• Marianne C Kalff, Laura F C Fransen, Eline M de Groot, Suzanne S Gisbertz, NieuwenhuijzenGrard A PGAPDepartment of Surgery, Catharina Hospital, Eindhoven, the Netherlands., Jelle P Ruurda, VerhoevenRob H ARHADepartment of Research & Development, Netherlands Comprehensive Cancer Organization (iKNL), Utrecht, the Netherlands., LuyerMisha D PMDPDepartment of Surgery, Catharina Hospital, Eindhoven, the Netherlands., Richard van Hillegersberg, Mark I van Berge Henegouwen, and Dutch Upper Gastrointestinal Cancer Audit group.
• Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
• Ann. Surg. 2022 Dec 1; 276 (6): e749e757e749-e757.

ObjectivesThis study aimed to compare long-term survival following MIE versus OE for esophageal cancer using a nationwide propensity-score matched cohort.Summary Of Background DataMIE provides lower postoperative morbidity and mortality, and similar short-term oncological quality compared to OE.MethodsData was acquired from the Dutch Upper Gastrointestinal Cancer Audit. Patients undergoing minimally invasive or open, transthoracic or transhiatal esophagectomy for primary esophageal cancer between 2011 and 2015 were included. A propensity-score matching analysis for MIE versus OE was performed separately for transthoracic and transhiatal esoph-agectomies.ResultsA total of 1036 transthoracic MIE and OE patients, and 582 transhiatal MIE and OE patients were matched. Long-term survival was comparable for MIE and OE for both transthoracic and transhiatal procedures (5-year overall survival: transthoracic MIE 49.2% vs OE 51.1%, P 0.695; transhiatal MIE 48.4% vs OE 50.7%, P 0.832). For both procedures, MIE yielded more lymph nodes (transthoracic median 21 vs 18, P < 0.001; transhiatal 15 vs 13, P 0.007). Postoperative morbidity was comparable after transthoracic MIE and OE (60.8% vs 64.9%, P 0.177), with a reduced length of stay after transthoracic MIE (median 12 vs 15 days, P < 0.001). After transhiatal MIE, more postoperative complications (64.9% vs 56.4%, P 0.034) were observed, without subsequent difference in length of stay.ConclusionLong-term survival after MIE was equivalent to open in both propensity-score matched cohorts of patients undergoing transthoracic or transhiatal esophageal resections. Transhiatal MIE was accompanied withmore postoperative morbidity. Both transthoracic and transhiatal MIE resulted in a more extended lymphadenectomy.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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