title: Minimally invasive versus open esophagectomy for patients with esophageal cancer.
abstract: BACKGROUND
  Minimally invasive esophagectomy (MIE) compared with open esophagectomy (OE) has been shown to have clinical advantages, but selection bias is present.
  
  
  METHODS
  All patients undergoing MIE or OE for cancer between 1999 and 2007 were eligible for analysis. To minimize selection bias, only patients who also met the selection criteria for the thoracoscopic approach were included in the open esophagectomy group.
  
  
  RESULTS
  Fifty-six patients underwent MIE and 98 OE. No significant differences in demographics or pathologic data between groups occurred, with the exception of thoracic epidural analgesia (OE 98%, MIE 71.1%, p < 0.001), and neoadjuvant treatment (OE 50.5%, MIE 71.4%, p = 0.016). Morbidity and in-hospital death were not significantly different. Duration of surgery was longer in MIE (250 vs 209 minutes, p < 0.001) and blood loss less (320 mL vs 857 mL, p < 0.001). Intensive care unit stay was shorter in MIE (3.0 vs 6.8 days, p = 0.022). The relative risk (RR) for in-hospital death was 0.57 (p = 0.475) if the patients underwent MIE. After adjusting for thoracic epidural analgesia, the RR was 0.29 (p = 0.213) for the MIE group. The RR for surgical morbidity was 1.47 (p = 0.154) for patients undergoing MIE. Neoadjuvant treatment increased the RR for surgical morbidity to 1.78 (p = 0.028). No difference between the two groups concerning survival occurred.
  
  
  CONCLUSIONS
  The MIE is comparable with the OE. In MIE, neoadjuvant treatment increased the risk of surgical morbidity. Thoracic epidural analgesia in MIE reduced the risk of in-hospital death and should be considered for all patients undergoing esophagectomy.
authors.affiliation: Department of Surgery, Flinders Medical Centre, Flinders University, South Australia, Australia. uzingg@uhbs.ch
authors.forename: Urs
authors.initials: U
authors.lastname: Zingg
authors.forename: Alexander
authors.initials: A
authors.lastname: McQuinn
authors.forename: Dennis
authors.initials: D
authors.lastname: DiValentino
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Esterman
authors.forename: Justin R
authors.initials: JR
authors.lastname: Bessell
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Thompson
authors.forename: Glyn G
authors.initials: GG
authors.lastname: Jamieson
authors.forename: David I
authors.initials: DI
authors.lastname: Watson
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D015996:Survival Rate; D016896:Treatment Outcome