Long-term outcomes following minimally invasive and open esophagectomy in Finland: A population-based study

: Eero Sihvo, Olli Helminen, Jarmo Gunn, Jussi O.T. Sipilä, Päivi Rautava, Ville Kytö

Publisher: Academic Press

: 2019

: EJSO - European Journal of Surgical Oncology

: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

: Eur J Surg Oncol

: 45

: 6

: 1099

: 1104

: 6

: 0748-7983

: 1532-2157

DOI: https://doi.org/10.1016/j.ejso.2018.12.001

Background
Studies of long-term survival after minimally invasive and open esophagectomy are needed. The aim of this study was to compare long-term outcomes following minimally invasive and open esophagectomy for esophageal cancer at the population level.
Methods
All patients undergoing minimally invasive (n = 159) or open transthoracic (n = 431) esophagectomy for esophageal cancer in Finland between 2004 and 2014 were identified from nationwide registries. Propensity score matching was used to create groups of 150 minimally invasive and open esophagectomies with balanced baseline characteristics (sex, age, comorbidity, center volume, year of surgery, histology, stage (local or locally advanced), and neoadjuvant therapy). The primary outcome was 1-year survival after surgery. Secondary outcomes were the 3-year, 5-year, and 90-day survival.
Results
The propensity matched 1-year survival rate was 85.3% after minimally invasive and 74.7% after open esophagectomy (adjusted HR 0.53, 95% CI 0.31–0.89; P = 0.0174). At 3 years, those were 68.7% and 55.6% (adjusted HR 0.62; 95% CI 0.43–0.91; P = 0.0144), respectively; at 5 years, survival rates were 61.8% and 51.9% (adjusted HR 0.68, 95% CI 0.47–0.97; P = 0.0347). The 30- and 90-day survival rates after minimally invasive and open surgery were 99.3% vs. 98.0% and 97.3% vs. 92.0%, respectively, without statistical significance.
Conclusions
In this population-based propensity matched study, minimally invasive esophagectomy was associated with improved long-term survival. Due to multiple confounding factors replication studies are needed.