Survival After Esophagectomy: A Propensity-Matched Study of Different Surgical Approaches

Background. Although open esophagectomy (OE) is considered the "gold standard" treatment for esophageal cancer, robotic-assisted minimally invasive esophagectomy (RAMIE), and laparoscopic/thoracoscopic minimally invasive esophagectomy (MIE) are becoming more common. This study aimed to compare short-term outcomes and overall survival of patients undergoing RAMIE, MIE, and OE. Methods. The National Cancer Data Base was queried for patients who had OE, RAMIE, or MIE for esophageal cancer from 2010 to 2013. Three propensity-matched cohorts were generated, one for each surgical approach. Survival was examined in the unmatched and matched cohorts. Results. We identified 9,217 patients who underwent RAMIE (581; 6.3%), MIE (2,379; 25.8%), or OE (6,257; 67.9%). In the unmatched cohort, 30-day mortality was higher after RAMIE. The RAMIE and MIE patients had more lymph nodes harvested than OE patients. Median survival was 48 months after RAMIE, 44 months after MIE, and 41 months after OE (p = 0.121). The propensity-matched groups contained 569 patients each. There was a trend toward higher 30-day mortality in the RAMIE group. The number of lymph nodes harvested was similar among the groups. There were no significant differences in survival, with a median survival of 48 months after RAMIE, 49 months after MIE, and 44 months after OE (p = 0.53). Conclusions. We were unable to find significant differences in long-term survival of patients with esophageal cancer undergoing RAMIE, OE, or MIE. Surgeon experience and expertise may be more important than surgical approach for esophageal cancer. (C) 2017 by The Society of Thoracic Surgeons