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Effectiveness of combined thoracoscopic–laparoscopic esophagectomy: comparison of postoperative complications and midterm oncological outcomes in patients with esophageal cancer

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Abstract

Background

During esophagectomy, laparoscopy can be used together with thoracoscopy, but it is not known whether a combined thoracoscopic–laparoscopic procedure is associated with fewer postoperative complications than open esophagectomy, and without compromising oncological outcome.

Methods

This was a longitudinal cohort study that included 185 esophageal cancer patients, including 72 who underwent combined thoracoscopic–laparoscopic esophagectomy (TLE), 34 who underwent thoracoscopic esophagectomy (TE), and 79 who underwent open esophagectomy (OE) between January 2002 and May 2010. The main outcome measures were postoperative respiratory and overall complications. The secondary outcome was 2-year relapse-free survival (RFS).

Results

Respiratory complications occurred in 9 patients who underwent TLE, 13 who underwent TE, and 31 who underwent OE. TLE was associated with fewer respiratory complications (TLE vs. OE: odds ratio [OR], 0.22; 95% confidence interval [CI], 0.09–0.53 and TE vs. OE: OR, 0.71; 95% CI 0.29–1.76). Overall complications occurred in 34 patients who underwent TLE, 20 who underwent TE, and 54 who underwent OE. TLE was associated with fewer overall complications (TLE vs. OE: OR, 0.47; 95% CI 0.23–0.94 and TE vs. OE: OR, 0.51; 95% CI 0.21–1.25). The 2-year RFS rates were similar among the three groups: 71.6% for TLE, 57.7% for TE, and 58.3% for OE (TLE vs. OE: hazard ratio, 0.65; 95% CI 0.35–1.20 and TE vs. OE: hazard ratio, 0.91; 95% CI 0.45–1.82).

Conclusion

Unlike TE, TLE was associated with fewer postoperative complications than was OE, with no compromise of 2-year RFS. A randomized controlled trial with longer follow-up is needed.

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Abbreviations

ASA-PS:

American Society of Anesthesiologists Physical Status classification

CI:

Confidence interval

CTCAE:

Common Terminology Criteria for Adverse Events

FEV1%:

Forced expiratory volume in 1 s as a percentage of the forced vital capacity

MIE:

Minimally invasive esophagectomy

OE:

Open esophagectomy

OR:

Odds ratio

RFS:

Relapse-free survival

TNM:

Tumor Node Metastasis classification

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Disclosures

Yousuke Kinjo, Noriaki Kurita, Fumiaki Nakamura, Hiroshi Okabe, Eiji Tanaka, Yoshiki Kataoka, Atsushi Itami, Yoshiharu Sakai, and Shunichi Fukuhara have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Yousuke Kinjo, Hiroshi Okabe, Eiji Tanaka, Yoshiki Kataoka, Atsushi Itami & Yoshiharu Sakai

  2. Department of Epidemiology and Healthcare Research, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan

    Noriaki Kurita, Fumiaki Nakamura & Shunichi Fukuhara

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  1. Yousuke Kinjo
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Correspondence to Shunichi Fukuhara.

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Kinjo, Y., Kurita, N., Nakamura, F. et al. Effectiveness of combined thoracoscopic–laparoscopic esophagectomy: comparison of postoperative complications and midterm oncological outcomes in patients with esophageal cancer. Surg Endosc 26, 381–390 (2012). https://doi.org/10.1007/s00464-011-1883-y

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