SpringerLink
Log in

Outcomes of minimally invasive total mesoesophageal excision: a propensity score-matched analysis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

This study aimed to investigate the safety and efficacy of minimally invasive total mesoesophageal excision (TME) for esophageal cancer.

Methods

We retrospectively collected data from patients with esophageal cancer who underwent esophagectomy at our center between January 2011 and June 2017. Among 611 eligible patients, 302 underwent minimally invasive total mesoesophageal excision (the TME group) and 309 underwent non-total mesoesophageal excision (the NME group). Outcomes were compared after 1-to-1 propensity score matching, and subgroup analyses were performed for cases involving pT1–2 or pT3–4a disease.

Results

The propensity score matching produced 249 pairs of patients. The TME group had a shorter operative time (P < 0.001), lower intraoperative bleeding (P < 0.001), and a shorter postoperative hospital stay (P < 0.001). There were no significant differences between the two groups in the number of removed lymph nodes, 30-day mortality, or postoperative complications. In addition, both groups had similar 3-year rates of overall survival (OS) and disease-free survival (DFS). However, the 3-year recurrence rate in the esophageal bed was significantly lower in the TME group (P = 0.033). Furthermore, among patients with pT3–4a disease, the TME group had better 3-year rates of OS, DFS, and recurrence.

Conclusion

Minimally invasive total mesoesophageal excision appears to be a safe technique that can reduce tumor recurrence in the esophageal bed. Furthermore, this technique provided survival benefits for patients with pT3–4a disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Rustgi AK, El-Serag HB (2014) Esophageal carcinoma. N Engl J Med 371:2499–2509

    Article  Google Scholar 

  2. Kikuchi H, Takeuchi H (2018) Future perspectives of surgery for esophageal cancer. Ann Thorac Cardiovasc Surg 24:219–222

    Article  Google Scholar 

  3. Matsubara T, Ueda M, Nagao N, Takahashi T, Nakajima T, Nishi M (1998) Cervicothoracic approach for total mesoesophageal dissection in cancer of the thoracic esophagus. J Am Coll Surg 187:238–245

    Article  CAS  Google Scholar 

  4. Tachimori Y (2014) Total mesoesophageal esophagectomy. Chin Med J 127:574–579

    PubMed  Google Scholar 

  5. Hwang SE, Kim JH, Bae SI, Rodriguez-Vazquez JF, Murakami G, Cho BH (2014) Mesoesophagus and other fascial structures of the abdominal and lower thoracic esophagus: a histological study using human embryos and fetuses. Anat Cell Biol 47:227–235

    Article  Google Scholar 

  6. Cuesta MA, Weijs TJ, Bleys RL, van Hillegersberg R, van Berge Henegouwen MI, Gisbertz SS, Ruurda JP, Straatman J, Osugi H, van der Peet DL (2015) A new concept of the anatomy of the thoracic oesophagus: the meso-oesophagus. Observational study during thoracoscopic esophagectomy. Surg Endosc 29:2576–2582

    Article  Google Scholar 

  7. Akiyama Y, Iwaya T, Endo F, Nikai H, Sato K, Baba S, Chiba T, Kimura T, Takahara T, Otsuka K, Nitta H, Mizuno M, Kimura Y, Koeda K, Sasaki A (2018) Thoracoscopic esophagectomy with total meso-esophageal excision reduces regional lymph node recurrence. Langenbecks Arch Surg 403:967–975

    Article  Google Scholar 

  8. Tsunoda S, Shinohara H, Kanaya S, Okabe H, Tanaka E, Obama K, Hosogi H, Hisamori S, Sakai Y (2020) Mesenteric excision of upper esophagus: a concept for rational anatomical lymphadenectomy of the recurrent laryngeal nodes in thoracoscopic esophagectomy. Surg Endosc 34:133–141

    Article  Google Scholar 

  9. Santillan AA, Farma JM, Meredith KL, Shah NR, Kelley ST (2008) Minimally invasive surgery for esophageal cancer. J Natl Compr Cancer Netw 6:879–884

    Article  Google Scholar 

  10. Chinese Society of Esophagenal Cancer CA-CA (2011) Clinical practice guidelines for the diagnosis and treatment of esophageal cancer, 1st edn. Peking Union Medical College Press, China

    Google Scholar 

  11. Chinese Society of Esophagenal Cancer CA-CA (2013) Clinical practice guidelines for the diagnosis and treatment of esophageal cancer, 2nd edn. Peking Union Medical College Press, China

    Google Scholar 

  12. Rice TW, Patil DT, Blackstone EH (2017) 8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice. Ann Cardiothorac Surg 6:119–130

    Article  Google Scholar 

  13. Doki Y, Ishikawa O, Takachi K, Miyashiro I, Sasaki Y, Ohigashi H, Murata K, Yamada T, Noura S, Eguchi H, Kabuto T, Imaoka S (2005) Association of the primary tumor location with the site of tumor recurrence after curative resection of thoracic esophageal carcinoma. World J Surg 29:700–707

    Article  Google Scholar 

  14. Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery–the clue to pelvic recurrence? Br J Surg 69:613–616

