148. comparison of early postoperative outcome between open and minimally invasive transthoracic esophagectomy for esophageal cancer: a retrospective study

Abstract Background Esophagectomy is a highly invasive surgical procedure for esophageal cancer, with open thoracotomy associated with a significant risk of pulmonary complications. Minimally invasive techniques, such as minimally invasive esophagectomy (MIE), are expected to reduce these complications and enhance postoperative recovery. This study aimed to compare the early postoperative outcomes of patients who underwent open esophagectomy versus MIE. Methods We conducted a retrospective study using a single-center database from January 1, 2010, to February 28, 2023, including patients aged 18–90 years with a resectable lesion of the esophagus or esophagogastric junction who underwent either open transthoracic esophagectomy or MIE (thoracoscopic/robotic-assisted). Patient data, surgical procedures, interventions, and early outcomes (within 30 days of operation) were collected and analyzed. The study included a total of 76 patients, with 50 patients in open esophagectomy group and 26 patients in MIE group. The primary outcome was the incidence of pulmonary complications during the hospital stay, and logistic regression was used for data analysis. Results The overall incidence of pulmonary complications was 37 cases (74%) in the open esophagectomy group and 14 cases (53.8%) in the MIE group, with the incidence of pulmonary infection occurring in 19 cases (38%) and 8 cases (30.8%), respectively. Perioperative mortality was 1 cases (2%) in the open esophagectomy group and 0 cases (0%) in the MIE group. After adjusting for age, sex, BMI, smoking, COPD, and operative time, the open esophagectomy group had a 4.29 times higher risk of pulmonary complications than the MIE group (odds ratio 4.29, 95% confidence interval 1.30–14.16; p = 0.017). Conclusion Our study demonstrates that MIE is associated with a lower incidence of pulmonary complications, reduced blood loss, and shorter ICU stays compared to open esophagectomy. Rates of anastomosis leakage, vocal cord paralysis, and hospital stays were comparable. These findings support the feasibility and safety of MIE, potentially improving surgical outcomes and enhancing postoperative recovery for the treatment of esophageal cancer.