title: Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer: A Comparison of Early Surgical Outcomes From The Society of Thoracic Surgeons National Database.
abstract: BACKGROUND
  Open esophagectomy results in significant morbidity and mortality. Minimally invasive esophagectomy (MIE) has become increasingly popular at specialized centers with the aim of improving perioperative outcomes. Numerous single-institution studies suggest MIE may offer lower short-term morbidity. The two approaches are compared using a large, multiinstitutional database.
  
  
  METHODS
  The Society of Thoracic Surgeons (STS) National Database (v2.081) was queried for all resections performed for esophageal cancer between 2008 and 2011 (n = 3,780). Minimally invasive approaches included both transhiatal (n = 214) and Ivor Lewis (n = 600), and these were compared directly with open transhiatal (n = 1,065) and Ivor Lewis (n = 1,291) procedures, respectively. Thirty-day outcomes were examined using nonparametric statistical testing.
  
  
  RESULTS
  Both open and MIE groups were similar in terms of preoperative risk factors. Morbidity and all-cause mortality were equivalent at 62.2% and 3.8%. MIE was associated with longer median procedure times (443.0 versus 312.0 minutes; p < 0.001), but a shorter median length of hospital stay (9.0 versus 10.0 days; p < 0.001). Patients who underwent MIE had higher rates of reoperation (9.9% versus 4.4%; p < 0.001) and empyema (4.1% versus 1.8%; p < 0.001). Open technique led to an increased rate of wound infections (6.3% versus 2.3%; p < 0.001), postoperative transfusion (18.7% versus 14.1%; p = 0.002), and ileus (4.5% versus 2.2%; p = 0.002). Propensity score-matched analysis confirmed these findings. High- and low-volume centers had similar outcomes.
  
  
  CONCLUSIONS
  Early results from the STS National Database indicate that MIE is safe, with comparable rates of morbidity and mortality as open technique. Longer procedure times and a higher rate of reoperation following MIE may reflect a learning curve.
authors.affiliation: Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: ssihag@partners.org.
authors.forename: Smita
authors.initials: S
authors.lastname: Sihag
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Andrzej S
authors.initials: AS
authors.lastname: Kosinski
authors.affiliation: Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Henning A
authors.initials: HA
authors.lastname: Gaissert
authors.affiliation: Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Wright
authors.affiliation: Department of Cardiothoracic Surgery, Oregon Health & Sciences University Medical Center, Portland, Oregon.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Schipper
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000601:surgery*; D016208:Databases, Factual; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009017:Morbidity / Q000639:trends; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors; D012955:Societies, Medical / Q000706:statistics & numerical data*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology