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Hybrid minimally invasive esophagectomy vs. open esophagectomy: a matched case analysis in 120 patients

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In esophageal surgery, total minimally invasive techniques compete with hybrid and robot-assisted procedures. The benefit of the individual techniques for the patient remains vague. At our institution, the hybrid minimally invasive laparoscopic-thoracotomic esophagectomy (HMIE) has been routinely applied since 2013. We conducted this retrospective study to analyze the perioperative outcome.


Since 2013, 60 patients were operated in HMIE technique for esophageal cancer. Each of these patients was paired according to the criteria of gender, BMI, age, tumor histology, pulmonary preexisting conditions, and a history of smoking with a patient treated by open esophagectomy (OE). Perioperative parameters were extracted from our prospectively maintained database and compared among the groups.


The HMIE and OE groups were homogeneous in terms of patient- and tumor-related data. There was no difference in lymph nodes harvested (22 vs. 20, p = 0.459) and R0-resection rate (95 vs. 93%, p = 0.500). The operation time for the HMIE was significantly shorter (329 vs. 407 min, p < 0.001). There was no difference between the groups with respect to surgical complications (37 vs. 37%, p = 0.575), but the patients undergoing hybrid technique showed more delayed gastric emptying (23 vs. 10%, p = 0.042). Pulmonary morbidity was significantly reduced after HMIE (20 vs. 42%, p = 0.009). This affected both the occurrence of pneumonia and pleural effusions. The difference in the overall complication rate was not significant (50 vs. 60%, p = 0.179), but life-threatening complications (Clavien/Dindo 4/5) were less frequent (2 vs. 12%, p = 0.031). Overall, there was significantly less need for transfusion after HMIE (18 vs. 50%, p < 0.001), and hospital (and IMC) stay was significantly shorter (14 (6) vs. 18 (7) days, p = 0.002 (0.003)). The multivariate analysis confirms the surgical procedure as an independent risk factor for the development of pulmonary complications (OR 3.2, p = 0.011). Furthermore, preexisting pulmonary conditions were identified as a risk factor (OR 3.6, p = 0.006).


Our retrospective analysis shows that reduction of postoperative pulmonary morbidity, perioperative blood loss, and shortening of hospital stay can be achieved by HMIE. The procedure is safe, and the rate of surgical complications and oncological radicality is comparable to the conventional procedure.

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  1. Biere SSAY, van Berge Henegouwen MI, Maas KW et al (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 379(9829):1887–1892. doi:10.1016/S0140-6736(12)60516-9

    Article  PubMed  Google Scholar 

  2. Briez N, Piessen G, Bonnetain F et al (2011) Open versus laparoscopically-assisted oesophagectomy for cancer: a multicentre randomised controlled phase III trial—the MIRO trial. BMC Cancer 11:310. doi:10.1186/1471-2407-11-310

    Article  PubMed  PubMed Central  Google Scholar 

  3. Briez N, Piessen G, Torres F, Lebuffe G, Triboulet J-P, Mariette C (2012) Effects of hybrid minimally invasive oesophagectomy on major postoperative pulmonary complications. Br J Surg 99(11):1547–1553. doi:10.1002/bjs.8931

    Article  CAS  PubMed  Google Scholar 

  4. Messager M, Pasquer A, Duhamel A, Caranhac G, Piessen G, Mariette C (2015) Laparoscopic gastric mobilization reduces postoperative mortality after esophageal cancer surgery: a French Nationwide Study. Ann Surg 262(5):817–822 . doi:10.1097/SLA.0000000000001470discussion 822-3

    Article  PubMed  Google Scholar 

  5. Naunheim KS, Petruska P, Roy TS, Andrus CH, Johnson FE, Schlueter JM, Baue AE (1992) Preoperative chemotherapy and radiotherapy for esophageal carcinoma. J Thorac Cardiovasc Surg 103(5):887

    CAS  PubMed  Google Scholar 

  6. van Hagen P, Hulshof MCCM, van Lanschot JJB et al (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366(22):2074–2084. doi:10.1056/NEJMoa1112088

    Article  PubMed  Google Scholar 

  7. Cunningham D, Allum WH, Stenning SP et al (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355(1):11–20. doi:10.1056/NEJMoa055531

    Article  CAS  PubMed  Google Scholar 

  8. Lorenzen S, Hentrich M, Haberl C, Heinemann V, Schuster T, Seroneit T, Roethling N, Peschel C, Lordick F (2007) Split-dose docetaxel, cisplatin and leucovorin/fluorouracil as first-line therapy in advanced gastric cancer and adenocarcinoma of the gastroesophageal junction: results of a phase II trial. Ann Oncol 18(10):1673–1679. doi:10.1093/annonc/mdm269

    Article  CAS  PubMed  Google Scholar 

  9. Allen MS (1992) Ivor Lewis esophagectomy. Semin Thorac Cardiovasc Surg 4(4):320–323

    CAS  PubMed  Google Scholar 

  10. Hoeppner J, Marjanovic G, Glatz T, Kulemann B, Hopt UT (2014) Laparoskopisch-thorakotomische Ösophagusresektion mit intrathorakaler Ösophagogastrostomie als Hybridverfahren (hybrid laparoscopic thoracotomic esophagectomy with intrathoracic esophagogastric anastomosis). Chirurg 85(7):628–635. doi:10.1007/s00104-014-2783-1

