University of Minnesota Medical School Minneapolis, Minnesota, United States
Disclosure(s):
Qianyun Luo, BS: No financial relationships to disclose
Purpose: The increasing incidence of esophageal cancer presents a significant medical challenge. Minimally invasive surgery (MIS) offers comparable survival and fewer complications than open esophagectomy. However, the optimal surgical approach after neoadjuvant therapy remains uncertain. This study aims to analyze outcomes of MIS and open esophagectomy following neoadjuvant therapy. Methods: A retrospective analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) esophagectomy targeted database to identify patients who underwent esophagectomy post-neoadjuvant therapy from 2016 to 2021 based on CPT codes. The cohorts were divided into two groups: those who underwent MIS surgery and those who underwent open surgery. Multivariable analysis, adjusting for variables such as age, race, socioeconomic status, comorbidity, and hospital characteristics, was conducted to compare 30-day perioperative outcomes. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated between the cohorts. Results: A total of 3,105 patients who underwent esophagectomy post-neoadjuvant therapy were identified in NSQIP. Of which, 1,654 patients underwent MIS esophagectomy and 1,451 patients underwent open surgery. Compared to patients who underwent open surgery, the MIS group had lower mortality (aOR 0.622, p=0.04), MACE (aOR 0.48, p< 0.01), and cardiac complications (aOR 0.494, p=0.01). No difference was found in esophageal anastomotic leak (aOR 1.073, p=0.51), wound complications (aOR 1.185, p=0.33), renal dysfunction (aOR 0.558, p=0.09), clot formation (aOR 0.987, p=0.94), pulmonary complication (aOR 0.827, p=0.06), bleeding events (aOR 0.674, p = 0.09), sepsis (aOR 1.143, p=0.53) or reoperation (aOR 0.832, p=0.08). However, the MIS group had higher positive margin compared to patients who underwent open surgery post-neoadjuvant therapy (aOR 1.63, p< 0.01). Conclusion: Minimally Invasive Surgery showed favorable outcomes in esophagectomy following neoadjuvant therapy, with lower mortality and reduced cardiac complications. However, further research is needed to address the higher rate of positive margins in the MIS group.
Identify the source of the funding for this research project: This project received no funding.
