Learning Curve for Minimally Invasive Oesophagectomy of Esophageal Cancer and contrast with Open Oesophagectomy

Abstract

Purpose: Minimally invasive oesophagectomy is a technically demanding procedure; thus, the learning curve of this procedure should be explored. Then the relatively mature minimally invasive oesophagectomy procedure should be contrasted with the open procedure. Methods: 214 consecutive patients underwent minimally invasive oesophagectomy were retrospectively reviewed. To evaluate the development of thoracoscopic-laparoscopic oesophagectomy and compare the mature minimally invasive oesophagectomy and open oesophagectomy (OE), we comprehensively studied the clinical and surgical parameters. The cumulative sum (CUSUM) plot was used to study the learning curve for systemic lymphadenectomy. Cox proportional hazards regression analysis was performed to evaluate the clinical factors affecting survival. Results: The bleeding volume, operation time, and postoperative mortality within 3 months significantly decreased after 20 patients. The rise point for the lymph nodes dissection number was visually determined to be at patient 57 in the CUSUM plots. Patients who underwent relatively mature thoracoscopic-laparoscopic oesophagectomy had better surgical data and short-term benefits than patients who underwent an open procedure. Cox proportional hazards regression analysis showed that the maximum diameter of the tumour cross-sectional area and the number of positive nodes had a significant influence on survival. Conclusions: The short-term benefits of thoracoscopic-laparoscopic oesophagectomy were suggested. There was no evidence that it is associated with a significantly better prognosis for patients with oesophageal cancer.