OGC O05 Does Minimally Invasive Transthoracic Esophagectomy Reduce Postoperative Pulmonary Complications? An International Cohort Study from the Oesophagogastric Anastomosis Audit (OGAA)

Abstract

Abstract Background Ongoing debate exists around optimum surgical approach to esophageal cancers, with limited data characterizing the external validity of randomised trials on MIE for esophageal cancers. This study aimed to report the postoperative pulmonary outcomes of transthoracic minimally invasive esophagectomy (MIE) in esophageal cancers patients from an international, multicenter cohort. Methods Patients undergoing open (OE, n=744), hybrid (HE, n=500), and totally MIE (TMIE, n=540) for esophageal cancers were identified from the Oesophagogastric Anastomosis Audit (OGAA). Results PPC rates were lower after MIE compared to OE and HE (31% vs 38% vs 39%, p=0.002), even on adjusted analyses compared to OE (odds ratio (OR): 0.57, CI95%: 0.44–0.74). MIE was associated with higher rates of AL (16% vs 11% vs. 11%, p=0.026), but not overall complications (60% vs 65% vs. 62%, p=0.2) and 90-day mortality compared to OE and HE (3% vs 4% vs. 3%, p=0.6). On adjusted analyses, MIE was associated with lower overall complications (OR: 0.67, CI95%: 0.51–0.87), but not AL (OR: 1.39, CI95%: 0.96–2.01) and 90-day mortality (OR: 0.49, CI95%: 0.22–1.04) compared to OE. Conclusions In contrast to previous reports, this study provides real-world data that TMIE was associated with lower 90-day PPC 90- than OE and HE, especially in patients with higher ASA grades and underlying respiratory disease. These warrant a further review into causes and mechanisms in selected patients, and that quality assurance in delivery of TMIE is probably of major importance. Finally, the proxies of oncologic impact, such as R0 rates and extend of lymphadenectomy, are superior with the TMIE approach. The ideal surgical approach remains unclear, and may be context dependent, and ongoing trials such as ROBOT-II will provide a large body of randomized data within a few years that may clarify the optimum approach to locally advanced esophageal cancers.