Skip to main content
SpringerLink
Log in

Retrospective Study Using the Propensity Score to Clarify the Oncologic Feasibility of Thoracoscopic Esophagectomy in Patients with Esophageal Cancer

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The present study aimed to clarify the long-term prognostic impact and oncologic feasibility of thoracoscopic esophagectomy (TSE) in patients with esophageal cancer in comparison with open thoracic esophagectomy (OTE).

Methods

Patients with esophageal cancer underwent surgically curative esophagectomy without neoadjuvant therapy from January 1991 to December 2008 and were analyzed retrospectively. Of 257 patients, 91 underwent TSE and 166 had OTE. Relations between the long-term prognosis after surgery, the surgical procedure, and clinicopathologic parameters were analyzed statistically. The propensity scores were calculated for all patients through a multiple logistic regression model that was optimized with Akaike’s Information Criterion. Using Cox’s proportional hazard model with prognostic variables and the propensity scores, we implemented a multivariate analysis for comparing the performance of two surgical methods.

Results

Patient characteristics and the incidence of perioperative morbidity or hospital death were similar for the TSE and OTE groups. Significantly more lymph nodes were dissected in the TSE group than in the OTE group (total p = 0.013; thoracic p = 0.0094; recurrent laryngeal p < 0.0001). The TSE group exhibited a more favorable prognosis after surgery than the OTE group in terms of overall survival (p = 0.011) and disease-specific survival (DSS) (p = 0.0040). Particularly in subgroup analysis of DSS, the TSE group had a favorable prognosis in upper thoracic esophageal cancer (p = 0.0053), invasive cancer (p = 0.046), node-positive cancer (p = 0.020), progressive cancer (p = 0.0052), cancer with lymphatic vessel invasion (p = 0.0019), and cancer without blood vessel invasion (p = 0.0081). In terms of DSS, the TSE group exhibited a more favorable prognosis than the OTE group regardless of the presence or absence of metastasis to lymph nodes around the thoracic (p < 0.0001) or recurrent laryngeal (p < 0.0001) nerves. TSE (p = 0.0430), lymph node metastasis (p = 0.0382), lymphatic invasion (p = 0.0418), and p stage (p = 0.0047) were independent prognostic parameters in the Cox’s proportional hazard model with the propensity scores.

Conclusions

TSE can contribute to prolonged survival after surgery in patients with esophageal cancer by enabling precise thoracic lymph node dissection based on a magnified surgical field. TSE might have maximum oncologic benefit and minimum invasiveness for patients with esophageal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jamieson GG, Mathew G, Ludemann R et al (2004) Postoperative mortality following esophagectomy and problems in reporting its rate. Br J Surg 91:943–947

    Article  PubMed  CAS  Google Scholar 

  2. Cuschieri A, Shimi S, Banting S (1992) Endoscopic esophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 37:7–11

    PubMed  CAS  Google Scholar 

  3. Akaishi T, Kaneda I, Higuchi N et al (1996) Thoracoscopic en bloc total esophagectomy with radical mediastinal lymphadenectomy. J Thorac Cardiovasc Surg 112:1533–1540 discussion 1540–1541

    Article  PubMed  CAS  Google Scholar 

  4. Kawahara K, Maekawa T, Okabayashi K et al (1999) Video-assisted thoracoscopic esophagectomy for esophageal cancer. Surg Endosc 13:218–223

    Article  PubMed  CAS  Google Scholar 

  5. Osugi H, Takemura M, Higashino M et al (2002) Video-assisted thoracoscopic esophagectomy and radical lymph node dissection for esophageal cancer: a series of 75 cases. Surg Endosc 16:1588–1593

    Article  PubMed  CAS  Google Scholar 

  6. Braghetto I, Csendes A, Cardemil G et al (2006) Open transthoracic or transhiatal esophagectomy versus minimally invasive esophagectomy in terms of morbidity, mortality and survival. Surg Endosc 20:1681–1686

    Article  PubMed  CAS  Google Scholar 

  7. Smithers BM, Gotley DC, Martin I et al (2007) Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg 245:232–240

    Article  PubMed  Google Scholar 

  8. Nguyen NT, Hinojosa MW, Smith BR et al (2008) Minimally invasive esophagectomy: lessons learned from 104 operations. Ann Surg 248:1081–1091

    Article  PubMed  Google Scholar 

  9. Berrisford RG, Wajed SA, Sanders D et al (2008) Short-term outcomes following total minimally invasive esophagectomy. Br J Surg 95:602–610

    Article  PubMed  CAS  Google Scholar 

  10. Schoppmann SF, Prager G, Langer FB et al (2010) Open versus minimally invasive esophagectomy: a single-center case controlled study. Surg Endosc 24:3044–3053

    Article  PubMed  Google Scholar 

  11. Nagpal K, Ahmed K, Vats A et al (2010) Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc 24:1621–1629

    Article  PubMed  Google Scholar 

  12. Sgourakis G, Gockel I, Radtke A et al (2010) Minimally invasive versus open esophagectomy: meta-analysis of outcomes. Dig Dis Sci 55:3031–3040

    Article  PubMed  Google Scholar 

  13. Osugi H, Takemura M, Higashino M et al (2003) A comparison of video-assisted thoracoscopic esophagectomy and radical lymph node dissection for squamous cell cancer of the oesophagus with open operation. Br J Surg 90:108–113

    Article  PubMed  CAS  Google Scholar 

  14. Taguchi S, Osugi H, Higashino M et al (2003) Comparison of three-field esophagectomy for esophageal cancer incorporating open or thoracoscopic thoracotomy. Surg Endosc 17:1445–1450

    Article  PubMed  CAS  Google Scholar 

  15. Parkin DM, Pisani P, Ferlay J (1999) Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 80:827–841

    Article  PubMed  CAS  Google Scholar 

  16. Pisani P, Parkin DM, Bray F et al (1999) Estimates of the worldwide mortality from 25 cancers in 1990. Int J Cancer 83:18–29

    Article  PubMed  CAS  Google Scholar 

  17. Akiyama H, Tsurumaru M, Udagawa H et al (1994) Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg 220:364–372 discussion 372–373

    Article  PubMed  CAS  Google Scholar 

  18. Fujita H, Kakegawa T, Yamana H et al (1995) Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer: comparison of three-field lymphadenectomy with two-field lymphadenectomy. Ann Surg 222:654–662

    Article  PubMed  CAS  Google Scholar 

  19. Peyre CG, Hagen JA, DeMeester SR et al (2008) The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg 248:549–556

    Article  PubMed  Google Scholar 

  20. Mayer RJ (1993) Overview: the changing nature of esophageal cancer. Chest 103(Suppl):404S–405S

    Article  PubMed  CAS  Google Scholar 

  21. Stiles BM, Mirza F, Port JL et al (2010) Predictors of cervical and recurrent laryngeal lymph node metastases from esophageal cancer. Ann Thorac Surg 90:1805–1811

    Article  PubMed  Google Scholar 

  22. Shimada H, Okazumi S, Shiratori T et al (2009) Mode of lymphadenectomy and surgical outcome of upper thoracic esophageal squamous cell carcinoma. J Gastrointest Surg 13:619–625

    Article  PubMed  Google Scholar 

  23. Li H, Yang S, Zhang Y et al (2012) Thoracic recurrent laryngeal lymph node metastases predict cervical node metastases and benefit from three-field dissection in selected patients with thoracic esophageal squamous cell carcinoma. J Surg Oncol 105:548–552

    Article  PubMed  Google Scholar 

  24. Jang HJ, Lee HS, Kim MS et al (2011) Patterns of lymph node metastasis and survival for upper esophageal squamous cell carcinoma. Ann Thorac Surg 92:1091–1097

    Article  PubMed  Google Scholar 

  25. Sobin LH, Gospodarowicz MK, Wittekind C, (eds) (2009) UICC TNM Classification of Malignant Tumours, 7th edn. Oxford, Wiley-Blackwell, pp 63–72

  26. Akaike H (1973) Information theory and an extension of the maximum likelihood principle. In: Petrov BN, Csaki F, (eds). 2nd International symposium on information theory. Budapest, Akadimiai Kiado, pp 267–281

  27. Osugi H, Takemura M, Higashino M et al (2003) Learning curve of video-assisted thoracoscopic esophagectomy and extensive lymphadenectomy for squamous cell cancer of the thoracic esophagus and results. Surg Endosc 17:515–519

    Article  PubMed  CAS  Google Scholar 

  28. Ando N, Ozawa S, Kitagawa Y et al (2000) Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg 232:225–232

    Article  PubMed  CAS  Google Scholar 

  29. Law S, Kwong DL, Kwok KF et al (2003) Improvement in treatment results and long-term survival of patients with esophageal cancer: impact of chemoradiation and change in treatment strategy. Ann Surg 238:339–347 discussion 347–348

    PubMed  Google Scholar 

  30. Cen P, Banki F, Cheng L et al (2012) Changes in age, stage distribution, and survival of patients with esophageal adenocarcinoma over three decades in the United States. Ann Surg Oncol 19:1685–1691

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Drs. Shinsuke Takeno, Yoshiaki Takahashi, Toshihiko Moroga, Katsunobu Kawahara, Yuichi Yamashita, and Megu Ohtaki have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Johnan-ku, Fukuoka, 814-0180, Japan

    Shinsuke Takeno, Yoshiaki Takahashi & Yuichi Yamashita

  2. Department of Surgery II, Faculty of Medicine, Oita University, Idaigaoka 1-1, Hasama-machi, Yufu, Oita, 879-5593, Japan

    Shinsuke Takeno, Toshihiko Moroga & Katsunobu Kawahara

  3. Department of Environmetrics and Biometrics, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Megu Ohtaki

Authors
  1. Shinsuke Takeno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshiaki Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toshihiko Moroga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katsunobu Kawahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuichi Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Megu Ohtaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shinsuke Takeno.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Takeno, S., Takahashi, Y., Moroga, T. et al. Retrospective Study Using the Propensity Score to Clarify the Oncologic Feasibility of Thoracoscopic Esophagectomy in Patients with Esophageal Cancer. World J Surg 37, 1673–1680 (2013). https://doi.org/10.1007/s00268-013-2008-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-013-2008-7

Keywords

Search

Navigation