Outcomes of Open Versus Minimally Invasive Ivor-Lewis Esophagectomy for Cancer: A Propensity-Score Matched Analysis of NSQIP Database

Robotic esophagectomy: the evolution of open esophagectomy to current techniques and a review of the literature

“…One hundred sixty-one OTTE patients were matched with patients 1:1 who underwent minimally invasive transthoracic esophagectomy. Higher completion rates of abdominal and mediastinal lymph node dissections were appreciated in the OTTE subgroup (26.7% vs. 3.1% and 38.5% vs. 16.1%, respectively; P < 0.001), and the mean operative times were also shorter (329 min vs. 414 min; P < 0.001) [92] . Conversely, higher rates of wound complications were appreciated in the OTTE population (7.5% vs. 1.9%), the median hospitalization was longer (10 days vs. 8 days), more patients required discharge to a facility (18.0% vs. 8.1%), and the need for postoperative blood transfusion trended towards significance (13.0% vs. 6.8%; P = 0.092).…”

“…Conversely, higher rates of wound complications were appreciated in the OTTE population (7.5% vs. 1.9%), the median hospitalization was longer (10 days vs. 8 days), more patients required discharge to a facility (18.0% vs. 8.1%), and the need for postoperative blood transfusion trended towards significance (13.0% vs. 6.8%; P = 0.092). They concluded the OTTE cohort demonstrated higher complication rates (46.0% vs. 33.5%; P = 0.028); however, there was no difference in the rates of negative margins, anastomotic leak, need for reoperation, readmission, or mortality [92] . The results were uniformly comparable when they evaluated laparoscopic vs. robotic approaches, with the exception of higher rates of procured lymph nodes when completed laparoscopically and higher rates of mediastinal lymph node procurement when using the robotic approach [92] .…”

“…They concluded the OTTE cohort demonstrated higher complication rates (46.0% vs. 33.5%; P = 0.028); however, there was no difference in the rates of negative margins, anastomotic leak, need for reoperation, readmission, or mortality [92] . The results were uniformly comparable when they evaluated laparoscopic vs. robotic approaches, with the exception of higher rates of procured lymph nodes when completed laparoscopically and higher rates of mediastinal lymph node procurement when using the robotic approach [92] .…”

“…In looking at open versus minimally invasive procedures, Naffouje et al [92] reported their results following a propensity score-matched analysis using the NSQIP database evaluating participants who underwent OE or MIE. One hundred sixty-one OTTE patients were matched with patients 1:1 who underwent minimally invasive transthoracic esophagectomy.…”

The Best Approach to Esophagectomy: Do We Know Yet?

“…In the current study, Naffouje et al compared purely open transthoracic esophagectomy (OTTE, Ivor-Lewis esophagectomy) versus purely minimally invasive transthoracic esophagectomy (MITTE) using the National Surgical Quality Improvement Project (NSQIP) esophagectomy-targeted database. 3 Only patients who underwent esophagectomy for cancer were included, and a propensity score design was used. 7 One major strength of the study is that only patients undergoing two-field operations were included in the pure open versus minimally invasive groups.…”