    Article  CAS  PubMed  Google Scholar 

  11. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  12. Low DE, Alderson D, Cecconello I et al (2015) International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg 262(2):286–294. doi:10.1097/SLA.0000000000001098

    Article  PubMed  Google Scholar 

  13. Haverkamp L, Seesing MFJ, Ruurda JP, Boone J, Rv H (2016) Worldwide trends in surgical techniques in the treatment of esophageal and gastroesophageal junction cancer. Diseases of the Esophagus: n/a-n/a. doi:10.1111/dote.12480

    Google Scholar 

  14. Hölscher AH, Schneider PM, Gutschow C, Schröder W (2007) Laparoscopic ischemic conditioning of the stomach for esophageal replacement. Ann Surg 245(2):241–246. doi:10.1097/01.sla.0000245847.40779.10

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mariette C, Meunier B, Pezet D et al. (2015) Hybrid minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicenter, open-label, randomized phase III controlled trial, the MIRO trial. ASCO Meeting Abstracts 33(3_suppl): 5

  16. Makowiec F, Baier P, Kulemann B, Marjanovic G, Bronsert P, Zirlik K, Henke M, Hopt UT, Hoeppner J (2013) Improved long-term survival after esophagectomy for esophageal cancer: influence of epidemiologic shift and neoadjuvant therapy. J Gastrointest Surg 17(7):1193–1201. doi:10.1007/s11605-013-2212-7

    Article  PubMed  Google Scholar 

  17. Glatz T, Marjanovic G, Zirlik K, Brunner T, Hopt UT, Makowiec F, Hoeppner J (2015) Chirurgische Therapie des Ösophaguskarzinoms: Entwicklung Von Management und Prognose über die letzten drei Jahrzehnte (surgical treatment of esophageal cancer : evolution of management and prognosis over the last 3 decades). Chirurg 86(7):662–669. doi:10.1007/s00104-014-2877-9

    Article  CAS  PubMed  Google Scholar 

  18. Porteous GH, Neal JM, Slee A, Schmidt H, Low DE (2015) A standardized anesthetic and surgical clinical pathway for esophageal resection: impact on length of stay and major outcomes. Reg Anesth Pain Med 40(2):139–149. doi:10.1097/AAP.0000000000000197

    Article  CAS  PubMed  Google Scholar 

  19. Jafari MD, Halabi WJ, Smith BR, Nguyen VQ, Phelan MJ, Stamos MJ, Nguyen NT (2013) A decade analysis of trends and outcomes of partial versus total esophagectomy in the United States. Ann Surg 258(3):450–458. doi:10.1097/SLA.0b013e3182a1b11d

    Article  PubMed  Google Scholar 

  20. Hoeppner J, Zirlik K, Brunner T, Bronsert P, Kulemann B, Sick O, Marjanovic G, Hopt UT, Makowiec F (2014) Multimodal treatment of locally advanced esophageal adenocarcinoma: which regimen should we choose? Outcome analysis of perioperative chemotherapy versus neoadjuvant chemoradiation in 105 patients. J Surg Oncol 109(3):287–293. doi:10.1002/jso.23498

    Article  PubMed  Google Scholar 

  21. Luketich JD, Pennathur A, Awais O et al (2012) Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg 256(1):95–103. doi:10.1097/SLA.0b013e3182590603

    Article  PubMed  PubMed Central  Google Scholar 

  22. Maas KW, Cuesta MA, van Berge Henegouwen MI et al (2015) Quality of life and late complications after minimally invasive compared to open esophagectomy: results of a randomized trial. World J Surg 39(8):1986–1993. doi:10.1007/s00268-015-3100-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Sihag S, Kosinski AS, Gaissert HA, Wright CD, Schipper PH (2015) Minimally invasive versus open esophagectomy for esophageal cancer: a comparison of early surgical outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg. doi:10.1016/j.athoracsur.2015.09.095

    PubMed  Google Scholar 

  24. Xiong W-L, Li R, Lei H-K, Jiang Z-Y (2015) Comparison of outcomes between minimally invasive oesophagectomy and open oesophagectomy for oesophageal cancer. ANZ J Surg. doi:10.1111/ans.13334

    PubMed  Google Scholar 

  25. Lee J-M, Cheng J-W, Lin M-T, Huang P-M, Chen J-S, Lee Y-C (2011) Is there any benefit to incorporating a laparoscopic procedure into minimally invasive esophagectomy? The impact on perioperative results in patients with esophageal cancer. World J Surg 35(4):790–797. doi:10.1007/s00268-011-0955-4

    Article  PubMed  Google Scholar 

  26. Bonavina L, Scolari F, Aiolfi A, Bonitta G, Sironi A, Saino G, Asti E (2015) Early outcome of thoracoscopic and hybrid esophagectomy: propensity-matched comparative analysis. Surgery. doi:10.1016/j.surg.2015.08.019

    PubMed  Google Scholar 

  27. Avery KNL, Metcalfe C, Berrisford R et al (2014) The feasibility of a randomized controlled trial of esophagectomy for esophageal cancer—the ROMIO (Randomized Oesophagectomy: Minimally Invasive or Open) study: protocol for a randomized controlled trial. Trials 15:200. doi:10.1186/1745-6215-15-200

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Torben Glatz.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Glatz, T., Marjanovic, G., Kulemann, B. et al. Hybrid minimally invasive esophagectomy vs. open esophagectomy: a matched case analysis in 120 patients. Langenbecks Arch Surg 402, 323–331 (2017).

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