Introduction of hybrid minimally invasive esophagectomy and comparison of perioperative outcomes following open versus hybrid esophagectomy; a propensity-matched retrospective study.

Abstract

INTRODUCTION: Esophagectomy is associated with increased rate of postoperative complications, making it one of the procedures with the highest impact on patients’ quality of life. Hybrid Ivor Lewis esophagectomy with laparoscopy and thoracotomy has been developed with the aim to reduce postoperative morbidity without to compromise oncological outcomes. We conducted this survey under the hypothesis that the hybrid approach results in reduced postoperative complications with equivalent oncological outcomes in two similarly matched groups of patients. METHODS: Propensity score matching was used to remove bias attributed to observational studies. After generating propensity scores using the variables age, body mass index, pulmonary comorbidities, cardiac comorbidities, histologic type, and neoadjuvant treatment, 17 patients in the hybrid group were matched with 17 patients in the open group. Surgical outcomes, oncological outcomes, and postoperative complications according to the guidelines of the Esophageal Complications Consensus Group were compared between the two groups. RESULTS: Open and hybrid procedures showed similar surgical and oncological outcomes. Although the hybrid group spent more time in the intensive care unit, the length of hospital stay was comparable between the groups. The rate of postoperative complications was similar between the two approaches. DISCUSSION: Our hypothesis that laparoscopy could reduce postoperative complications was not confirmed. Hybrid Ivor Lewis esophagectomy is a safe procedure, resulting in radical oncological resection and similar morbidity with open esophagectomy. Surgeons who are proficient in open approach and laparoscopic anti-reflux and gastric surgery can safely adopt the hybrid approach without significant learning curve associated morbidity.