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Effect of Phased Implementation of Totally Minimally Invasive Ivor Lewis Esophagectomy for Esophageal Cancer after Previous Adoption of the Hybrid Minimally Invasive Technique: Results from a French Nationwide Population-Based Cohort Study

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Several randomized controlled trials (RCTs) have demonstrated improved short-term outcomes of totally minimally invasive esophagectomy (TMIE) compared with open esophagectomy (OE); however, to what extent these outcomes can be extrapolated to a national level remains debatable.

Objective

The aim of this study was to evaluate, on a nationwide basis, the short-term outcomes of TMIE and to analyze these results within the context of previously implemented hybrid minimally invasive esophagectomy (HMIE).

Methods

All consecutive patients who underwent a curative Ivor Lewis esophagectomy in France between 2017 and 2019 were included in this retrospective cohort study. The primary endpoint was to compare 90-day postoperative mortality (POM) between OE, HMIE, and TMIE, while secondary endpoints were defined as the rate of postoperative complications. A matched and multivariate analysis was adjusted for confounding factors.

Results

Overall, 2675 patients were included (1003 OE vs. 1498 HMIE vs. 174 TMIE). In every center where TMIE was performed, HMIE had been previously adopted. The matched 90-day POM rate in the TMIE group was significantly lower compared with the OE group (2.3% vs. 6.3%, p = 0.046) but not compared with the HMIE group (2.3% vs. 4.9%, p = 0.156). There was no significant difference between TMIE and OE, or TMIE and HMIE, regarding the 30-day fistula rate (21.8% vs. 17%, p = 0.176; and 21.8% vs. 21.3%, p = 0.88, respectively). TMIE was associated with a reduced rate of pulmonary complications compared with OE (33.9% vs. 44%, p = 0.027) and HMIE (33.9% vs. 42.8%, p = 0.05). Low-volume centers were identified as a negative predictive factor for 90-day POM (odds ratio 1.89, 95% confidence interval 1.3–2.75, p = 0.001).

Conclusion

TMIE is associated with a lower 90-day POM rate compared with OE and offers reduced rates of pulmonary complications compared with OE and HMIE. After previous adoption of the HMIE technique, TMIE can be safely implemented in high-volume centers nationwide.

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Funding

No sources of funding were used to assist in the preparation of this article.

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Authors and Affiliations

  1. Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, University Lille, Lille, France

    Frederiek Nuytens MD, Clarisse Eveno MD, PhD & Guillaume Piessen MD, PhD

  2. Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge Hospital, Kortrijk, Belgium

    Frederiek Nuytens MD

  3. Medical Information Department, Lille University Hospital, Lille, France

    Xavier Lenne MSc, Guillaume Clément MD & Amelie Bruandet MD, PhD

  4. ULR 2694 – METRICS: Evaluation des technologies de sante et des pratiques médicales, University Lille, CHU Lille, Lille, France

    Xavier Lenne MSc & Amelie Bruandet MD, PhD

  5. UMR9020-U1277 – CANTHER – Cancer Heterogeneity, Plasticity and Resistance to Therapies, University Lille, CNRS, Inserm, CHU Lille, Lille, France

    Clarisse Eveno MD, PhD & Guillaume Piessen MD, PhD

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  1. Frederiek Nuytens MD
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Correspondence to Frederiek Nuytens MD.

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Frederiek Nuytens, Xavier Lenne, Guillaume Clément, Amelie Bruandet, Clarisse Eveno, and Guillaume Piessen have no conflicts of interest to declare.

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Nuytens, F., Lenne, X., Clément, G. et al. Effect of Phased Implementation of Totally Minimally Invasive Ivor Lewis Esophagectomy for Esophageal Cancer after Previous Adoption of the Hybrid Minimally Invasive Technique: Results from a French Nationwide Population-Based Cohort Study. Ann Surg Oncol 29, 2791–2801 (2022). https://doi.org/10.1245/s10434-021-11110-x

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