Propensity-Matched Analysis Comparing Survival After Hybrid Thoracoscopic-Laparotomy Esophagectomy and Complete Thoracoscopic-Laparoscopic Esophagectomy.

Abstract

BACKGROUND:

Hybrid thoracoscopic-laparotomy esophagectomy (hTE) and complete thoracoscopic-laparoscopic esophagectomy (cTLE) are the two most frequently used minimally invasive esophagectomy (MIE) procedures and are broadly utilized for esophageal cancer. We evaluated differences in short- and long-term outcomes between hTE and cTLE in patients with esophageal squamous cell carcinoma (ESCC).

METHODS:

Patients who underwent MIE for ESCC between September 2009 and February 2016 were included in this retrospective study. Propensity score matching (PSM) was utilized to contrast the postoperative results of hTE and cTLE according to the obtained and analyzed pertinent patient features and postoperative variables. Univariate and multivariate Cox proportional hazard regression analysis was used on possible predictors of survival.

RESULTS:

Eighty-six well-balanced pairs of patients were available for outcome comparison after PSM. Compared to Group 1 (hTE), the patients in Group 2 (cTLE) had significantly shorter operative times and less intraoperative blood loss, but a higher number of retrieved nodes (p = 0.000, p = 0.003, and p = 0.000, respectively). The incidence of postoperative complications was 40.7% (70/172) and did not significantly differ between the two groups. The patients in Group 2 exhibited higher disease-free survival and disease-specific survival (DSS) than those in Group 1 (p = 0.048 and p = 0.041, respectively). Univariate and multivariate Cox proportional hazard regression analyses showed that pT stage, pN stage, differentiation grade, and the surgical procedure had significant HRs, which suggested that cTLE is associated with better DSS.

CONCLUSIONS:

cTLE possibly shows better postoperative and oncologic outcomes than hTE.

• Authors: Kun-Kun Li, Yin-Jian Wang, Xue-Hai Liu, Ru-Wen Wang, Yao-Guang Jiang, Wei Guo
• Journal: World journal of surgery (World J Surg) Vol. 43 Issue 3 Pg. 853-861 (Mar 2019) ISSN: 1432-2323 [Electronic] United States
• PMID: 30386913 (Publication Type: Journal Article)

Topics

• Aged
• Blood Loss, Surgical
• Esophageal Neoplasms (surgery)
• Esophageal Squamous Cell Carcinoma (surgery)
• Esophagectomy (adverse effects, methods)
• Female
• Humans
• Incidence
• Laparoscopy (adverse effects, methods)
• Laparotomy (adverse effects, methods)
• Male
• Middle Aged
• Multivariate Analysis
• Operative Time
• Postoperative Complications (epidemiology)
• Propensity Score
• Retrospective Studies
• Survival Analysis