604. DOES MINIMALLY INVASIVE ESOPHAGECTOMY REDUCE POSTOPERATIVE PULMONARY COMPLICATIONS? AN INTERNATIONAL COHORT STUDY FROM THE OESOPHAGOGASTRIC ANASTOMOSIS AUDIT (OGAA). (24th September 2022) - ,
Abstract: There is limited data characterizing the external validity of randomised trials on MIE for esophageal cancers. This study aimed to characterise the global impact of minimally invasive esophagectomy (MIE) on postoperative pulmonary complications (PPC). Patients undergoing open (OE, n=350), hybrid (HE, n=368), and MIE for esophageal cancers were identified from the Oesophagogastric Anastomosis Audit (OGAA). Primary outcome was PPC and secondary outcomes were anastomotic leaks (AL) and 90-day mortality. PPC rates were lower after MIE compared to OE and HE (38% vs 39% vs 31%, p=0.002), even on adjusted analyses compared to OE (odds ratio (OR): 0.57, CI95%: 0.44 - 0.74). On adjusted analyses, MIE was not associated with higher AL (OR: 2.05, CI95%: 1.26 - 3.34) and 90-day mortality (OR: 4.55, CI95%: 2.70 - 7.69) compared to OE. Stratified analyses demonstrated lower PPC rates after MIE compared to OE in patients operated in high volume centers and high-income countries. In contrast to previous reports, global adoption of MIE is associated with reduced PPC with no compromise in AL or overall complications. Introduction of MIE in standardized fashion with guidance from expert, high-volume surgeons justify benefits of MIE.