Comparative study between minimally invasive and open esophagectomy for the treatment of esophageal cancer

Ahmed Daoud; Moustafa Elhamami; Samir Keshk; Mohamed Mostafa  Agha; Yin Li

Ahmed Daoud Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt https://orcid.org/0000-0003-0472-7912
Moustafa Elhamami Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Samir Keshk Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Mohamed Mostafa Agha Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Yin Li Department of Thoracic Surgical Oncology, National Cancer Center/Cancer Hospital, Beijing, China; Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China

Keywords: Esophagectomy, Minimally invasive, Esophageal cancer, Esophagus, Thoracoscopic, Laparoscopic

Abstract

Background: Complete resection of the esophageal tumor is the gold standard therapy. The optimal surgical approach for esophagectomy is still controversial. This study compared the short-term outcomes of minimally invasive (MIE) and open esophagectomy for treating esophageal cancer.

Methods: A prospective study was conducted on 70 consecutive patients who received esophagectomy for esophageal carcinoma between 2017 and 2019 at Henan Cancer Hospital, Zhengzhou, China. Fifty patients received MIE (Group A), and 20 received open esophagectomy (Group B). Among Group B, 17 patients had left thoracotomy, and three had three incision esophagectomy.

Results: The mean age in Group A was 61.48 ± 8.06 years, and 61.3 ± 7.52 years in Group B (p= 0.932). In Group A, most of the tumors were located in the middle thoracic area (56%), while in the open esophagectomy group, most of the tumors were located in the lower thoracic-esophagogastric junction area (50%) (p<0.001). The most common stage in Group A was (T3N0M0) and (T3N0M0) in Group B (p= 0.044). Neoadjuvant therapy was used in 48% of patients in Group A and 15% in Group B (p=0.08). The mean number of resected lymph nodes in Group A was 28.8 ± 7.8 lymph nodes versus 22.4 ± 7.7 in the open esophagectomy group (p=0.003). The mean operative bleeding amount was 80±34.6 ml and 185± 46.2 ml for groups A and B, respectively (p=0.001). The mean ICU stay for Group A was 0.5± 0.7 days versus 0.4± 0.6 days for Group B (p=0.4). The mean postoperative hospital stay for Group A was 8± 3 days, while in Group B, the mean postoperative hospital stay was 14± 3 days (p=0.001). Postoperative complications occurred in 2 patients (4%) in Group A and seven in Group B (p= 0.001). No tumor recurrence was detected radiologically among the two groups in the three months follow-up period.

Conclusion: Minimally invasive esophagectomy may be a feasible and safe procedure for patients with early-stage esophageal cancer or locally advanced neoplasms who have received neoadjuvant therapy.