Propensity‐Matched Analysis Comparing Survival After Hybrid Thoracoscopic–Laparotomy Esophagectomy and Complete Thoracoscopic–Laparoscopic Esophagectomy

Abstract

Background Hybrid thoracoscopic–laparotomy esophagectomy (hTE) and complete thoracoscopic–laparoscopic esophagectomy (cTLE) are the two most frequently used minimally invasive esophagectomy (MIE) procedures and are broadly utilized for esophageal cancer. We evaluated differences in short‐ and long‐term outcomes between hTE and cTLE in patients with esophageal squamous cell carcinoma (ESCC). Methods Patients who underwent MIE for ESCC between September 2009 and February 2016 were included in this retrospective study. Propensity score matching (PSM) was utilized to contrast the postoperative results of hTE and cTLE according to the obtained and analyzed pertinent patient features and postoperative variables. Univariate and multivariate Cox proportional hazard regression analysis was used on possible predictors of survival. Results Eighty‐six well‐balanced pairs of patients were available for outcome comparison after PSM. Compared to Group 1 (hTE), the patients in Group 2 (cTLE) had significantly shorter operative times and less intraoperative blood loss, but a higher number of retrieved nodes (p = 0.000, p = 0.003, and p = 0.000, respectively). The incidence of postoperative complications was 40.7% (70/172) and did not significantly differ between the two groups. The patients in Group 2 exhibited higher disease‐free survival and disease‐specific survival (DSS) than those in Group 1 (p = 0.048 and p = 0.041, respectively). Univariate and multivariate Cox proportional hazard regression analyses showed that pT stage, pN stage, differentiation grade, and the surgical procedure had significant HRs, which suggested that cTLE is associated with better DSS. Conclusions cTLE possibly shows better postoperative and oncologic outcomes than hTE.

Minimally invasive techniques for transthoracic oesophagectomy for oesophageal cancer: systematic review and network meta-analysis

“…The review identified 98 studies 6,7,34–129 comparing surgical approaches for oesophagectomy, involving 32 315 patients ( Fig . 1 ).…”

The Impact of Hybrid Minimally Invasive Esophagectomy with Neck‐Abdominal First Approach on the Short‐ and Long‐Term Outcomes for Esophageal Squamous Cell Carcinoma

“…The effect of cMIE on respiratory complications has been reported in the last 2–3 years. Kun–Kun et al indicated the frequency of postoperative respiratory complications being similar in hMIE and cMIE (thoracoscopic‐laparotomy esophagectomy and thoracoscopic‐laparoscopy esophagectomy, respectively) [27]; this is potentially due to the thoracoscopic operative time being the same in both groups. Conversely, another study reported that cMIE reduced postoperative pneumonia compared with hMIE (thoracotomy‐laparoscopy esophagectomy) because postoperative pain was reduced by laparoscopic surgery [28]; however, severe postoperative complications of CDgrade III or higher could not be reduced.…”

Right gastroepiploic artery length determined anastomotic leakage after minimally invasive esophagectomy for esophageal cancer: a prospective cohort study

“…The primary surgical technique for esophageal procedures is Thoracoscopic McKeown esophagectomy 14 , 15 . In this procedure, the thoracic esophagus is mobilized from the hilum and pericardium to the cervicothoracic area, with mediastinal lymphadenectomy extending to stations No.…”