title: Effects of hybrid minimally invasive oesophagectomy on major postoperative pulmonary complications.
abstract: BACKGROUND
  Morbidity after oesophageal cancer surgery remains high, mainly due to major postoperative pulmonary complications (MPPCs). The aim of this study was to test the hypothesis that hybrid minimally invasive oesophagectomy (HMIO) decreases the 30-day MPPC rate without compromising oncological outcomes.
  
  
  METHODS
  Consecutive patients undergoing curative oesophagectomy for cancer by laparoscopic gastric mobilization and open thoracotomy (HMIO) between January 2004 and December 2009 were matched to randomly selected patients undergoing a totally open approach during the same study interval. Matching variables were age, sex, cancer stage, location of the primary tumour, histological subtype, American Society of Anesthesiologists grade, malnutrition, neoadjuvant chemoradiation and epidural analgesia.
  
  
  RESULTS
  MPPCs at 30 days were significantly less frequent after HMIO compared with open surgery (15·7 versus 42·9 per cent; P < 0·001). Postoperative in-hospital mortality and overall morbidity rates were 4·3 and 47·5 per cent respectively, again significantly lower in the HMIO group: 1·4 versus 7·1 per cent (P = 0·018) and 35·7 versus 59·3 per cent (P < 0·001). In multivariable analysis, HMIO, adenocarcinoma subtype, epidural analgesia and surgery after 2006 were independent protective factors against MPPCs, and HMIO was independently protective against acute respiratory distress syndrome (ARDS). Lymph node yields and survival were similar in the two groups.
  
  
  CONCLUSIONS
  HMIO for oesophageal cancer, using laparoscopic gastric mobilization and open right thoracotomy, offered a substantial and independent protective effect against MPPCs, including ARDS, without compromising oncological outcomes.
authors.affiliation: Departments of Digestive and Oncological Surgery, University Hospital C. Huriez, Centre Hospitalier Régional Universitaire de Lille, France.
authors.forename: N
authors.initials: N
authors.lastname: Briez
authors.forename: G
authors.initials: G
authors.lastname: Piessen
authors.forename: F
authors.initials: F
authors.lastname: Torres
authors.forename: G
authors.initials: G
authors.lastname: Lebuffe
authors.forename: J-P
authors.initials: JP
authors.lastname: Triboulet
authors.forename: C
authors.initials: C
authors.lastname: Mariette
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000401:mortality; D008171:Lung Diseases / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult