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

• Published in: Surgical endoscopy Vol. 36; no. 5; pp. 3234 - 3245
• Main Authors: Lin, Jihong, He, Junjie, Chen, Shuchen, Lin, Jiangbo, Han, Ziyang, Chen, Mingduan, Yu, Shaobin, Gao, Lei, Peng, Kaiming, Shen, Zhimin, Zhang, Peipei, Kang, Mingqiang
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-05-2022; Springer Nature B.V
• Subjects: Abdominal Surgery; Cancer therapies; Chemotherapy; Endoscopy; Esophageal cancer; Esophageal Neoplasms - pathology; Esophagectomy - methods; Gastroenterology; Gynecology; Hepatology; Hospitals; Humans; Intubation; Laparoscopy - methods; Lymph Node Excision - methods; Lymphatic system; Medicine; Medicine & Public Health; Mortality; Ostomy; Patients; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Proctology; Propensity Score; Retrospective Studies; Surgery; Thoracic surgery; Tomography; Treatment Outcome; Tumors; Veins & arteries; Mesoesophagus; Esophageal surgery; Esophageal cancer
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-021-08634-4

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.