Outcomes, quality of life, and survival after esophagectomy for squamous cell carcinoma: A propensity score-matched comparison of operative approaches.
BACKGROUND
Minimally invasive esophagectomy (MIE) theoretically offers advantages compared with open esophagectomy (OE). However, the long-term outcomes have not been well studied, especially for esophageal squamous cell carcinoma. We retrospectively compared postoperative outcomes, quality of life (QOL), and survival in a matched population of patients undergoing MIE, with a control (OE) group.


METHODS
From May 2004 to August 2013, MIE was performed for a group of 735 patients, which was compared with a group of 652 cases of OE. Eventually, 444 paired cases, matched using propensity-score matching, were selected for further statistical analysis.


RESULTS
Compared with the OE group, the MIE group had shorter operation duration (191 ± 47 minutes vs 211 ± 44 minutes, P < .001); less blood loss (135 ± 74 ml vs 163 ± 84 ml, P < .001); similar lymph node harvest (24.1 ± 6.2 vs 24.3 ± 6.0, P = .607); shorter postoperative hospital stay (11 days [range: 7-90 days] vs 12 days [range: 8-112 days], P < .001); fewer major complications (30.4% vs 36.9%, P = .039); a lower readmission rate to the intensive-care unit (5.6% vs 9.7%, P = .023); and similar perioperative mortality (1.1% vs 2.0%, P = .281). At a median follow-up of 27 months, the 2-year overall survival rates in the MIE and OE group were: (1) stage 0 and I: 92% versus 90% (P = .864); (2) stage II: 83% versus 82% (P = .725); (3) stage III: 59% versus 55% (P = .592); (4) stage IV: 43% versus 43% (P = .802). The generalized estimating equation analysis showed that MIE had an independently positive impact on patients' postoperative QOL.


CONCLUSIONS
In our experience, MIE is a safe and effective procedure for the treatment of esophageal squamous cell carcinoma. It may offer better perioperative outcomes, better postoperative QOL, and equal oncologic survival, compared with OE.
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Hao
H
Wang
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Yaxing
Y
Shen
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Mingxiang
M
Feng
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Yi
Y
Zhang
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Wei
W
Jiang
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Songtao
S
Xu
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China. Electronic address: tan.lijie@zs-hospital.sh.cn.
Lijie
L
Tan
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Qun
Q
Wang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D057216:Propensity Score; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013906:Thoracoscopy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome