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Erschienen in: Langenbeck's Archives of Surgery 4/2020

09.05.2020 | Original Article

Propensity score–matched comparison between open and minimal invasive hybrid esophagectomy for esophageal adenocarcinoma

verfasst von: Arnulf H. Hölscher, Tom R. DeMeester, Henner Schmidt, Felix Berlth, Elfriede Bollschweiler

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 4/2020

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Abstract

Background

This study compared the outcome between patients who had an open and those who had a hybrid esophagectomy for T1 or T3 esophageal adenocarcinoma (eAC). No clear data are available concerning this question based on T-category.

Methods

Two groups of patients with esophagectomy and high intrathoracic esophagogastrostomy for eAC were analyzed: hybrid (laparoscopy + right thoracotomy) (n = 835) and open (laparotomy + right thoracotomy) (n = 188). Outcome criteria were 30- and 90-day mortality, R0-resection rate (R0), number of resected lymph nodes (rLNs), and 5-year survival rate (5y-SR). For each type of surgery, three patient groups were analyzed: pT1-carcinoma (group-1), cT3Nx and neoadjuvant chemoradiation (group-2), and pT3N0-3 without neoadjuvant therapy (group-3). The comparison was based on a propensity score matching in relation of 1:2 for open versus hybrid.

Results

In group-1 (38 open vs 76 hybrid) R0-resection (100%), 30-day mortality (0%), 90-day mortality (2.6% vs 0%), and rLNs (median 29.5 vs 28.5) were not significantly different. The pN0-rate was 76% in the open and 92% in the hybrid group (p = 0.036). Accordingly, the 5y-SR was 69% and 87% (p = 0.016), but the prognosis of the subgroups pT1pN0 or pT1pN+ was not significantly different between open or hybrid. In group-2 (68 open vs 135 hybrid) R0-resection (97%), 30-day (0% vs 0.7%) and 90-day (4%) mortality, rLNs (28.5 vs 26), and 5y-SR (36% vs 41%) were not significantly different. In group-3 (37 open vs 75 hybrid) R0, postoperative mortality, rLNs, and 5y-SR were not significantly different.

Conclusion

In a propensity score–matched comparison of patients with an open or hybrid esophagectomy for esophageal adenocarcinoma the quality of oncologic resection, postoperative mortality and prognosis are not different.
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Metadaten
Titel
Propensity score–matched comparison between open and minimal invasive hybrid esophagectomy for esophageal adenocarcinoma
verfasst von
Arnulf H. Hölscher
Tom R. DeMeester
Henner Schmidt
Felix Berlth
Elfriede Bollschweiler
Publikationsdatum
09.05.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 4/2020
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-020-01882-3

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