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Propensity score–matched comparison between open and minimal invasive hybrid esophagectomy for esophageal adenocarcinoma

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Abstract

Background

This study compared the outcome between patients who had an open and those who had a hybrid esophagectomy for T1 or T3 esophageal adenocarcinoma (eAC). No clear data are available concerning this question based on T-category.

Methods

Two groups of patients with esophagectomy and high intrathoracic esophagogastrostomy for eAC were analyzed: hybrid (laparoscopy + right thoracotomy) (n = 835) and open (laparotomy + right thoracotomy) (n = 188). Outcome criteria were 30- and 90-day mortality, R0-resection rate (R0), number of resected lymph nodes (rLNs), and 5-year survival rate (5y-SR). For each type of surgery, three patient groups were analyzed: pT1-carcinoma (group-1), cT3Nx and neoadjuvant chemoradiation (group-2), and pT3N0-3 without neoadjuvant therapy (group-3). The comparison was based on a propensity score matching in relation of 1:2 for open versus hybrid.

Results

In group-1 (38 open vs 76 hybrid) R0-resection (100%), 30-day mortality (0%), 90-day mortality (2.6% vs 0%), and rLNs (median 29.5 vs 28.5) were not significantly different. The pN0-rate was 76% in the open and 92% in the hybrid group (p = 0.036). Accordingly, the 5y-SR was 69% and 87% (p = 0.016), but the prognosis of the subgroups pT1pN0 or pT1pN+ was not significantly different between open or hybrid. In group-2 (68 open vs 135 hybrid) R0-resection (97%), 30-day (0% vs 0.7%) and 90-day (4%) mortality, rLNs (28.5 vs 26), and 5y-SR (36% vs 41%) were not significantly different. In group-3 (37 open vs 75 hybrid) R0, postoperative mortality, rLNs, and 5y-SR were not significantly different.

Conclusion

In a propensity score–matched comparison of patients with an open or hybrid esophagectomy for esophageal adenocarcinoma the quality of oncologic resection, postoperative mortality and prognosis are not different.

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Author information

Authors and Affiliations

  1. Medical Faculty, University of Cologne, Köln, Germany

    Arnulf H. Hölscher & Elfriede Bollschweiler

  2. Center for Esophageal Diseases, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany

    Arnulf H. Hölscher

  3. University of Southern California, Los Angeles, CA, USA

    Tom R. DeMeester

  4. Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Konstanz, Constance, Germany

    Henner Schmidt

  5. Department of General, Visceral and Transplant Surgery, University of Mainz, Mainz, Germany

    Felix Berlth

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  1. Arnulf H. Hölscher
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Correspondence to Arnulf H. Hölscher.

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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.

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

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Mini abstract

This propensity score–matched study compared the completeness of tumor and lymph node resection, mortality and prognosis between patients with a standard open esophagectomy and those with a minimal invasive hybrid procedure (laparoscopy + thoracotomy) with high intrathoracic esophagogastrostomy. Mortality and survival are similar after hybrid or open esophagectomy for cancer.

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Hölscher, A.H., DeMeester, T.R., Schmidt, H. et al. Propensity score–matched comparison between open and minimal invasive hybrid esophagectomy for esophageal adenocarcinoma. Langenbecks Arch Surg 405, 521–532 (2020). https://doi.org/10.1007/s00423-020-01882-3

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  • DOI: https://doi.org/10.1007/s00423-020-01882-3

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