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No difference in the incidence of postoperative pulmonary complications between abdominal laparoscopy and laparotomy for minimally invasive thoracoscopic esophagectomy: a retrospective cohort study using a nationwide Japanese database

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Abstract

Introduction

There remains a lack of evidence regarding the optimal abdominal approach, including laparoscopy, hand-assisted, and open laparotomy for minimally invasive thoracoscopic esophagectomy. We aimed to compare the incidence of postoperative complications, particularly pulmonary complications, between laparoscopy and open laparotomy for minimally invasive thoracoscopic esophagectomy using nationwide Japanese databases.

Methods

Data from patients in the National Clinical Database (NCD) who underwent thoracoscopic esophagectomy for esophageal cancer were analyzed. The incidence of pulmonary complications was compared between abdominal laparoscopy and laparotomy after matching the propensity scores (PS) from preoperative factors to account for confounding bias. Laparoscopic-assisted surgery (LAS) was also compared to hand-assisted laparoscopic surgery (HALS).

Results

Of the 24,790 patients who underwent esophagectomy between 2018 and 2021, data from 12,633 underwent thoracoscopic procedure. The proportion of patients who experienced pulmonary complications did not significantly differ between the laparoscopy group and the laparotomy group after matching (664/3195 patients, 20.8% versus 702/3195 patients, 22.0%; P = 0.25). No difference in the incidence of pulmonary complications was observed among patients treated using the laparoscopic approach (508/2439 patients, 20.8% in the LAS group versus 498/2439 patients, 20.4% in the HALS group; P = 0.72).

Conclusions

We observed no significant difference in the incidence of postoperative pulmonary complications between laparoscopy and laparotomy for thoracoscopic esophagectomy. Short-term outcomes were similar between the laparoscopic-assisted approach and the hand-assisted approach. This study provides valuable insights into the optimal abdominal approach for thoracoscopic esophagectomy using data from a nationwide database that reflect real-world clinical practice.

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Acknowledgements

We thank all data managers and hospital staff who participated in this National Clinical Database project for their efforts in data entry.

Funding

Dr. Kitagawa reports grants and personal fees from Asahi Kasei Pharma Corporation, grants, personal fees, and others from Ono Pharmaceutical Co., Ltd., grants and personal fees from Otsuka Pharmaceutical Factory, Inc., grants and personal fees from Nippon Covidien Inc., grants, personal fees, and others from Taiho Pharmaceutical Co., Ltd, grants, personal fees, and others from Chugai Pharmaceutical Co., Ltd., grants and personal fees from Kaken Pharmaceutical Co., Ltd., personal fees from AstraZeneca K.K., personal fees from Ethicon Inc., personal fees from Olympus Corporation, personal fees from Shionogi & Co., Ltd., personal fees and others from Bristol-Myers Squibb K.K., personal fees from Msd K.K., personal fees from Smith & Nephew KK, personal fees from Aska Pharmaceutical Co., Ltd., personal fees from Miyarisan Pharmaceutical Co. Ltd., personal fees from Toray Industries, Inc., personal fees from Daiichi Sankyo Company, Limited, personal fees from Chugai Foundation for Innovative Drug Discovery Science, personal fees from Nippon Kayaku Co., Ltd., grants from Yakult Honsha Co. Ltd., grants from Otsuka Pharmaceutical Co., Ltd., grants from Tsumura & CO., grants from Sumitomo Pharma Co., Ltd., grants and personal fees from EA Pharma Co., Ltd., grants from Eisai Co., Ltd., grants from Kyowa Kirin Co.,Ltd., grants from Medicon Inc., grants from Takeda Pharmaceutical Co., Ltd., grants from Teijin Pharma Limited, and personal fees from Intuitive Surgical G.K., outside the submitted work. Hideki Endo, Hiraku Kumamaru and Hiroaki Miyata are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo. The department is a social collaboration department supported by the National Clinical Database, Johnson & Johnson K.K., Nipro Corporation, and Intuitive Surgical Sàrl. Hiraku Kumamaru reports receiving consultation fee from EPS Corporation, and speaker fee from Chugai Pharmaceutical Co., Ltd.

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Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan

    Masashi Takeuchi, Hirofumi Kawakubo, Satoru Matsuda & Yuko Kitagawa

  2. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Hideki Endo, Hiraku Kumamaru & Hiroaki Miyata

  3. Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Hirotoshi Kikuchi & Shingo Kanaji

  4. Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Hideki Ueno

  5. Department of Surgery, National Defense Medical College, Saitama, Japan

    Hideki Ueno

  6. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Yasuyuki Seto

  7. The Japan Esophageal Society, Tokyo, Japan

    Masayuki Watanabe & Yuichiro Doki

  8. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Yuko Kitagawa

Authors
  1. Masashi Takeuchi
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  2. Hideki Endo
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  3. Hirofumi Kawakubo
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  13. Yuko Kitagawa
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Corresponding author

Correspondence to Masashi Takeuchi.

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Conflicts of interest

Dr. Kitagawa reports grants and personal fees from Asahi Kasei Pharma Corporation, grants, personal fees, and others from Ono Pharmaceutical Co., Ltd., grants and personal fees from Otsuka Pharmaceutical Factory, Inc., grants and personal fees from Nippon Covidien Inc., grants, personal fees, and others from Taiho Pharmaceutical Co., Ltd, grants, personal fees, and others from CHUGAI Pharmaceutical Co., Ltd., grants and personal fees from Kaken Pharmaceutical CO., Ltd., personal fees from AstraZeneca K.K., personal fees from Ethicon Inc., personal fees from Olympus Corporation, personal fees from Shionogi & Co., Ltd., personal fees and others from Bristol-Myers Squibb K.K., personal fees from Msd K.K., personal fees from Smith & Nephew KK, personal fees from Aska Pharmaceutical Co., Ltd., personal fees from Miyarisan Pharmaceutical CO. LTD., personal fees from Toray Industries, Inc., personal fees from Daiichi Sankyo Company, Limited, personal fees from Chugai Foundation for Innovative Drug Discovery Science, personal fees from Nippon Kayaku Co., Ltd., grants from Yakult Honsha Co. Ltd., grants from Otsuka Pharmaceutical Co., Ltd., grants from Tsumura & CO., grants from Sumitomo Pharma Co., Ltd., grants and personal fees from EA Pharma Co., Ltd., grants from Eisai Co., Ltd., grants from Kyowa Kirin Co., Ltd., grants from Medicon Inc., grants from Takeda Pharmaceutical Co., Ltd., grants from Teijin Pharma Limited, and personal fees from Intuitive Surgical G.K., outside the submitted work. Hideki Endo, Hiraku Kumamaru and Hiroaki Miyata are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo. The department is a social collaboration department supported by the National Clinical Database, Johnson & Johnson K.K., Nipro Corporation, and Intuitive Surgical Sàrl. Hiraku Kumamaru reports receiving consultation fee from EPS Corporation, and speaker fee from Chugai Pharmaceutical Co., Ltd.

Ethical Statement

The study protocol was reviewed and approved by the Institutional Review Board of Keio University School of Medicine, and the requirement for individual written informed consent was waived (ID: 2022–1066).

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Takeuchi, M., Endo, H., Kawakubo, H. et al. No difference in the incidence of postoperative pulmonary complications between abdominal laparoscopy and laparotomy for minimally invasive thoracoscopic esophagectomy: a retrospective cohort study using a nationwide Japanese database. Esophagus 21, 11–21 (2024). https://doi.org/10.1007/s10388-023-01032-w

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