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Completely minimally invasive versus hybrid Ivor-Lewis oesophagectomy for oesophageal and gastro-oesophageal junctional cancer: a UK multi-centre comparative study

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Abstract

Background

Limited robust evidence exists comparing outcomes following completely minimally invasive oesophagectomy (CMIO) to hybrid oesophagectomy (HO) in the treatment of resectable oesophageal and gastro-oesophageal junctional (GOJ) cancer. This multi-centre study aims to assess postoperative morbidity between HO and CMIO according to the full Esophagectomy Complications Consensus Group (ECCG) complication platform.

Methods

All consecutive patients undergoing an Ivor-Lewis HO or Ivor-Lewis CMIO for cancer between 2016 and 2018 in three UK tertiary centres were included. The primary study outcome was 30-day overall complications, evaluated by the ECCG complication subgroups. Secondary outcomes included survival outcomes and perioperative parameters between the two approaches.

Results

Of the 382 patients included, 228 (59.7%) patients had HOs and 154 (40.3%) patients had CMIOs with no inter-group baseline differences. Patients undergoing CMIO experienced less 30-day postoperative complications compared to those under undergoing HO (43.5% vs 57.0%, p = 0.010). ECCG defined pulmonary and infective complications were less frequent in the CMIO group. Anastomotic leak rates and oncological outcomes were similar between the two groups. Independent predictors of 30-day postoperative complications include surgical approach with HO and high ASA grade on multivariable analysis.

Conclusions

Ivor-Lewis CMIO demonstrates superior short-term surgical outcomes when compared to Ivor-Lewis HO with no compromise in oncological feasibility. Anastomotic leak rates were equivalent between both groups. A robust randomised controlled trial is required to validate the findings of this study.

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Authors and Affiliations

  1. Essex Upper GI, Regional Centre for Oesophagogastric Surgery, Broomfield Hospital, Court Road, Broomfield, Chelmsford, CM1 7ET, UK

    Krashna Patel, Omar Abbassi & Naga Venkatesh Jayanthi

  2. Upper GI Cancer Centre, Watford General Hospital, Vicarage Road, Watford, UK

    Alan Askari, Joshua Wong, Mohamed Aly & Periyathambi Jambulingam

  3. The Department of Upper Gastrointestinal (UGI) Surgery, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, UK

    Oliver Claydon, James Laycock, Aravindh Ramalingam & Bhaskar Kumar

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  1. Krashna Patel
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Correspondence to Krashna Patel.

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The authors of this study (Krashna Patel, Omar Abbassi, Venkatesh Naga Jayanthi, Alan Askari, Mohamed Aly, Joshua Wong, Periyathambi Jambulingam, Oliver Claydon, James Laycock, Aravindh Ramalingam and Bhaskar Kumar) have no conflicts of interest or financial ties to disclose.

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Patel, K., Askari, A., Abbassi, O. et al. Completely minimally invasive versus hybrid Ivor-Lewis oesophagectomy for oesophageal and gastro-oesophageal junctional cancer: a UK multi-centre comparative study. Surg Endosc 36, 5822–5832 (2022). https://doi.org/10.1007/s00464-022-09043-x

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