Propensity score–matched comparison between open and minimal invasive hybrid esophagectomy for esophageal adenocarcinoma

• Published in: Langenbeck's archives of surgery 2020-06, Vol.405 (4), p.521-532
• Main Authors: Hölscher, Arnulf H., DeMeester, Tom R., Schmidt, Henner, Berlth, Felix, Bollschweiler, Elfriede
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Cardiac Surgery; General Surgery; Medicine; Medicine & Public Health; Original Article; Thoracic Surgery; Traumatic Surgery; Vascular Surgery
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-020-01882-3

Background This study compared the outcome between patients who had an open and those who had a hybrid esophagectomy for T1 or T3 esophageal adenocarcinoma (eAC). No clear data are available concerning this question based on T-category. Methods Two groups of patients with esophagectomy and high intrathoracic esophagogastrostomy for eAC were analyzed: hybrid (laparoscopy + right thoracotomy) ( n  = 835) and open (laparotomy + right thoracotomy) ( n  = 188). Outcome criteria were 30- and 90-day mortality, R0-resection rate (R0), number of resected lymph nodes (rLNs), and 5-year survival rate (5y-SR). For each type of surgery, three patient groups were analyzed: pT1-carcinoma (group-1), cT3Nx and neoadjuvant chemoradiation (group-2), and pT3N0-3 without neoadjuvant therapy (group-3). The comparison was based on a propensity score matching in relation of 1:2 for open versus hybrid. Results In group-1 (38 open vs 76 hybrid) R0-resection (100%), 30-day mortality (0%), 90-day mortality (2.6% vs 0%), and rLNs (median 29.5 vs 28.5) were not significantly different. The pN0-rate was 76% in the open and 92% in the hybrid group ( p  = 0.036). Accordingly, the 5y-SR was 69% and 87% ( p  = 0.016), but the prognosis of the subgroups pT1pN0 or pT1pN+ was not significantly different between open or hybrid. In group-2 (68 open vs 135 hybrid) R0-resection (97%), 30-day (0% vs 0.7%) and 90-day (4%) mortality, rLNs (28.5 vs 26), and 5y-SR (36% vs 41%) were not significantly different. In group-3 (37 open vs 75 hybrid) R0, postoperative mortality, rLNs, and 5y-SR were not significantly different. Conclusion In a propensity score–matched comparison of patients with an open or hybrid esophagectomy for esophageal adenocarcinoma the quality of oncologic resection, postoperative mortality and prognosis are not different.