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Survival After Esophagectomy: A Propensity-Matched Study of Different Surgical Approaches
Journal article   Peer reviewed

Survival After Esophagectomy: A Propensity-Matched Study of Different Surgical Approaches

Benny Weksler and Jennifer L Sullivan
The Annals of thoracic surgery, v 104(4), pp 1138-1146
Oct 2017
DOI: https://doi.org/10.1016/j.athoracsur.2017.04.065
PMID: 28760463
Featured in Collection :   UN Sustainable Development Goals @ Drexel
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https://doi.org/10.1016/j.athoracsur.2017.04.065View
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Abstract

Cause of Death Cohort Studies Databases, Factual Disease-Free Survival Esophageal Neoplasms - mortality Esophageal Neoplasms - pathology Esophageal Neoplasms - surgery Esophagectomy - methods Esophagectomy - mortality Female Humans Kaplan-Meier Estimate Laparoscopy - methods Laparoscopy - mortality Logistic Models Male Middle Aged Minimally Invasive Surgical Procedures - methods Minimally Invasive Surgical Procedures - mortality Multivariate Analysis Neoplasm Invasiveness - pathology Neoplasm Staging Prognosis Propensity Score Retrospective Studies Robotic Surgical Procedures - methods Robotic Surgical Procedures - mortality Survival Analysis Thoracoscopy - methods Thoracoscopy - mortality Thoracotomy - methods Treatment Outcome
Although open esophagectomy (OE) is considered the "gold standard" treatment for esophageal cancer, robotic-assisted minimally invasive esophagectomy (RAMIE), and laparoscopic/thoracoscopic minimally invasive esophagectomy (MIE) are becoming more common. This study aimed to compare short-term outcomes and overall survival of patients undergoing RAMIE, MIE, and OE. The National Cancer Data Base was queried for patients who had OE, RAMIE, or MIE for esophageal cancer from 2010 to 2013. Three propensity-matched cohorts were generated, one for each surgical approach. Survival was examined in the unmatched and matched cohorts. We identified 9,217 patients who underwent RAMIE (581; 6.3%), MIE (2,379; 25.8%), or OE (6,257; 67.9%). In the unmatched cohort, 30-day mortality was higher after RAMIE. The RAMIE and MIE patients had more lymph nodes harvested than OE patients. Median survival was 48 months after RAMIE, 44 months after MIE, and 41 months after OE (p = 0.121). The propensity-matched groups contained 569 patients each. There was a trend toward higher 30-day mortality in the RAMIE group. The number of lymph nodes harvested was similar among the groups. There were no significant differences in survival, with a median survival of 48 months after RAMIE, 49 months after MIE, and 44 months after OE (p = 0.53). We were unable to find significant differences in long-term survival of patients with esophageal cancer undergoing RAMIE, OE, or MIE. Surgeon experience and expertise may be more important than surgical approach for esophageal cancer.

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66 citations in Web of Science
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UN Sustainable Development Goals (SDGs)

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#3 Good Health and Well-Being

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Web of Science research areas
Cardiac & Cardiovascular Systems
Respiratory System
Surgery
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