301. LONG TERM RESULTS OF SINGLE AND MULTI-INCISION MINIMALLY INVASIVE ESOPHAGECTOMY (MIE) FOR TREATING ESOPHAGEAL CANCER: A PROPENSITY SCORE MATCHED STUDY. (24th September 2022)

• Record Type: Journal Article
• Authors: Chen, Yung-Hsin; Lee, Jang-Ming
• Is Part Of: Diseases of the esophagus. Volume 35(2022)Supplement 2
• Publication Date: 2022-09-24
• Subjects: Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doac051.301
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: Minimally invasive esophagectomy (MIE) is widely accepted as the standard treatment for esophageal cancer. It provides similar oncological outcomes with less pain and morbidity compared to open surgery. We first described MIE with single-incision both in the laparoscopic and thoracoscopic phase in 2015. Compared to multi-portal approach, short-term result showed comparable perioperative outcome with significantly reduced pain after surgery. With accumulated clinical experience, we compared our long-term follow-up result for single-incision MIE versus multi-incision MIE. Patients with esophageal cancer, receiving MIE at our institute from 2008 to 2022 were included. 337 patients underwent single-incision MIE, while 467 patients received multi-incision MIE. Matching based on propensity scores produced 290 patients in each group. The baseline characteristics between the two groups were similar after matching. Overall survival (OS) and progression free survival (PFS) were not compromised in single-incision MIE compared to multiple-incision MIE (5-year OS: 42.9% vs. 21.2%, p < 0.001; 5-year PFS: 35.1% vs. 17.1%, p < 0.001). The operation time was shorter (505.7 min vs. 562.4 min, p < 0.001). Single-incision MIE had larger mean number of dissected lymph nodes (45.6 vs 37.4, p < 0.001). There were no significant differences between the two groups in terms of short-term complications (single vs multi: 20.3% vs 15.9%, p = 0.196) and R1/2 rate (single vs multi: 11.5% vs 9.0%, p = 0.340). Single-incision MIE is safe, feasible and effective for patients with esophageal cancer. Its long-term oncological outcomes are not compromised when compared to multiple-incision MIE, while its short-term perioperative outcomes are comparable to multi-incision approach. Three-dimensional imaging may play a role in higher quality oncological resection with more lymphatic clearance for single-incision MIE compared to multiple-incision MIE.