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Short-Term Outcomes Following Minimally Invasive and Open Esophagectomy: A Population-Based Study from Finland and Sweden

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Population-based studies comparing minimally invasive esophagectomy (MIE) and open esophagectomy (OE) relative to 90-day postoperative mortality are needed.

Objective

The aim of this study was to compare short-term outcomes following these two techniques for esophageal cancer.

Methods

Patients undergoing MIE (n = 217) or OE (n = 1397) for esophageal cancer between 2007 and 2014 were identified from nationwide complete registries in Finland and Sweden. The primary outcome was 90-day mortality, and secondary outcomes were 30-day mortality, length of hospital stay, and 30- and 90-day readmission rate. Results were adjusted for age, sex, comorbidity, tumor histology, surgery year, and country.

Results

Ninety-day mortality rates were 4.1% (n = 9 of 217) for MIE and 6.8% (n = 95 of 1397) for OE; 90-day mortality was halved after MIE [adjusted hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.24–0.99]. There was no difference in 30-day mortality (adjusted HR 0.87, 95% CI 0.29–2.66). Median hospital stay was 15 days for MIE and 16 days for OE (adjusted β −0.17, standard error 0.08, p = 0.030). The 30-day readmission rates were 8.9% after MIE and 12.0% after OE (adjusted HR 0.57, 95% CI 0.34–0.94), while the 90-day readmission rates were 28.8% and 33.6%, respectively, without a statistically significant difference (adjusted HR 0.82, 95% CI 0.61–1.10).

Conclusions

This population-based study from Finland and Sweden revealed lower 90-day mortality, shorter hospital stay, and lower 30-day readmission rates after MIE compared with OE for esophageal cancer. These findings support the use of minimally invasive approaches.

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ACKNOWLEDGEMENT

This study was supported by grants from Sigrid Juselius Foundation (JHK), Orion Research Foundation (JHK), Swedish Research Council (JL), and the Swedish Cancer Society (JL).

Disclosure

Joonas H. Kauppila, Olli Helminen, Ville Kytö, Jarmo Gunn, Jesper Lagergren and Eero Sihvo declare no conflicts of interest.

Author information

Author notes

  1. Joonas H. Kauppila and Olli Helminen contributed equally as first authors.

Authors and Affiliations

  1. Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176, Stockholm, Sweden

    Joonas H. Kauppila MD, PhD & Jesper Lagergren MD, PhD

  2. Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland

    Joonas H. Kauppila MD, PhD & Olli Helminen MD, PhD

  3. Department of Surgery, Central Finland Central Hospital, 40620, Jyväskylä, Finland

    Olli Helminen MD, PhD & Eero Sihvo MD, PhD

  4. Heart Center, Turku University Hospital, Turku, Finland

    Ville Kytö MD, PhD & Jarmo Gunn MD, PhD

  5. Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland

    Ville Kytö MD, PhD

  6. Department of Surgery, Faculty of Medicine, University of Turku, Turku, Finland

    Jarmo Gunn MD, PhD

  7. Division of Cancer Studies, King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Jesper Lagergren MD, PhD

Authors
  1. Joonas H. Kauppila MD, PhD
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  2. Olli Helminen MD, PhD
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  3. Ville Kytö MD, PhD
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  4. Jarmo Gunn MD, PhD
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  5. Jesper Lagergren MD, PhD
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  6. Eero Sihvo MD, PhD
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Corresponding author

Correspondence to Eero Sihvo MD, PhD.

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Kauppila, J.H., Helminen, O., Kytö, V. et al. Short-Term Outcomes Following Minimally Invasive and Open Esophagectomy: A Population-Based Study from Finland and Sweden. Ann Surg Oncol 25, 326–332 (2018). https://doi.org/10.1245/s10434-017-6212-9

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  • DOI: https://doi.org/10.1245/s10434-017-6212-9

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