title: Open versus minimally invasive esophagectomy: trends of utilization and associated outcomes in England.
abstract: OBJECTIVE
  To assess the trends in uptake of minimal invasive esophagectomy in England over the last 12 years (1996/1997-2007/2008) and to compare their clinical outcomes with those after open esophagectomy.
  
  
  BACKGROUND
  Around 7400 people are affected each year in the United Kingdom. Prognosis following esophageal resection is, however, poor. Even after "curative" surgery, 5-year survival rates do not exceed 25%. The minimally invasive approach to esophagectomy has attracted attention as a potentially less invasive alternative to conventional surgery.
  
  
  METHODS
  Data on patients undergoing esophagectomy for esophageal cancer were extracted from a national administrative database. The outcomes of interest were in-hospital mortality, 30-day in-hospital mortality, 30-day total (ie, in and out of hospital) mortality, 365-day total mortality, 28-day emergency readmission rates, and length of hospital stay. Hierarchical logistic regression was used to identify the effect of minimal invasive esophagectomy (MIE) on the outcomes after adjustment for age, gender, socioeconomic deprivation, and comorbidity.
  
  
  RESULTS
  A total of 18,673 esophagectomies were performed over the 12-year study period. The use of minimal access surgery increased exponentially over time (from 0.6% in 1996/1997 to 16.0% in 2007/2008). There was a suggestion that patients undergoing MIE had better 1-year survival rates than patients receiving open esophagectomy (OR = 0.68, 95% CI = 0.46-1.01, P = 0.058).
  
  
  CONCLUSIONS
  The uptake of MIE in England is increasing exponentially. With the possible exception of 1-year survival, patients selected for MIE demonstrated similar mortality and length of stay outcomes when compared with those undergoing conventional surgery. These results need to be confirmed in large-scale randomized controlled trials.
authors.affiliation: Dr Foster Unit at Imperial College, Department of Primary Care and Social Medicine, Imperial College London, London, United Kingdom. a.lazzarino@imperial.ac.uk
authors.forename: Antonio Ivan
authors.initials: AI
authors.lastname: Lazzarino
authors.forename: Kamal
authors.initials: K
authors.lastname: Nagpal
authors.forename: Alex
authors.initials: A
authors.lastname: Bottle
authors.forename: Omar
authors.initials: O
authors.lastname: Faiz
authors.forename: Krishna
authors.initials: K
authors.lastname: Moorthy
authors.forename: Paul
authors.initials: P
authors.lastname: Aylin
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D015996:Survival Rate; D006113:United Kingdom