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Outcomes of Open Versus Minimally Invasive Ivor-Lewis Esophagectomy for Cancer: A Propensity-Score Matched Analysis of NSQIP Database

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

We conducted this analysis to compare the outcomes of open transthoracic esophagectomy (OTTE) and minimally invasive transthoracic esophagectomy (MITTE) when performed for oncologic indications.

Methods

The NSQIP esophagectomy-targeted database during 2-year period was used. Only patients who underwent elective TTE for oncologic indications were included. Patients were matched per a propensity score for the likelihood of receiving OTTE versus MITTE.

Results

Overall, 2098 esophagectomies were reported; 576 met the inclusion criteria. A total of 161 purely OTTE patients were matched 1:1 with patients who received purely MITTE. OTTE was associated with higher reported rates of abdominal and mediastinal lymphadenectomies (LAD) (26.7% vs. 3.1% and 38.5% vs. 16.1%, respectively; p < 0.001) and had shorter mean operative time (329 vs. 414 min; p < 0.001). However, OTTE patients had higher rates of wound infection (7.5% vs. 1.9%), longer median hospitalization (10 vs. 8 days), more non-home discharges (18.0 vs. 8.1%), and a tendency toward higher rates of postoperative transfusion (13.0% vs. 6.8%; p = 0.092). The overall complications rate was higher in OTTE (46.0% vs. 33.5%; p = 0.028). No difference was noted in the rates of anastomotic leak, negative margins, reoperation, readmission, or mortality. Laparoscopic versus robotic approaches were uniformly comparable, except for higher rates of reported abdominal LAD in laparoscopic and higher rates of reported mediastinal LAD in robotic approach.

Conclusions

MITTE is comparable to OTTE for oncologic indications in immediate postoperative outcomes. A concern is raised regarding the oncologic outcome given the lower reported rates of lymphadenectomies. Comparison of long-term outcomes is essential to address this concern.

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Authors and Affiliations

  1. Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA

    Samer A. Naffouje MD & Rony H. Salloum MD

  2. University of Illinois at Chicago College of Medicine, Chicago, IL, USA

    Zaynab Khalaf BS

  3. Division of Surgical Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA

    George I. Salti MD FACS

  4. Department of Surgical Oncology, Edward Hospital Cancer Center, Naperville, IL, USA

    George I. Salti MD FACS

Authors
  1. Samer A. Naffouje MD
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  2. Rony H. Salloum MD
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  3. Zaynab Khalaf BS
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  4. George I. Salti MD FACS
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Contributions

Study conception and design: SN and GS. Acquisition of data: SN. Analysis and interpretation of data: SN, RS and GS. Drafting of manuscript: SN, RS, ZK and GS. Critical revision: SN, RS, ZK and GS

Corresponding author

Correspondence to Samer A. Naffouje MD.

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DISCLOSURES

The authors have no personal, institutional, or financial disclosures. The authors have no conflicts of interest to report. The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. All authors have read and approved the manuscript.

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Naffouje, S.A., Salloum, R.H., Khalaf, Z. et al. Outcomes of Open Versus Minimally Invasive Ivor-Lewis Esophagectomy for Cancer: A Propensity-Score Matched Analysis of NSQIP Database. Ann Surg Oncol 26, 2001–2010 (2019). https://doi.org/10.1245/s10434-019-07319-6

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  • DOI: https://doi.org/10.1245/s10434-019-07319-6

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