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Population-Based Cohort Study from a Prospective National Registry: Better Long-Term Survival in Esophageal Cancer After Minimally Invasive Compared with Open Transthoracic Esophagectomy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Recent research indicates long-term survival benefits of minimally invasive esophagectomy (MIE) compared with open esophagectomy (OE) for patients with esophageal and gastroesophageal junction (GEJ) cancers, but there is a need for more population-based studies.

Methods

We conducted a prospective population-based nationwide cohort study including all patients in Sweden diagnosed with esophageal or junctional cancer who underwent a transthoracic esophagectomy with intrathoracic anastomosis. Data were collected from the Swedish National Register for Esophageal and Gastric Cancer in 2006–2019. Patients were grouped into OE and MIE including hybrid MIE (HMIE) and totally MIE (TMIE). Overall survival and short-term postoperative outcomes were compared using Cox regression and logistic regression models, respectively. All models were adjusted for age, sex, American Society of Anesthesiologists (ASA) score, clinical T and N stage, neoadjuvant therapy, year of surgery, and hospital volume.

Results

Among 1404 patients, 998 (71.1%) underwent OE and 406 (28.9%) underwent MIE. Compared with OE, overall survival was better following MIE (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.55–0.94), TMIE (HR 0.67, 95% CI 0.47–0.94), and possibly also after HMIE (HR 0.76, 95% CI 0.56–1.02). MIE was associated with shorter operation time, less intraoperative bleeding, higher number of resected lymph nodes, and shorter hospital stay compared with OE. MIE was also associated with fewer overall complications (odds ratio [OR] 0.70, 95% CI 0.47–1.03) as well as non-surgical complications (OR 0.64, 95% CI 0.40–1.00).

Conclusions

MIE seems to offer better survival and similar or improved short-term postoperative outcomes in esophageal and GEJ cancers compared with OE in this unselected population-based cohort.

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Funding

No specific funding was received for this work.

Author information

Authors and Affiliations

  1. Department of Upper Abdominal Surgery, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden

    Masaru Hayami MD, PhD, Mats Lindblad MD, PhD, Magnus Nilsson MD, PhD & Ioannis Rouvelas MD, PhD

  2. Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Masaru Hayami MD, PhD

  3. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden

    Nelson Ndegwa, Mats Lindblad MD, PhD, Lars Lundell MD, PhD, Magnus Nilsson MD, PhD & Ioannis Rouvelas MD, PhD

  4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Nelson Ndegwa

  5. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

    Gustav Linder MD, PhD & Jakob Hedberg MD, PhD

  6. Department of Surgery, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden

    David Edholm MD, PhD

  7. Department of Surgery, Skåne University Hospital, Lund, Sweden

    Jan Johansson MD, PhD

  8. Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Jesper Lagergren MD, PhD

  9. School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK

    Jesper Lagergren MD, PhD

  10. Department of Surgery, Odense University Hospital, Odense, Denmark

    Lars Lundell MD, PhD

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  1. Masaru Hayami MD, PhD
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Contributions

Study design: MH, GL, JH, DE, JJ, JL, LL, ML, MN, and IR. Data analysis: MH and NN. Manuscript writing, review and final approval: all authors.

Corresponding author

Correspondence to Masaru Hayami MD, PhD.

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Disclosures

Masaru Hayami, Nelson Ndegwa, Mats Lindblad, Gustav Linder, Jakob Hedberg, David Edholm, Jan Johansson, Jesper Lagergren, Lars Lundell, Magnus Nilsson, and Ioannis Rouvelas declare no conflicts of interest.

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Hayami, M., Ndegwa, N., Lindblad, M. et al. Population-Based Cohort Study from a Prospective National Registry: Better Long-Term Survival in Esophageal Cancer After Minimally Invasive Compared with Open Transthoracic Esophagectomy. Ann Surg Oncol 29, 5609–5621 (2022). https://doi.org/10.1245/s10434-022-11922-5

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  • DOI: https://doi.org/10.1245/s10434-022-11922-5

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