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Minimally invasive esophagectomy for esophageal cancer reduced blood loss, shortened hospital stays

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Minimally invasive esophagectomy for esophageal cancer resulted in less intraoperative blood loss and shorter hospital stays than open surgery, without influencing mortality or morbidity, according to data presented at the Society of American Gastrointestinal and Endoscopic Surgeons Annual Meeting in Baltimore.

Researchers performed a retrospective analysis to compare surgical outcomes and determine the impact of comorbidities among 146 patients who underwent either open (n=64) or minimally invasive esophagectomy (MIE; n=71, along with 11 conversions classified as MIE) for stage II or stage III esophageal cancer between 1995 and 2011. Factors assessed included overall and 30-day mortality, incidence of major complications, operative time, length of hospital stay (LOS) and intraoperative estimated blood loss (EBL). Comorbidity was measured according to the Charlson Comorbidity Index-Grade (CCI-G).

The two groups had similar 30-day mortality rates (2% in the MIE group vs. 5% in the open group; P=.459) and major complications (33% for both groups; P=.988). Estimated survival at 3 (52% for MIE vs. 48% for open) and 5 years (42% vs. 37%) were similar (P=.513). Patients who underwent MIE had a significantly shorter length of hospital stay (ratio 0.8 vs. open procedure; P=.018), less intraoperative EBL (mean 234 mL; P<.001) and a higher lymph node harvest (P<.001) compared with open esophagectomy patients.

Patients with a CCI-G of 1 had significantly poorer overall survival than those with a CCI-G of 0 (HR=1.99; P=.027). Those with a CCI-G of 3 also were more likely to experience major complications (OR=10.1; P=.048) and had a longer length of stay (P<.001) and operative time (P=.004) than those with a CCI-G of 0.

“MIE is a safe alternative to open esophagectomy,” the researchers concluded. “MIE decreases intraoperative EBL and LOS without increasing operative time, morbidity or mortality related to the procedure. In addition, presence of comorbidities … increases operative time, length of hospital stay and post-operative complications while worsening overall survival.”

For more information:

Dolan JP. S046: Impact of Comorbidity on Outcomes and Overall Survival After Open and Minimal Invasive Esophagectomy For Locally Advanced Esophageal Cancer. Presented at: the Society of American Gastrointestinal and Endoscopic Surgeons 2013 Annual Meeting; April 17-20, Baltimore.