    Article  CAS  Google Scholar 

  15. Tokairin Y, Nakajima Y, Kawada K, Hoshino A, Okada T, Ryotokuji T, Okuda M, Kume Y, Kawamura Y, Yamaguchi K, Nagai K, Akita K, Kinugasa Y (2018) Histological study of the thin membranous structure made of dense connective tissue around the esophagus in the upper mediastinum. Esophagus 15:272–280

    Article  Google Scholar 

  16. Weijs TJ, Ruurda JP, Luyer MDP, Cuesta MA, van Hillegersberg R, Bleys R (2017) New insights into the surgical anatomy of the esophagus. J Thorac Dis 9:S675-s680

    Article  Google Scholar 

  17. Oshikiri T, Takiguchi G, Miura S, Goto H, Otsubo D, Hasegawa H, Yamamoto M, Kanaji S, Yamashita K, Matsuda T, Fu**o Y, Tominaga M, Nakamura T, Suzuki S, Kakeji Y (2019) Thoracic duct resection during esophagectomy does not contribute to improved prognosis in esophageal squamous cell carcinoma: a propensity score matched-cohort study. Ann Surg Oncol 26:4053–4061

    Article  Google Scholar 

  18. Altorki N, Skinner D (2001) Should en bloc esophagectomy be the standard of care for esophageal carcinoma? Ann Surg 234:581–587

    Article  CAS  Google Scholar 

  19. Corsini EM, Mitchell KG, Zhou N, Antonoff MB, Mehran RJ, Rice DC, Roth JA, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Maru DM, Lin SH, Ajani JA, Hofstetter WL (2021) Modified en bloc esophagectomy compared with standard resection after neoadjuvant chemoradiation. Ann Thorac Surg 111:1133–1140

    Article  Google Scholar 

  20. Emile SH, de Lacy FB, Keller DS, Martin-Perez B, Alrawi S, Lacy AM, Chand M (2018) Evolution of transanal total mesorectal excision for rectal cancer: from top to bottom. World J Gastrointest Surg 10:28–39

    Article  Google Scholar 

  21. Lm S (2014) Total meso-esophagogastrectomy in surgically resectable siewert type II-III junctional gastric cancer: safety and long term oncologic outcome. J Cancer Res Ther 2:153–159

    Article  Google Scholar 

  22. Liu S, Anfossi S, Qiu B, Zheng Y, Cai M, Fu J, Yang H, Liu Q, Chen Z, Fu J, Liu M, Burks JK, Lin SH, Reuben J, Liu H (2017) Prognostic factors for locoregional recurrence in patients with thoracic esophageal squamous cell carcinoma treated with radical two-field lymph node dissection: results from long-term follow-up. Ann Surg Oncol 24:966–973

    Article  Google Scholar 

  23. Yamashita K, Watanabe M, Mine S, Kurogochi T, Okamura A, Hayami M, Imamura Y (2017) Patterns and outcomes of recurrent esophageal cancer after curative esophagectomy. World J Surg 41:2337–2344

    Article  Google Scholar 

  24. **e D, Osaiweran H, Liu L, Wang X, Yu C, Tong Y, Hu J, Gong J (2013) Mesogastrium: a fifth route of metastasis in gastric cancer? Med Hypotheses 80:498–500

    Article  Google Scholar 

  25. Höckel M (2012) Cancer permeates locally within ontogenetic compartments: clinical evidence and implications for cancer surgery. Future Oncol 8:29–36

    Article  Google Scholar 

  26. Altorki NK, Girardi L, Skinner DB (1997) En bloc esophagectomy improves survival for stage III esophageal cancer. J Thorac Cardiovasc Surg 114:948–955 (discussion 955-946)

    Article  CAS  Google Scholar 

Download references

Acknowledgements

None

Funding

None.

Author information

Author notes

  1. Jihong Lin and Junjie He have contributed equally to this work.

Authors and Affiliations

  1. Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29, **nquan Road, Fuzhou City, 350001, Fujian Province, China

    Jihong Lin, Junjie He, Shuchen Chen, Jiangbo Lin, Ziyang Han, Mingduan Chen, Shaobin Yu, Lei Gao, Kaiming Peng, Zhimin Shen, Peipei Zhang & Mingqiang Kang

Authors
  1. Jihong Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Junjie He
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shuchen Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jiangbo Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ziyang Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mingduan Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shaobin Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lei Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kaiming Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Zhimin Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Peipei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Mingqiang Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mingqiang Kang.

Ethics declarations

Disclosures

Jihong Lin, Junjie He, Shuchen Chen, Jiangbo Lin, Ziyang Han, Mingduan Chen, Shaobin Yu, Lei Gao, Kaiming Peng, Zhimin Shen, Peipei Zhang, and Mingqiang Kang have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lin, J., He, J., Chen, S. et al. Outcomes of minimally invasive total mesoesophageal excision: a propensity score-matched analysis. Surg Endosc 36, 3234–3245 (2022). https://doi.org/10.1007/s00464-021-08634-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08634-4

Keywords

Search

Navigation