title: Short-term outcomes following open versus minimally invasive esophagectomy for cancer in England: a population-based national study.
abstract: OBJECTIVE
  To compare short-term outcomes of open and minimally invasive esophagectomy (MIE) for cancer.
  
  
  BACKGROUND
  Numerous studies have demonstrated the safety and possible advantages of MIE in selected cohorts of patients. The increasing use of MIE is not coupled with conclusive evidence of its benefits over "open" esophagectomy, especially in the absence of randomized trials.
  
  
  METHODS
  Hospital Episode Statistics data were analyzed from April 2005 to March 2010. This is a routinely collected database of all English National Health Service Trusts. Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures, 4th revision (OPCS-4), procedure codes were used to identify index resections and International Statistical Classification of Diseases, 10th Revision (ICD-10), diagnostic codes were used to ascertain comorbidity status and complications. Thirty-day in-hospital mortality, medical complications, and surgical reinterventions were analyzed. Unadjusted and risk-adjusted regression analyses were undertaken.
  
  
  RESULTS
  Seven thousand five hundred and two esophagectomies were undertaken; of these, 1155 (15.4%) were MIE. In 2009-2010, 24.7% of resections were MIE. There was no difference in 30-day mortality (4.3% vs 4.0%; P = 0.605) and overall medical morbidity (38.0% vs 39.2%; P = 0.457) rates between open and MIE groups, respectively. A higher reintervention rate was associated with the MIE group than with the open group (21% vs 17.6%, P = 0.006; odds ratio, 1.17; 95% confidence interval, 1.00-1.38; P = 0.040).
  
  
  CONCLUSIONS
  Minimally invasive esophagectomy is increasingly performed in the United Kingdom. Although the study confirmed the safety of MIE in a population-based national data, there are no significant benefits demonstrated in mortality and overall morbidity. Minimally invasive esophagectomy is associated with higher reintervention rate. Further evidence is needed to establish the long-term survival of MIE.
authors.affiliation: Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, United Kingdom.
authors.forename: Ravikrishna
authors.initials: R
authors.lastname: Mamidanna
authors.forename: Alex
authors.initials: A
authors.lastname: Bottle
authors.forename: Paul
authors.initials: P
authors.lastname: Aylin
authors.forename: Omar
authors.initials: O
authors.lastname: Faiz
authors.forename: George B
authors.initials: GB
authors.lastname: Hanna
mesh_terms: D000368:Aged; D004739:England; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000639:trends; D005260:Female; D017052:Hospital Mortality; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000639:trends; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000639:trends; D016896:Treatment Outcome