The Impact of Hybrid Minimally Invasive Esophagectomy with Neck-Abdominal First Approach on the Short- and Long-Term Out
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ORIGINAL SCIENTIFIC REPORT
The Impact of Hybrid Minimally Invasive Esophagectomy with Neck-Abdominal First Approach on the Short- and LongTerm Outcomes for Esophageal Squamous Cell Carcinoma Akihiro Hoshino1 • Yasuaki Nakajima1 • Kenro Kawada1 • Yutaka Tokairin1 • Takuya Okada1 • Toshihiro Matsui1 • Kazuya Yamaguchi1 • Tatsuyuki Kawano1 Yusuke Kinugasa1
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Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Currently, there is no consensus for an optimal minimally invasive esophagectomy (MIE) approach. This study aimed to compare hybrid MIE (hMIE) with neck-abdominal first approach to standard open esophagectomy (OE). Methods Data from a cohort of 301 patients were retrospectively analyzed. All participants received either hMIE or OE for the treatment of esophageal squamous cell carcinoma at Tokyo Medical and Dental University between January 2003 and December 2013. Analyses included propensity score matching and the Kaplan–Meier statistical method to determine overall survival (OS) and disease-free survival (DFS) of the cohort. Results After one-to-one propensity score matching, there were 68 patient pairs. The hMIE group had significantly lower incidence of severe postoperative complications (20.1% vs. 7.4%; p = 0.026) and severe respiratory complications (7.4% vs. 0%; p = 0.058) than the OE group. The 5-year oncological outcomes of the two groups were almost equivalent (OS: OE, 55.0%; hMIE, 69.0%; p = 0.063 and DFS: OE, 54.0%; hMIE, 62.0%; p = 0.28). Conclusions This study compared hMIE with neck-abdominal first approach to standard OE. The results showed significantly less severe postoperative complications for hMIE with neck-abdominal first approach in comparison with OE, without a compromise in long-term oncological outcomes.
Introduction Although surgical resection is the main treatment for early and localized esophageal cancer, high rates of morbidity and mortality associated with its high invasiveness have been reported [1, 2]. Minimally invasive esophagectomy (MIE) has emerged as an alternative approach to the standard open esophagectomy (OE) in order to reduce surgical invasiveness, intraoperative blood loss, postoperative pulmonary complications, postoperative pain, and & Akihiro Hoshino [email protected] 1
Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo 113-8519, Japan
length of hospital stays [3–6]. MIE can be performed using three techniques (McKeown, Ivor Lewis, and transhiatal esophagectomy) and two procedures [combined thoracoscopic-laparoscopic esophagectomy (complete MIE; cMIE) and combined thoracoscopic-laparotomy/thoracotomy plus laparoscopic esophagectomy (hybrid MIE; hMIE)]. The optimal MIE technique and procedure have not been determined. The standard OE surgery for esophageal cancer is associated with a 5-year survival of only 40%; it is anticipated that MIE can improve the disease prognosis because of its low invasiveness [7]. While a few studies have compared the long-term oncological outcomes between MIE
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