Objectives: To evaluate the efficacy and advantage of minimally invasive esophagectomy for surgical treatment of submucosal esophageal cancer compared to conventional open procedure.
Methods: Clinical data of consecutive 168 patients with stage T1b submucosal esophageal cancer undergoing minimally invasive esophagectomy (MIE, esophagectomy by thoracoscope, stomach freeing by laparoscope or open abdomen, cervical esophagogastric anastomosis) or conventional open esophagectomy (OE) at the Shanghai Chest Hospital between January 1, 2012 and December 31, 2014 were reviewed retrospectively. Intraoperative and postoperative information was compared between the two groups.
Results: Both groups were equally stratified by sex, body mass index and age. No patient of MIE group was transferred to open operation. As compared to the OE group, the MIE group had significantly more harvest lymph nodes (median 12 vs. median 9, P=0.004), lower rate of postoperative pneumonia [5.8% (4/69) vs. 21.2% (21/99), P=0.011] and pleural effusion [8.7% (6/69) vs. 23.2% (23/99), P=0.027], and shorter hospital stay (median 11 d vs. median 14 d, P=0.041), but positive margin was found in 1 case. There were no significant differences of respiratory failure, pneumothorax, atrial arrhythmia, pulmonary embolism, recurrent nerve palsy, anastomotic leak, reoperations and 30-day mortality between the two groups. Multivariate logistic analysis revealed recurrent nerve palsy, anastomotic leak and surgical approach were found to be the main factors of hospital stay within postoperative 12 days, while leakage when the in-hospital time more than 12 days. Kaplan-Meier analysis showed that the surgical approach was the independent factor of hospital stay, MIE could shorten the hospital stay (P=0.013).
Conclusion: MIE should be considered as the standard approach in the treatment of T1b submucosal esophageal cancer.