 patients who underwent radical esophageal cancer surgery at our hospital between May 2012 and May 2017, with and without propensity score matching (PSM) between groups. RESULTS: Before PSM, OL (n = 65) and HALS (n = 77) groups differed significantly in overall survival (OS) (3-year OS rate: 74.2% and 87.3%, respectively; log-rank p = 0.040). Additionally, clinical abdominal lymph node metastasis (cALNM) independently predicted OS (p = 0.031). After PSM, the OL and HALS groups did not differ significantly in OS (3-year OS rate: 80.5% and 89.8%, respectively; log-rank p = 0.716). There was no statistically significant difference in abdominal-specific recurrence-free survival between the OL and HALS group before and after PSM. CONCLUSION: HALS may be a well-accepted procedure for radical esophagectomy in esophageal cancer, with oncological safety, including local control specific to the abdomen, comparable to that of the conventional OL.
BACKGROUND: In esophageal cancer, long-term outcomes of minimally invasive surgery using endoscopic surgery are currently being verified. However, most trials have compared thoracic procedures; few studies have focused on the abdominal procedures, which are important for lymph node dissection in radical esophageal cancer surgery. Hand-assisted laparoscopic surgery (HALS) is a simple and minimally invasive procedure. Although HALS superiority in short-term outcomes has been reported, its oncological safety in esophageal cancer remains unclear. Therefore, we retrospectively evaluated oncological safety of HALS compared with that of conventional open laparotomy (OL) in radical surgery for thoracic and abdominal esophageal cancer. METHODS: We retrospectively analyzed the postoperative survival in 142 patients who underwent radical esophageal cancer surgery at our hospital between May 2012 and May 2017, with and without propensity score matching (PSM) between groups. RESULTS: Before PSM, OL (n = 65) and HALS (n = 77) groups differed significantly in overall survival (OS) (3-year OS rate: 74.2% and 87.3%, respectively; log-rank p = 0.040). Additionally, clinical abdominal lymph node metastasis (cALNM) independently predicted OS (p = 0.031). After PSM, the OL and HALS groups did not differ significantly in OS (3-year OS rate: 80.5% and 89.8%, respectively; log-rank p = 0.716). There was no statistically significant difference in abdominal-specific recurrence-free survival between the OL and HALS group before and after PSM. CONCLUSION: HALS may be a well-accepted procedure for radical esophagectomy in esophageal cancer, with oncological safety, including local control specific to the abdomen, comparable to that of the conventional OL.
Authors: Rachel C Brierley; Daisy Gaunt; Chris Metcalfe; Jane M Blazeby; Natalie S Blencowe; Marcus Jepson; Richard G Berrisford; Kerry N L Avery; William Hollingworth; Caoimhe T Rice; Aida Moure-Fernandez; Newton Wong; Joanna Nicklin; Anni Skilton; Alex Boddy; James P Byrne; Tim Underwood; Ravi Vohra; James A Catton; Kish Pursnani; Rachel Melhado; Bilal Alkhaffaf; Richard Krysztopik; Peter Lamb; Lucy Culliford; Chris Rogers; Benjamin Howes; Katy Chalmers; Sian Cousins; Jackie Elliott; Jenny Donovan; Rachael Heys; Robin A Wickens; Paul Wilkerson; Andrew Hollowood; Christopher Streets; Dan Titcomb; Martyn Lee Humphreys; Tim Wheatley; Grant Sanders; Arun Ariyarathenam; Jamie Kelly; Fergus Noble; Graeme Couper; Richard J E Skipworth; Chris Deans; Sukhbir Ubhi; Robert Williams; David Bowrey; David Exon; Paul Turner; Vinutha Daya Shetty; Ram Chaparala; Khurshid Akhtar; Naheed Farooq; Simon L Parsons; Neil T Welch; Rebecca J Houlihan; Joanne Smith; Rachel Schranz; Nicola Rea; Jill Cooke; Alexandra Williams; Carolyn Hindmarsh; Sally Maitland; Lucy Howie; Christopher Paul Barham Journal: BMJ Open Date: 2019-11-19 Impact factor: 2.692