Minimally invasive esophagectomy versus open esophagectomy, a symptom assessment study

Abstract

Minimally invasive esophagectomy (MIE) is used with hope to decrease the morbidity associated with an open esophagectomy. Reflux and dumping syndromes are the most important functional complaints in patients after esophagectomy. This study compares the functional benefits of MIE with open esophagectomy. The study enrolled patients who underwent either minimally invasive or open esophagectomy for cancer between 2004 and 2009. No patients in the MIE group had a pyloroplasty or myotomy. Each patient in the MIE group was paired to a patient in the open esophagectomy group via propensity matching. Matching variables included age, race, gender, preoperative treatment, history of prior cancer, American Society of Anesthesiologists Risk Scale, performance status, clinical stage, body mass index, histology, level of anastomosis, and time elapsed since surgery. The patients were asked to answer 26 questions about their reflux and dumping using validated questionnaires. A total of 181 patients were included in the study. From this group, 44 pairs of patients were created and used for the analysis. The median follow-up was 12.1 months for the MIE group and 18.3 months for the open group. The reflux score was slightly worse in the MIE group (5.5 versus 3.5, P= 0.021). There was no difference in the dumping symptoms between the two groups. The most common complaints seen in the dumping questionnaire in almost one-third of all patients were early satiety, abdominal discomfort, nausea, and diarrhea. Of the patients, 77% were satisfied or very satisfied with their condition in the MIE group compared with 93% in the open group (P= 0.287). Reflux, dumping, and overall satisfaction after MIE without pyloroplasty are comparable with those obtained after open esophagectomy with a pyloric drainage procedure.

Minimally invasive oesophagectomy versus open esophagectomy for resectable esophageal cancer: a meta-analysis

“…The MIO group showed lower total complication rates, pulmonary complications occupying the major part. However, a number of studies have reported significantly lower pulmonary complications for those who underwent MIO 17.1% (813/4761) versus OE 22.6% (2264/10,020), with overall morbidity of 20.8% (3077/14,781), consistent with the result of 3.1–37.0% from other studies [15–20, 45, 58–76, 95]. …”

Comparison of Pyloric Intervention Strategies at the Time of Esophagectomy: Is More Better?

“…In 2013, another meta-analysis aimed to readdress the issues, evaluating outcomes from studies performed within the last decade. 11,22,29,30 Each of the studies considered in this publication suggested that pyloric drainage was unnecessary and could be omitted. Reasons for the shift in paradigm may be related to an evolution over time with regard to the type of gastric conduit used, as it has been shown that use of whole stomach pull-ups has a greater tendency toward gastric outlet obstruction and delayed gastric emptying.…”

Review of Minimally Invasive Esophagectomy and Current Controversies

“…Seventy-seven percent in the MIE group compared to 93% in the open group were satisfied with the overall result. Overall, functional outcomes were comparable between open and MIE [48]. …”