Introduction: Evidence on the safety of minimally invasive oesophagectomy (MIO) compared to open oesophagectomy (OO) in nationwide practice is lacking. The aim of this study was to compare surgical complications after MIO and OO in a nationwide, population-based, unselected cohort.

Materials and methods: Descriptive statistics were used to report complications and complication categories defined by the Oesophagectomy Complications Consensus Group, major complications, reoperations and 90-day mortality in all patients undergoing MIO and OO in Finland during 2007–2016. Main outcomes were compared using logistic regression, adjusting for confounding.

Results: Out of 699 patients, 295 (42 %) underwent MIO and 404 (58 %) underwent OO. Rates of anastomotic leakage (10 % vs 14 %, OR 0.47 (0.25–0.89)), intrathoracic abscesses (3 % vs 9 %, OR 0.13 (0.05–0.46)), major complications (35 % vs 47 %, OR 0.39 (0.25–0.60)) and reoperations (18 % vs 26 %, OR 0.43 (0.26–0.73)) were lower with MIO. Rates of pneumonia (16 % vs 27 %, OR 0.62 (0.38–1.03)), intra-abdominal abscesses (0.7 % vs 3.0 %, OR 0.20 (0.04–1.13)) and 90-day mortality (3.1 % vs 6.7 %, HR 0.48 (0.18–1.26)) were lower with MIO, but non-significant after adjustment. Pulmonary complications (36 % vs 46 %, OR 0.63 (0.41–0.96)) and infectious complications (11 % vs 22 %, OR 0.41 (0.23–0.73)) were less common with MIO, while rates of cardiac, gastrointestinal, urologic, thromboembolic, and neurologic complications were similar.

Conclusion: This study suggests a significant reduction in various surgical complications in patients undergoing MIO compared to OO and that implementing MIO into nationwide practice can be done safely.