Population-Based Cohort Study from a Prospective National Registry : Better Long-Term Survival in Esophageal Cancer After Minimally Invasive Compared with Open Transthoracic Esophagectomy
(2022) In Annals of Surgical Oncology 29(9). p.5609-5621- Abstract
BACKGROUND: Recent research indicates long-term survival benefits of minimally invasive esophagectomy (MIE) compared with open esophagectomy (OE) for patients with esophageal and gastroesophageal junction (GEJ) cancers, but there is a need for more population-based studies.
METHODS: We conducted a prospective population-based nationwide cohort study including all patients in Sweden diagnosed with esophageal or junctional cancer who underwent a transthoracic esophagectomy with intrathoracic anastomosis. Data were collected from the Swedish National Register for Esophageal and Gastric Cancer in 2006-2019. Patients were grouped into OE and MIE including hybrid MIE (HMIE) and totally MIE (TMIE). Overall survival and short-term... (More)
BACKGROUND: Recent research indicates long-term survival benefits of minimally invasive esophagectomy (MIE) compared with open esophagectomy (OE) for patients with esophageal and gastroesophageal junction (GEJ) cancers, but there is a need for more population-based studies.
METHODS: We conducted a prospective population-based nationwide cohort study including all patients in Sweden diagnosed with esophageal or junctional cancer who underwent a transthoracic esophagectomy with intrathoracic anastomosis. Data were collected from the Swedish National Register for Esophageal and Gastric Cancer in 2006-2019. Patients were grouped into OE and MIE including hybrid MIE (HMIE) and totally MIE (TMIE). Overall survival and short-term postoperative outcomes were compared using Cox regression and logistic regression models, respectively. All models were adjusted for age, sex, American Society of Anesthesiologists (ASA) score, clinical T and N stage, neoadjuvant therapy, year of surgery, and hospital volume.
RESULTS: Among 1404 patients, 998 (71.1%) underwent OE and 406 (28.9%) underwent MIE. Compared with OE, overall survival was better following MIE (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.55-0.94), TMIE (HR 0.67, 95% CI 0.47-0.94), and possibly also after HMIE (HR 0.76, 95% CI 0.56-1.02). MIE was associated with shorter operation time, less intraoperative bleeding, higher number of resected lymph nodes, and shorter hospital stay compared with OE. MIE was also associated with fewer overall complications (odds ratio [OR] 0.70, 95% CI 0.47-1.03) as well as non-surgical complications (OR 0.64, 95% CI 0.40-1.00).
CONCLUSIONS: MIE seems to offer better survival and similar or improved short-term postoperative outcomes in esophageal and GEJ cancers compared with OE in this unselected population-based cohort.
(Less)
- author
- publishing date
- 2022-09
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cohort Studies, Esophageal Neoplasms/surgery, Esophagectomy, Humans, Minimally Invasive Surgical Procedures, Postoperative Complications/surgery, Prospective Studies, Registries, Retrospective Studies, Stomach Neoplasms/surgery, Treatment Outcome
- in
- Annals of Surgical Oncology
- volume
- 29
- issue
- 9
- pages
- 5609 - 5621
- publisher
- Springer
- external identifiers
-
- pmid:35752726
- scopus:85132185407
- ISSN
- 1534-4681
- DOI
- 10.1245/s10434-022-11922-5
- language
- English
- LU publication?
- no
- id
- ee7a6461-6e4d-4aa4-add2-7d9d99c818c1
- date added to LUP
- 2022-09-19 19:32:05
- date last changed
- 2024-06-14 04:30:31
@article{ee7a6461-6e4d-4aa4-add2-7d9d99c818c1,
abstract = {{<p>BACKGROUND: Recent research indicates long-term survival benefits of minimally invasive esophagectomy (MIE) compared with open esophagectomy (OE) for patients with esophageal and gastroesophageal junction (GEJ) cancers, but there is a need for more population-based studies.</p><p>METHODS: We conducted a prospective population-based nationwide cohort study including all patients in Sweden diagnosed with esophageal or junctional cancer who underwent a transthoracic esophagectomy with intrathoracic anastomosis. Data were collected from the Swedish National Register for Esophageal and Gastric Cancer in 2006-2019. Patients were grouped into OE and MIE including hybrid MIE (HMIE) and totally MIE (TMIE). Overall survival and short-term postoperative outcomes were compared using Cox regression and logistic regression models, respectively. All models were adjusted for age, sex, American Society of Anesthesiologists (ASA) score, clinical T and N stage, neoadjuvant therapy, year of surgery, and hospital volume.</p><p>RESULTS: Among 1404 patients, 998 (71.1%) underwent OE and 406 (28.9%) underwent MIE. Compared with OE, overall survival was better following MIE (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.55-0.94), TMIE (HR 0.67, 95% CI 0.47-0.94), and possibly also after HMIE (HR 0.76, 95% CI 0.56-1.02). MIE was associated with shorter operation time, less intraoperative bleeding, higher number of resected lymph nodes, and shorter hospital stay compared with OE. MIE was also associated with fewer overall complications (odds ratio [OR] 0.70, 95% CI 0.47-1.03) as well as non-surgical complications (OR 0.64, 95% CI 0.40-1.00).</p><p>CONCLUSIONS: MIE seems to offer better survival and similar or improved short-term postoperative outcomes in esophageal and GEJ cancers compared with OE in this unselected population-based cohort.</p>}},
author = {{Hayami, Masaru and Ndegwa, Nelson and Lindblad, Mats and Linder, Gustav and Hedberg, Jakob and Edholm, David and Johansson, Jan and Lagergren, Jesper and Lundell, Lars and Nilsson, Magnus and Rouvelas, Ioannis}},
issn = {{1534-4681}},
keywords = {{Cohort Studies; Esophageal Neoplasms/surgery; Esophagectomy; Humans; Minimally Invasive Surgical Procedures; Postoperative Complications/surgery; Prospective Studies; Registries; Retrospective Studies; Stomach Neoplasms/surgery; Treatment Outcome}},
language = {{eng}},
number = {{9}},
pages = {{5609--5621}},
publisher = {{Springer}},
series = {{Annals of Surgical Oncology}},
title = {{Population-Based Cohort Study from a Prospective National Registry : Better Long-Term Survival in Esophageal Cancer After Minimally Invasive Compared with Open Transthoracic Esophagectomy}},
url = {{http://dx.doi.org/10.1245/s10434-022-11922-5}},
doi = {{10.1245/s10434-022-11922-5}},
volume = {{29}},
year = {{2022}},
}