title: Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer: A Population-Based Analysis.
abstract: The objective of this study was to evaluate outcomes of minimally invasive approaches to esophagectomy using population-level data.
  
  
  
  Multivariable regression modeling was used to determine predictors associated with the use of minimally invasive approaches for patients in the National Cancer Data Base who underwent resection of middle and distal clinical T13N03M0 esophageal cancers from 2010 to 2012. Perioperative outcomes and 3-year survival were compared between propensity-matched groups of patients with esophageal cancer who underwent minimally invasive esophagectomy (MIE) or open esophagectomy (OE). A subgroup analysis was performed to evaluate the impact of using robotic-assisted operations as part of the minimally invasive approach.
  
  
  
  Among 4,266 patients included, 1,308 (30.6%) underwent MIE. It was more likely to be used in patients treated at academic (adjusted odds ratio [OR], 10.1; 95% confidence interval [CI], 4.2-33.1) or comprehensive cancer facilities (adjusted OR, 6.4; 95% CI, 2.6-21.1). Compared with propensity-matched patients who underwent OE, patients who underwent MIE had significantly more lymph nodes examined (15 versus 13; p = 0.016) and shorter hospital lengths of stay (10 days versus 11 days; p = 0.046) but similar resection margin positivity, readmission, and 30-day mortality (all p > 0.05). Survival was similar between the matched groups at 3 years for both adenocarcinoma and squamous cell carcinoma (p > 0.05). Compared with MIE without robotic assistance, use of a robotic approach was not associated with any significant differences in perioperative outcomes (p > 0.05).
  
  
  
  The use of minimally invasive techniques to perform esophagectomy for esophageal cancer is associated with modestly improved perioperative outcomes without compromising survival.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Babatunde A
authors.initials: BA
authors.lastname: Yerokun
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Zhifei
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Chi-Fu Jeffrey
authors.initials: CJ
authors.lastname: Yang
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Gulack
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Adam
authors.affiliation: Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.affiliation: Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Onaitis
authors.affiliation: Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
authors.affiliation: Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: matthew.hartwig@duke.edu.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013906:Thoracoscopy / Q000379:methods*; D013997:Time Factors; D014481:United States / Q000453:epidemiology