Outcomes of open and minimally invasive esophagectomy for esophageal cancer

Abstract

Objective To compare the safety, feasibility, and long-term outcomes between com- bined thoracoscopic and laparoscopic esophagectomy （TLE） and open three-field esophagectomy （OE） for esophageal cancer. Methods The data of 183 patients with esophageal cancer who accepted T LE （n = 94） or OE （n = 89） from February 2009 to December 2011 were retrospectively collected and compared. Results Demographics, pathologic data in each cohort were almost identical. No significant differences were observed in operative time, the number of lymph node harvested, rates of anastomotic leak, thoracic ab- scess, chyle chest, re-operation, vocal cord paralysis, gastric emptying dysfunction and morbidity. A significant difference was observed in blood loss （86. 6 ±38.3 ml in TLE group vs. 217.4 ±87. 2 ml in OE group, P=0.000）, rate of transfusion （1.1% vs. 6.7%, P=0.045）, hospital stay （13.9 ±7.5 d vs. 17. 1 ± 10. 2 d, P =0. 017）, rate of overall surgical complications （23.4% vs. 38. 2% , P =0. 030） , rate of pulmonary complications （9.6% vs. 27.0%, P =0.002） and rate of arythmia （4. 1% vs. 12.4%, P = 0. 046）. Median follow-up time was 28.0 ±2. 0 months （95% CI： 24. 2-31.8）. No difference between the two groups concerning survival was observed （P = 0. 954）. Conclusion The TLE for esophageal cancer is safe and feasible. Although it cannot improve the survival of long-term, it is worth spreading in intraoperative and postoperative advantages compared with OE group. Key words: Esophageal neoplasms ; Thoracoscopes ; Laparoscopes ; Thoraeis surgical procedures; Controlled clinical trials