• Sofie P G Henckens, Nannet Schuring, Jessie A Elliott, Asif Johar, Sheraz R Markar, Amaia Gantxegi, Pernilla Lagergren, George B Hanna, Manuel Pera, John V Reynolds, Mark I van Berge Henegouwen, Suzanne S Gisbertz, and ENSURE study group.
• Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, the Netherlands.
• Ann. Surg. 2024 Aug 1; 280 (2): 267273267-273.

ObjectiveTo determine the impact of operative approach [open (OE), hybrid minimally invasive (HMIE), and total minimally invasive (TMIE) esophagectomy] on operative and oncologic outcomes for patients treated with curative intent for esophageal and junctional cancer.BackgroundThe optimum oncologic surgical approach to esophageal and junctional cancer is unclear.MethodsThis secondary analysis of the European multicenter ENSURE study includes patients undergoing curative-intent esophagectomy for cancer between 2009 and 2015 across 20 high-volume centers. Primary endpoints were disease-free survival (DFS) and the incidence and location of disease recurrence. Secondary endpoints included among others R0 resection rate, lymph node yield, and overall survival (OS).ResultsIn total, 3199 patients were included. Of these, 55% underwent OE, 17% HMIE, and 29% TMIE. DFS was independently increased post-TMIE [hazard ratio (HR): 0.86 (95% CI: 0.76-0.98), P = 0.022] compared with OE. Multivariable regression demonstrated no difference in absolute locoregional recurrence risk according to the operative approach [HMIE vs OE, odds ratio (OR): 0.79, P = 0.257; TMIE vs OE, OR: 0.84, P = 0.243]. The probability of systemic recurrence was independently increased post-HMIE (OR: 2.07, P = 0.031), but not TMIE (OR: 0.86, P = 0.508). R0 resection rates ( P = 0.005) and nodal yield ( P < 0.001) were independently increased after TMIE, but not HMIE ( P = 0.424; P = 0.512) compared with OE. OS was independently improved following both HMIE (HR: 0.79, P = 0.009) and TMIE (HR: 0.82, P = 0.003) as compared with OE.ConclusionIn this European multicenter study, TMIE was associated with improved surgical quality and DFS, whereas both TMIE and HMIE were associated with improved OS as compared with OE for esophageal cancer.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

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