title: Open versus minimally invasive esophagectomy: a single-center case controlled study.
abstract: BACKGROUND
  Recent advances in laparoscopic and thoracoscopic surgery have made it possible to perform esophagectomy using minimally invasive techniques. Although technically complex, recent case studies showed that minimally invasive approaches to esophagectomy are feasible and have the potential to improve mortality, hospital stay, and functional outcome.
  
  
  METHODS
  We have performed a case controlled pair-matched study comparing 62 patients who had undergone either minimally invasive (MIE) or open esophagectomy (OE) between 2004 and 2007. Patients were matched by tumor stage and localization, sex, age, and preoperative ASA score. Pathologic stage, operative time, blood loss, transfusion requirements, hospital length of stay, postoperative morbidity, and mortality were recorded.
  
  
  RESULTS
  Statistically significant differences were seen in the overall number of patients with surgical morbidity (MIE: 25% vs. OE: 74%, p = 0.014), the transfusion rate (MIE: 12.9% vs. OE: 41.9%, p = 0.001), and the rate of postoperative respiratory complications (MIE: 9.7% vs. OE: 38.7%, p = 0.008). There was no difference with respect to the duration of surgery. The number of resected lymph nodes and rate of pathologic complete resection were comparable. ICU stay [MIE: 3 days (range = 0-15) vs. OE: 6 days (range = 1-40), p = 0.03] and hospital stay [MIE: 12 days (range = 8-46) vs. OE: 24 days (range = 10-79), p = 0.001] were significantly shorter in the MIE group.
  
  
  CONCLUSIONS
  The results of this case-controlled study provide further evidence for the feasibility and possible improvements in the postoperative morbidity of minimally invasive esophagectomy. Our data are comparable to those from other centers and lead us to initiate the first prospectively randomized study comparing the morbidity of total minimally invasive esophagectomy with the open technique.
authors.affiliation: Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. sebastian.schoppmann@meduniwien.ac.at
authors.forename: Sebastian F
authors.initials: SF
authors.lastname: Schoppmann
authors.forename: Gerhard
authors.initials: G
authors.lastname: Prager
authors.forename: Felix B
authors.initials: FB
authors.lastname: Langer
authors.forename: Franz M
authors.initials: FM
authors.lastname: Riegler
authors.forename: Barbara
authors.initials: B
authors.lastname: Kabon
authors.forename: Edith
authors.initials: E
authors.lastname: Fleischmann
authors.forename: Johannes
authors.initials: J
authors.lastname: Zacherl
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
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