Short-Term Outcomes Following Minimally Invasive and Open Esophagectomy: A Population-Based Study from Finland and Sweden
- 260 Downloads
Population-based studies comparing minimally invasive esophagectomy (MIE) and open esophagectomy (OE) relative to 90-day postoperative mortality are needed.
The aim of this study was to compare short-term outcomes following these two techniques for esophageal cancer.
Patients undergoing MIE (n = 217) or OE (n = 1397) for esophageal cancer between 2007 and 2014 were identified from nationwide complete registries in Finland and Sweden. The primary outcome was 90-day mortality, and secondary outcomes were 30-day mortality, length of hospital stay, and 30- and 90-day readmission rate. Results were adjusted for age, sex, comorbidity, tumor histology, surgery year, and country.
Ninety-day mortality rates were 4.1% (n = 9 of 217) for MIE and 6.8% (n = 95 of 1397) for OE; 90-day mortality was halved after MIE [adjusted hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.24–0.99]. There was no difference in 30-day mortality (adjusted HR 0.87, 95% CI 0.29–2.66). Median hospital stay was 15 days for MIE and 16 days for OE (adjusted β −0.17, standard error 0.08, p = 0.030). The 30-day readmission rates were 8.9% after MIE and 12.0% after OE (adjusted HR 0.57, 95% CI 0.34–0.94), while the 90-day readmission rates were 28.8% and 33.6%, respectively, without a statistically significant difference (adjusted HR 0.82, 95% CI 0.61–1.10).
This population-based study from Finland and Sweden revealed lower 90-day mortality, shorter hospital stay, and lower 30-day readmission rates after MIE compared with OE for esophageal cancer. These findings support the use of minimally invasive approaches.
This study was supported by grants from Sigrid Juselius Foundation (JHK), Orion Research Foundation (JHK), Swedish Research Council (JL), and the Swedish Cancer Society (JL).
Joonas H. Kauppila, Olli Helminen, Ville Kytö, Jarmo Gunn, Jesper Lagergren and Eero Sihvo declare no conflicts of interest.
- 1.Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Allen C, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol. 2017;3:524–48.Google Scholar
- 4.Luketich JD, Alvelo-Rivera M, Buenaventura PO, et al. Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg. 2003;238:486–94; discussion 494–5.Google Scholar
- 13.Sihag S, Kosinski AS, Gaissert HA, et al. 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. 2016;101:1281–8; discussion 1288–9.Google Scholar
- 17.Messager M, Pasquer A, Duhamel A, et al. Laparoscopic gastric mobilization reduces postoperative mortality after esophageal cancer surgery: a French Nationwide Study. Ann Surg. 2015;262:817–22; discussion 822–3.Google Scholar