Negar Ahmadi, MD, MSc1, Agnes Crnic, MSc2, Andrew J Seely, MD, PhD3, Sudhir R Sundaresan, MD3, P James Villeneuve, MD, PhD3, Donna E Maziak, MD, MSc3, Farid M Shamji, MD3, Sebastien Gilbert, MD3. 1Department of General Surgery, University of Ottawa, Ottawa, Canada, 2Faculty of Medicine, University of Ottawa, Ottawa, Canada, 3Division of Thoracic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
Introduction: Surgical resection remains a critical component of esophageal cancer treatment with curative-intent. Minimally Invasive Esophagectomy(MIE) has been increasingly performed worldwide. The aim of this study was to compare MIE to open esophagectomy(OE) with respect to perioperative and oncologic outcomes.
Methods and procedures: Retrospective, single-institution review of consecutive MIE and OE patients operated between 2001 and 2015 was conducted. Qualitative variables were analyzed using Fisher’s exact test or the chi-squared method, and quantitative data using appropriate parametric and non-parametric statistical tests. Univariable and multivariable models were created using Cox regression and Kaplan-Meier method was used to compare oncologic outcomes. Propensity score matching(1:1 nearest-neighbor matching) was used to compare oncological outcomes in MIE and OE patients. The covariates included in the propensity algorithm included surgery year, chemoradiation, cancer stage, number of lymph nodes retrieved and postoperative adverse events.
Results: Of 291 esophagectomy patients, 72%(210/291) underwent Ivor-Lewis esophagectomy (OE=47%[137/291]; MIE=25%[73/291]). The MIE and OE groups were comparable with respect to median age at diagnosis(MIE=64yrs [IQR:54-73]; OE=65 yrs[IQR:57-72]; p=0.9), male gender (MIE=86% [63/73]; OE=89% [122/137]; p=0.6), median BMI(MIE=26 kg/m2 [IQR:24-31]; OE=27 kg/m2 [IQR:22-29]; p=0.3), adenocarcinoma histology (MIE=84% [58/69]; OE=89% [116/130]; p=0.3), tumor location in lower esophagus (MIE=92% 67/73]; OE=95% [130/137]; p=0.4) and R0 resection (MIE=82% [60/73]; OE=74% [101/136]; p=0.2). A significantly smaller proportion of OE patients received neoadjuvant chemoradiation (MIE=45%[33/73]; OE=23%[32/137]; p=0.001). MIE was associated with higher median number of resected lymph nodes (MIE=30 [IQR:22-39]; OE=14 [IQR:7-19], p <0.001) and significantly less intraoperative blood loss (MIE=312 mL[100-400]; OE=657 mL [350-700], p<0.001). MIE patients had shorter median length of stay (MIE=10 days[IQR=8-14]; OE=14 days [IQR=11-22] p<0.01). The two groups had similar rates of postoperative adverse events (MIE=74%[54/73]; OE=73%[100/137]; p=0.09), however, the OE group had significantly more adverse events resulting in reoperation or intensive care unit admission (p=0.009). On multivariable analysis, age (HR=1.03[95% CI: 1.002-1.05]), and positive resection margins (HR=2.20 [95% CI: 1.25-3.87]) were associated with decreased odds of survival and number of lymph nodes retrieved (HR=0.98 [95% CI: 0.97-0.99], positive resection margins (HR=1.68 [95% CI: 1.11-2.53]) and pathologic stage (HR=1.51 [95% CI: 1.18-1.93]) were significant predictors of disease-free survival. Analysis of 65 matched pairs showed equivalent median overall survival (p=0.20) and disease-free survival (p=0.30) between the two groups.
Conclusion: MIE was associated with significantly less intraoperative blood loss, improved lymphadenectomy, fewer severe postoperative adverse events and shorter length of stay. The minimally invasive and open approaches were associated with statistically equivalent overall and disease-free survival.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80502
Program Number: S029
Presentation Session: Foregut 1
Presentation Type: Podium
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