An Analysis of Outcomes After Transition From Open to Minimally Invasive Ivor Lewis Esophagectomy

Abstract

The morbidity and mortality remain relatively high for transthoracic esophagectomy with open thoracotomy. We compared a total laparoscopic and thoracoscopic minimally invasive Ivor Lewis esophagectomy (M-ILE) cohort with a propensity score-weighted cohort of open Ivor Lewis esophagectomy (O-ILE) cases. This is a retrospective review of 259 patients diagnosed with esophageal carcinoma who underwent M-ILE (n= 173) or O-ILE (n= 86) from April 2009 to March 2019. The postoperative morbidity and mortality were reported for each group. Inverse probability of treatment weighting (IPTW) adjustment was used to balance the baseline characteristics between study groups. Recurrence-free and overall survival rates were compared on an intention-to-treat basis. The IPTW cohort included 249 patients with esophageal carcinoma who underwent M-ILE (n= 163) or O-ILE (n= 86). The overall rate of postoperative adverse events was significantly higher after IPTW adjustment in the O-ILE group (54.2% vs 39.02%; P= .039). The median hospital length of stay was 8.0 (interquartile range, 7.0-9.0) days for the M-ILE group compared with 10.0 (interquartile range, 8.0-14.0) days for the O-ILE group (P < .001). The 3-year overall survival for the M-ILE group was 64.63% (95% confidence interval, 54.7%-72.9%) compared with 54.76% (95% confidence interval, 39.9%-67.4%) for the O-ILE group (P= .447). The 3-year recurrence-free survival rate did not differ significantly between the groups (P= .461). The M-ILE approach demonstrated short-term clinical outcomes that were superior to O-ILE at our institution. The survival rate and recurrence-free survival rate for M-ILE were not significantly different from O-ILE for esophageal carcinoma.