title: Changes in oncological outcomes: comparison of the conventional and minimally invasive esophagectomy, a single institution experience.
abstract: Minimally invasive esophagectomy is becoming the routine procedure for resectable esophageal cancer. The aim of this retrospective study is to analyze the oncologic adequacy of these two procedures at our Centre. Out of 1252 registered esophageal cancer patients at our institute from 2006 to 2015, 206 patients who underwent a surgical resection with curative intent and a complete medical record were retrospectively evaluated thru hospital medical record system (HIS). Patients were allocated into the conventional open OE, and minimally invasive MIE and Hybrid esophagectomy groups. Primary outcomes are tumor recurrence and disease-free survival over a minimum follow-up of 1 year along with assessment of adequacy of pathological specimen in terms of lymph nodes harvested and clear longitudinal <1 cm and circumferential (≥1 mm) resection margins for patients with post-neo-adjuvant residual disease. Secondary endpoint is to look for trends in the adequacy of oncologic clearance in each group over the study period. Overall, there was no statistically significant difference (p > 0.05) between groups (OE vs. MIE vs. Hybrid) for median number of lymph nodes retrieved (13 vs.14 vs.15), resection margin positive disease (55.8 vs. 35.7 vs. 44 % of patients with any residual disease N = 103,50 %), or tumor recurrence (45.2 vs. 37.3 vs. 25 %). Disease-free survival over a mean follow-up of 2.3 years was higher in the conventional group (13.8 months vs. 9.7MIE and 11.8hybrid) without any statistical significance. Learning curve for MIE to achieve a comparable mean lymph nodes harvest to OE was 1 year, while pathological complete resection stayed persistently better with minimally invasive approach. Minimally invasive esophagectomy is found to be oncologically adequate and gives results matching their conventional analogue with an increasing experience.
authors.affiliation: Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre SKMCH & RC, 7-A Block R-3, Johar Town, Lahore, 54000, Pakistan. misbahkhan52@gmail.com.
authors.forename: Misbah
authors.identifier: http://orcid.org/0000-0001-6076-8415
authors.initials: M
authors.lastname: Khan
authors.affiliation: Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre SKMCH & RC, 7-A Block R-3, Johar Town, Lahore, 54000, Pakistan.
authors.forename: Anam
authors.initials: A
authors.lastname: Muzaffar
authors.affiliation: Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre SKMCH & RC, 7-A Block R-3, Johar Town, Lahore, 54000, Pakistan.
authors.forename: Aamir Ali
authors.initials: AA
authors.lastname: Syed
authors.affiliation: Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre SKMCH & RC, 7-A Block R-3, Johar Town, Lahore, 54000, Pakistan.
authors.forename: Shahid
authors.initials: S
authors.lastname: Khatak
authors.affiliation: Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre SKMCH & RC, 7-A Block R-3, Johar Town, Lahore, 54000, Pakistan.
authors.forename: Ali Raza
authors.initials: AR
authors.lastname: Khan
authors.affiliation: Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre SKMCH & RC, 7-A Block R-3, Johar Town, Lahore, 54000, Pakistan.
authors.forename: Muhammad Ijaz
authors.initials: MI
authors.lastname: Ashraf
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010154:Pakistan / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Conventional esophagectomy; Esophageal cancer surgery; Minimally invasive esophagectomy; Oncologic outcomes; Oncologic surgery