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Patterns of Recurrence and Long-Term Survival of Minimally Invasive Esophagectomy Versus Open Esophagectomy for Locally Advanced Esophageal Cancer Treated with Neoadjuvant Chemotherapy: a Propensity Score–Matched Analysis

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Journal of Gastrointestinal Surgery

Abstract

Background

The use of minimally invasive esophagectomy (MIE) as a treatment for patients with esophageal cancer has recently become more common worldwide. However, differences in the pattern of recurrence between MIE and open esophagectomy (OE) using the transthoracic approach have not been fully investigated, particularly in patients treated with neoadjuvant chemotherapy.

Methods

We searched the prospective databases of two institutes for patients with esophageal cancer who underwent neoadjuvant chemotherapy followed by esophagectomy between 2011 and 2018. Propensity score–matched analysis was performed to reduce bias from confounding patient-related variables. Operative outcomes, regionally harvested lymph nodes (LNs), recurrence pattern, and prognosis were investigated in two groups.

Results

We identified 410 patients who underwent OE (n = 263) and MIE (n = 147). After propensity score matching, 131 pairs of patients were selected. There were no significant differences in baseline characteristics after matching. The total number of harvested LNs in both groups was similar (55.1 vs. 58.9, P = 0.132). The incidence of LN recurrence in the MIE group was significantly lower than that in the OE group (27% vs. 15%, P = 0.010). In particular, the incidence of mediastinal LN recurrence in the MIE group was significantly lower than that in the OE group (16% vs. 6%, P = 0.017). There were no significant differences between the two groups in hematogenous (19% vs.12%, P = 0.173), dissemination (5% vs. 4%, P = 0.769), local (4% vs. 1%. P = 0.213), and other recurrence (3% vs. 3%, P = 1.000). The 3-year disease-free and overall survival of MIE were significantly better than OE (71.4% vs. 50.5%, P = 0.004 and 80.3% vs. 61.2%, P = 0.002, respectively). Multivariate analysis showed that the thoracic approach (OE vs. MIE) (HR 1.93, P = 0.004) was an independent prognostic factor, along with the pathological N stage (HR 3.05, P < 0.001).

Conclusions

MIE has less intramediastinal LN recurrence than OE and may lead to a better long-term prognosis in patients with advanced esophageal cancer who underwent neoadjuvant chemotherapy.

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Abbreviations

MIE:

Minimally invasive esophagectomy

OE:

Open esophagectomy

LN:

Lymph node

HR:

Hazard ratio

5-FU:

5-Fluorouracil

DCF:

5-Fluorouracil and cisplatin plus docetaxel

CD:

Clavien-Dindo

DFS:

Disease-free survival

OS:

Overall survival

PSM:

Propensity score–matched analysis

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan

    Keijiro Sugimura, Hiroshi Miyata, Takashi Kanemura, Tomohira Takeoka & Takahito Sugase

  2. Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki City, Hyogo, 660-8511, Japan

    Keijiro Sugimura, Toru Masuzawa, Shinnsuke Katsuyama, Yutaka Takeda & Kohei Murata

  3. Department of Surgery, Osaka General Medical Center, 3-1-56, Manndaihigashi, Sumiyoshi-Ku, Osaka, 541-8567, Japan

    Masaaki Motoori

  4. Department of Surgery, Osaka Suita Municipal Hospital, 5-7, Kishibeshinnmachi, Suita City, Osaka, 564-8567, Japan

    Masakiho Yano

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  1. Keijiro Sugimura
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Patient selection and propensity score matching. (PNG 1201 kb)

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Sugimura, K., Miyata, H., Kanemura, T. et al. Patterns of Recurrence and Long-Term Survival of Minimally Invasive Esophagectomy Versus Open Esophagectomy for Locally Advanced Esophageal Cancer Treated with Neoadjuvant Chemotherapy: a Propensity Score–Matched Analysis. J Gastrointest Surg 27, 1055–1065 (2023). https://doi.org/10.1007/s11605-023-05615-x

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