Masaru Hayami1,2, Nelson Ndegwa3,4, Mats Lindblad5,3, Gustav Linder6, Jakob Hedberg6, David Edholm7, Jan Johansson8, Jesper Lagergren9,10, Lars Lundell3,11, Magnus Nilsson5,3, Ioannis Rouvelas5,3. 1. Department of Upper Abdominal Surgery, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. masaru.hayami@jfcr.or.jp. 2. Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. masaru.hayami@jfcr.or.jp. 3. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden. 4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 5. Department of Upper Abdominal Surgery, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. 6. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. 7. Department of Surgery, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. 8. Department of Surgery, Skåne University Hospital, Lund, Sweden. 9. Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 10. School of Cancer and Pharmaceutical Sciences, King's College London, London, UK. 11. Department of Surgery, Odense University Hospital, Odense, Denmark.
Abstract
BACKGROUND: Recent research indicates long-term survival benefits of minimally invasive esophagectomy (MIE) compared with open esophagectomy (OE) for patients with esophageal and gastroesophageal junction (GEJ) cancers, but there is a need for more population-based studies. METHODS: We conducted a prospective population-based nationwide cohort study including all patients in Sweden diagnosed with esophageal or junctional cancer who underwent a transthoracic esophagectomy with intrathoracic anastomosis. Data were collected from the Swedish National Register for Esophageal and Gastric Cancer in 2006-2019. Patients were grouped into OE and MIE including hybrid MIE (HMIE) and totally MIE (TMIE). Overall survival and short-term postoperative outcomes were compared using Cox regression and logistic regression models, respectively. All models were adjusted for age, sex, American Society of Anesthesiologists (ASA) score, clinical T and N stage, neoadjuvant therapy, year of surgery, and hospital volume. RESULTS: Among 1404 patients, 998 (71.1%) underwent OE and 406 (28.9%) underwent MIE. Compared with OE, overall survival was better following MIE (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.55-0.94), TMIE (HR 0.67, 95% CI 0.47-0.94), and possibly also after HMIE (HR 0.76, 95% CI 0.56-1.02). MIE was associated with shorter operation time, less intraoperative bleeding, higher number of resected lymph nodes, and shorter hospital stay compared with OE. MIE was also associated with fewer overall complications (odds ratio [OR] 0.70, 95% CI 0.47-1.03) as well as non-surgical complications (OR 0.64, 95% CI 0.40-1.00). CONCLUSIONS: MIE seems to offer better survival and similar or improved short-term postoperative outcomes in esophageal and GEJ cancers compared with OE in this unselected population-based cohort.
BACKGROUND: Recent research indicates long-term survival benefits of minimally invasive esophagectomy (MIE) compared with open esophagectomy (OE) for patients with esophageal and gastroesophageal junction (GEJ) cancers, but there is a need for more population-based studies. METHODS: We conducted a prospective population-based nationwide cohort study including all patients in Sweden diagnosed with esophageal or junctional cancer who underwent a transthoracic esophagectomy with intrathoracic anastomosis. Data were collected from the Swedish National Register for Esophageal and Gastric Cancer in 2006-2019. Patients were grouped into OE and MIE including hybrid MIE (HMIE) and totally MIE (TMIE). Overall survival and short-term postoperative outcomes were compared using Cox regression and logistic regression models, respectively. All models were adjusted for age, sex, American Society of Anesthesiologists (ASA) score, clinical T and N stage, neoadjuvant therapy, year of surgery, and hospital volume. RESULTS: Among 1404 patients, 998 (71.1%) underwent OE and 406 (28.9%) underwent MIE. Compared with OE, overall survival was better following MIE (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.55-0.94), TMIE (HR 0.67, 95% CI 0.47-0.94), and possibly also after HMIE (HR 0.76, 95% CI 0.56-1.02). MIE was associated with shorter operation time, less intraoperative bleeding, higher number of resected lymph nodes, and shorter hospital stay compared with OE. MIE was also associated with fewer overall complications (odds ratio [OR] 0.70, 95% CI 0.47-1.03) as well as non-surgical complications (OR 0.64, 95% CI 0.40-1.00). CONCLUSIONS: MIE seems to offer better survival and similar or improved short-term postoperative outcomes in esophageal and GEJ cancers compared with OE in this unselected population-based cohort.
Authors: P van Hagen; M C C M Hulshof; J J B van Lanschot; E W Steyerberg; M I van Berge Henegouwen; B P L Wijnhoven; D J Richel; G A P Nieuwenhuijzen; G A P Hospers; J J Bonenkamp; M A Cuesta; R J B Blaisse; O R C Busch; F J W ten Kate; G-J Creemers; C J A Punt; J T M Plukker; H M W Verheul; E J Spillenaar Bilgen; H van Dekken; M J C van der Sangen; T Rozema; K Biermann; J C Beukema; A H M Piet; C M van Rij; J G Reinders; H W Tilanus; A van der Gaast Journal: N Engl J Med Date: 2012-05-31 Impact factor: 91.245
Authors: Jennifer Straatman; Nicole van der Wielen; Miguel A Cuesta; Freek Daams; Josep Roig Garcia; Luigi Bonavina; Camiel Rosman; Mark I van Berge Henegouwen; Suzanne S Gisbertz; Donald L van der Peet Journal: Ann Surg Date: 2017-08 Impact factor: 12.969
Authors: Donald E Low; Madhan Kumar Kuppusamy; Derek Alderson; Ivan Cecconello; Andrew C Chang; Gail Darling; Andrew Davies; Xavier Benoit D'Journo; Suzanne S Gisbertz; S Michael Griffin; Richard Hardwick; Arnulf Hoelscher; Wayne Hofstetter; Blair Jobe; Yuko Kitagawa; Simon Law; Christophe Mariette; Nick Maynard; Christopher R Morse; Philippe Nafteux; Manuel Pera; C S Pramesh; Sonia Puig; John V Reynolds; Wolfgang Schroeder; Mark Smithers; B P L Wijnhoven Journal: Ann Surg Date: 2019-02 Impact factor: 12.969
Authors: Katrin M Sjoquist; Bryan H Burmeister; B Mark Smithers; John R Zalcberg; R John Simes; Andrew Barbour; Val Gebski Journal: Lancet Oncol Date: 2011-06-16 Impact factor: 41.316
Authors: Surya S A Y Biere; Mark I van Berge Henegouwen; Kirsten W Maas; Luigi Bonavina; Camiel Rosman; Josep Roig Garcia; Suzanne S Gisbertz; Jean H G Klinkenbijl; Markus W Hollmann; Elly S M de Lange; H Jaap Bonjer; Donald L van der Peet; Miguel A Cuesta Journal: Lancet Date: 2012-05-01 Impact factor: 79.321
Authors: Pieter C van der Sluis; Sylvia van der Horst; Anne M May; Carlo Schippers; Lodewijk A A Brosens; Hans C A Joore; Christiaan C Kroese; Nadia Haj Mohammad; Stella Mook; Frank P Vleggaar; Inne H M Borel Rinkes; Jelle P Ruurda; Richard van Hillegersberg Journal: Ann Surg Date: 2019-04 Impact factor: 12.969
Authors: K W Maas; M A Cuesta; M I van Berge Henegouwen; J Roig; L Bonavina; C Rosman; S S Gisbertz; S S A Y Biere; D L van der Peet; J H Klinkenbijl; M W Hollmann; E S de Lange; H J Bonjer Journal: World J Surg Date: 2015-08 Impact factor: 3.352