Comparing Perioperative Mortality and Morbidity of Minimally Invasive Esophagectomy Versus Open Esophagectomy for Esophageal Cancer: A Nationwide Retrospective Analysis.

Abstract

We compared the surgical outcomes of minimally invasive esophagectomy (MIE) and open esophagectomy (OE) for esophageal cancer. MIE has become a widespread procedure. However, the definitive advantages of MIE over OE at a nationwide level have not been established. We analyzed patients who underwent esophagectomy for clinical stage 0 to III esophageal cancer from April 2014 to March 2017 using a Japanese inpatient database. We performed propensity score matching to compare in-hospital mortality and morbidities between MIE and OE, accounting for clustering of patients within hospitals. Among 14,880 patients, propensity matching generated 4572 pairs. MIE was associated with lower incidences of in-hospital mortality (1.2% vs 1.7%, P = 0.048), surgical site infection (1.9% vs 2.6%, P = 0.04), anastomotic leakage (12.8% vs 16.8%, P < 0.001), blood transfusion (21.9% vs 33.8%, P < 0.001), reoperation (8.6% vs 9.9%, P = 0.03), tracheotomy (4.8% vs 6.3%, P = 0.002), and unplanned intubation (6.3% vs 8.4%, P < 0.001); a shorter postoperative length of stay (23 vs 26 days, P < 0.001); higher incidences of vocal cord dysfunction (9.2% vs 7.5%, P < 0.001) and prolonged intubation period after esophagectomy (23.2% vs 19.3%, P < 0.001); and a longer duration of anesthesia (408 vs 363 minutes, P < 0.001). MIE had favorable outcomes in terms of in-hospital mortality, morbidities, and the postoperative hospital stay.