Abstract
BackgroundOesophagectomy, the gold standard for oesophageal cancer treatment, causes significantly high morbidity and mortality. McKeown minimally invasive oesophagectomy (MIE) is preferred for treating oesophageal malignancies; however, limited studies with large sample sizes focusing on the surgical and oncological outcomes of this procedure have been reported. We aimed to compare the clinical safety and efficacy of McKeown MIE with those of open oesophagectomy (OE).Patients and methodsOverall, 338 oesophageal cancer patients matched by gender, age, location, size, and T and N stages (McKeown MIE: 169 vs OE: 169) were analysed. The clinicopathologic features, operational factors, postoperative complications, and prognoses were compared between the groups.ResultsMcKeown MIE resulted in less bleeding (200 mL vs 300 mL, p<0.01), longer operation time (335.0 h vs 240.0 h, p<0.01), and higher number of harvested lymph nodes (22 vs 9, p<0.01) than OE did. Although the rate of recurrent laryngeal nerve injury in the two groups was not significantly different, incidence of anastomotic leakage (8 vs 24, p=0.003) was significantly lower in the McKeown MIE group. In addition, patients who underwent McKeown MIE had higher 5-year overall survival than those who underwent OE (69.9% vs 40.4%, p<0.001).ConclusionMcKeown MIE is proved to be feasible and safe to achieve better surgical and oncological outcomes for oesophageal cancer compared with OE.
Highlights
Oesophagectomy, the gold standard for oesophageal cancer treatment, causes significantly high morbidity and mortality
McKeown minimally invasive oesophagectomy (MIE) is proved to be feasible and safe to achieve better surgical and oncological outcomes for oesophageal cancer compared with OE
In the current study, we found that McKeown MIE resulted in less bleeding, longer operative time, shorter postoperative hospitalisation, and showed a trend of lower in-hospital/30-day mortality than OE did
Summary
Oesophagectomy, the gold standard for oesophageal cancer treatment, causes significantly high morbidity and mortality. McKeown minimally invasive oesophagectomy (MIE) is preferred for treating oesophageal malignancies; limited studies with large sample sizes focusing on the surgical and oncological outcomes of this procedure have been reported. Open oesophagectomy (OE) is correlated with remarkably high rates of morbidity and mortality during the perioperative period and is considered as one of the most traumatic and extensive surgeries in cancer [9]. With the development of minimally invasive technique [10, 11], McKeown minimally invasive oesophagectomy (MIE), which was first reported in 2000 and achieved similar or better clinical outcomes compared with OE [12], has become increasingly popular and is favourably performed at most academic centres. Most of them reported that MIE reduced the surgical access-related trauma, which resulted in shorter hospitalisation and lower rates of respiratory complications and wound infections [13,14,15,16,17]
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