title: Minimally invasive esophagectomy provides significant survival advantage compared with open or hybrid esophagectomy for patients with cancers of the esophagus and gastroesophageal junction.
abstract: BACKGROUND
  Minimally invasive esophagectomy (MIE) is increasingly being used to treat patients with cancer of the esophagus and gastroesophageal junction. We previously reported that oncologic efficacy may be improved with MIE compared with open or hybrid esophagectomy (OHE). We compared survival of patients undergoing MIE and OHE.
  
  
  METHODS
  Our contemporary series of patients who underwent MIE (2008 to 2013) was compared with a cohort undergoing OHE (3-hole [n = 39], Ivor Lewis [n = 16], hybrid [n = 13], 2000 to 2013). Summary statistics were calculated by operation type; Kaplan-Meier methods were used to compare survival. Cox regression was used to assess the impact of operation type (MIE vs OHE) on mortality, adjusting for age, sex, total lymph nodes, lymph node ratio (LNR), neoadjuvant chemoradiotherapy (CRT), and stage.
  
  
  RESULTS
  The MIE (n = 104) and OHE (n = 68) groups were similar with respect to age and sex. The MIE group tended to have higher BMI, earlier stage disease, and was less likely to receive CRT. The MIE group experienced lower operative mortality (3.9% vs 8.8%, p = 0.35) and significantly fewer major complications. Five-year survival between groups was significantly different (MIE, 64%, OHE, 35%, p < 0.001). Multivariate analysis demonstrated that patients undergoing OHE had a significantly worse survival compared with MIE independent of age, LNR, CRT, and pathologic stage (hazard ratio 2.00, p = 0.019).
  
  
  CONCLUSIONS
  This study supports MIE for EC as a superior procedure with respect to overall survival, perioperative mortality, and severity of postoperative complications. Several biases may have affected these results: earlier stage in the MIE group and disparity in timing of the procedures. These results will need to be confirmed in future prospective studies with longer follow-up.
authors: The Jefferson Gastro-Esophageal Center, the Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA. Electronic address: Francesco.Palazzo@jefferson.edu.
authors: Francesco
authors: F
authors: Palazzo
authors: The Jefferson Gastro-Esophageal Center, the Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
authors: Ernest L
authors: EL
authors: Rosato
authors: The Jefferson Gastro-Esophageal Center, the Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
authors: Asadulla
authors: A
authors: Chaudhary
authors: The Jefferson Gastro-Esophageal Center, the Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
authors: Nathaniel R
authors: NR
authors: Evans
authors: Division of Biostatistics, Department of Clinical Pharmacology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
authors: Jocelyn A
authors: JA
authors: Sendecki
authors: Division of Biostatistics, Department of Clinical Pharmacology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
authors: Scott
authors: S
authors: Keith
authors: The Jefferson Gastro-Esophageal Center, the Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
authors: Karen A
authors: KA
authors: Chojnacki
authors: The Jefferson Gastro-Esophageal Center, the Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
authors: Charles J
authors: CJ
authors: Yeo
authors: The Jefferson Gastro-Esophageal Center, the Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
authors: Adam C
authors: AC
authors: Berger
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004943:Esophagogastric Junction; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009367:Neoplasm Staging; D010414:Pennsylvania / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome