Long-term Survival After Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer

Kalff, Marianne C.; Fransen, Laura F C; Groot, Eline M de; Gisbertz, Suzanne S.; Nieuwenhuijzen, Grard A. P.; Ruurda, Jelle P.; Verhoeven, Rob H.A.; Luyer, Misha; Hillegersberg, Richard van; Henegouwen, Mark I. van Berge

doi:10.1097/sla.0000000000004708

Cited by 25 publications

(17 citation statements)

References 31 publications

(61 reference statements)

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“…12, 29 It is conceivable that TTE enables direct visualization of the operative field and extended resection of mediastinal lymph nodes, [24][25][26] whereas by comparison, the limited view to the mediastinum during THE prevents a full thoracic lymphadenectomy. [24][25][26] Several studies have shown a higher lymph node yield after TTE, 15,16,24,26 which also was seen in the current study. This, however, had no survival effect in any of the analyses, including model 2, which did not adjust for N stage.…”

Section: Discussionsupporting

confidence: 88%

“…However, a recent Dutch study showed no differences in survival between minimally invasive and open THE, so this should not be a major confounder. 15 Although studies have compared short-and long-term outcomes after THE and TTE, the available evidence is contradictory. No previous population-based studies have compared long-term survival between the two approaches.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Survival After Transhiatal Versus Transthoracic Esophagectomy: A Population-Based Nationwide Study in Finland

Junttila

Helminen²,

Helmiö³

et al. 2022

Ann Surg Oncol

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Background No population-based studies comparing long-term survival after transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE) exist. This study aimed to compare the 5-year survival of esophageal cancer patients undergoing THE or TTE in a population-based nationwide setting. Methods This study included all curatively intended THE and TTE for esophageal cancer in Finland during 1987–2016, with follow-up evaluation until 31 December 2019. Cox proportional hazard models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of 5-year and 90-day mortality. The results were adjusted for age, sex, year of operation, comorbidities, histology, neoadjuvant treatment, and pathologic stage. Results A total of 1338 patients underwent THE (n = 323) or TTE (n = 1015). The observed 5-year survival rate was 39.3% after THE and 45.0% after TTE (p = 0.072). In adjusted model 1, THE was not associated with greater 5-year mortality (HR 0.99; 95% CI 0.82–1.20) than TTE. In adjusted model 2, including T stage instead of pathologic stage, the 5-year mortality hazard rates after THE (HR 0.87, 95% CI 0.72–1.05) and TTE were comparable. The 90-day mortality rate for THE was higher than for TTE (adjusted HR 0.72; 95% CI 0.45–1.14). In subgroup analyses, no differences between THE and TTE were observed in Siewert II gastroesophageal junction cancers, esophageal cancers, or pN0 tumors, nor in the comparison of THE and TTE with two-field lymphadenectomy. The sensitivity analysis, including patients with missing patient records, who underwent surgery during 1996–2016 mirrored the main analysis. Conclusions This Finnish population-based nationwide study suggests no difference in 5-year or 90-day mortality after THE and TTE for esophageal cancer.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Long-Term Survival After Transhiatal Versus Transthoracic Esophagectomy: A Population-Based Nationwide Study in Finland

Junttila

Helminen²,

Helmiö³

et al. 2022

Ann Surg Oncol

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“…The median duration of postoperative hospital stay in the ABPC/SBT group was 17 days, which was longer than the 11-15 days in the nationwide databases of the United States and the Netherlands. 33,34 However, this is an acceptable result considering the 23 days of postoperative stay for the 5359 patients in the Japanese database who underwent minimally invasive esophagectomy. 35 Japanese hospital stays for acute care tend to be much longer than those in other countries.…”

Section: Discussionmentioning

confidence: 94%

Significance of Antimicrobial Prophylaxis for the Prevention of Early-Onset Pneumonia After Radical Esophageal Cancer Resection: A Retrospective Analysis of 356 Patients Undergoing Thoracoscopic Esophagectomy

Higaki

Fujieda

et al. 2021

Ann Surg Oncol

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Background. Postoperative pneumonia is a common complication after esophagectomy and is associated with a high mortality rate. Although many randomized, controlled trials have been conducted on the prevention of postoperative pneumonia, little attention has been paid to the efficacy of antimicrobial prophylaxis. The purpose of this study was to investigate the impact of antimicrobial prophylaxis on the prevention of postoperative pneumonia. Methods. Data of patients with esophageal cancer who underwent thoracoscopic esophagectomy between 2016 and 2020 were collected. Early-period patients received cefazolin (CEZ) per protocol as antimicrobial prophylaxis (n = 250), and later-period patients received ampicillin/sulbactam (ABPC/SBT) (n = 106) because of the unavailability of CEZ in Japan. The incidence of pneumonia was compared between treatments in this quasiexperimental setting. Pneumonia detected by routine computed tomography (CT) on postoperative Days 5-6 was defined as early-onset pneumonia, and pneumonia that developed later was defined as late-onset pneumonia.Results. The incidence of early-onset pneumonia was significantly lower (3.8% vs. 13.6%, P = 0.006), and the median length of postoperative hospital stay was significantly shorter (17 vs. 20 days, P \ 0.001) in the ABPC/ SBT group than in the CEZ group. The incidence of lateonset pneumonia was similar between groups (9.4% vs. 10.0%, P = 0.870). The incidence of Clostridioides difficile infections and the incidence of multidrug-resistant organisms were similar between groups. Multivariate analyses consistently showed the superiority of ABPC/SBT to CEZ in preventing early-onset pneumonia (odds ratio: 0.20, P = 0.006). Conclusions. ABPC/SBT after esophagectomy was better at preventing early-onset pneumonia compared with CEZ and was feasible regarding the development of antimicrobial resistance.

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“…However, minimally invasive techniques are associated with considerable proficiency-gain curves [ 64 ]. Multiple population-based studies have failed to confirm the RCT-proven advantages of minimally invasive surgery over open procedures [ 65 , 66 , 67 , 68 , 69 ]. A recent study examined the implementation of minimally invasive surgery outside of the randomized controlled setting into national practice [ 70 ].…”

Section: Currently Practiced Surgical Techniquesmentioning

confidence: 99%

Surgical Therapy of Esophageal Adenocarcinoma—Current Standards and Future Perspectives

Schröder

Gisbertz

Voeten

et al. 2021

Cancers

Self Cite

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Transthoracic esophagectomy is currently the predominant curative treatment option for resectable esophageal adenocarcinoma. The majority of carcinomas present as locally advanced tumors requiring multimodal strategies with either neoadjuvant chemoradiotherapy or perioperative chemotherapy alone. Minimally invasive, including robotic, techniques are increasingly applied with a broad spectrum of technical variations existing for the oncological resection as well as gastric reconstruction. At the present, intrathoracic esophagogastrostomy is the preferred technique of reconstruction (Ivor Lewis esophagectomy). With standardized surgical procedures, a complete resection of the primary tumor can be achieved in almost 95% of patients. Even in expert centers, postoperative morbidity remains high, with an overall complication rate of 50–60%, whereas 30- and 90-day mortality are reported to be <2% and <6%, respectively. Due to the complexity of transthoracic esophagetomy and its associated morbidity, esophageal surgery is recommended to be performed in specialized centers with an appropriate caseload yet to be defined. In order to reduce postoperative morbidity, the selection of patients, preoperative rehabilitation and postoperative fast-track concepts are feasible strategies of perioperative management. Future directives aim to further centralize esophageal services, to individualize surgical treatment for high-risk patients and to implement intraoperative imaging modalities modifying the oncological extent of resection and facilitating surgical reconstruction.

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Long-term Survival After Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer

Cited by 25 publications

References 31 publications

Long-Term Survival After Transhiatal Versus Transthoracic Esophagectomy: A Population-Based Nationwide Study in Finland

Long-Term Survival After Transhiatal Versus Transthoracic Esophagectomy: A Population-Based Nationwide Study in Finland

Significance of Antimicrobial Prophylaxis for the Prevention of Early-Onset Pneumonia After Radical Esophageal Cancer Resection: A Retrospective Analysis of 356 Patients Undergoing Thoracoscopic Esophagectomy

Surgical Therapy of Esophageal Adenocarcinoma—Current Standards and Future Perspectives

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