Does the Approach Matter? Comparing Survival in Robotic, Minimally Invasive, and Open Esophagectomies

被引:74
作者
Espinoza-Mercado, Fernando [1 ,2 ]
Imai, Taryne A. [1 ,2 ]
Borgella, Jerald D. [1 ,2 ]
Sarkissian, Ariella [1 ,2 ]
Serna-Gallegos, Derek [2 ]
Alban, Rodrigo F. [1 ,2 ]
Soukiasian, Harmik J. [1 ,2 ]
机构
[1] Cedars Sinai Med Ctr, Div Thorac Surg, 8631 W Third St,Ste 240E, Los Angeles, CA 90048 USA
[2] Cedars Sinai Med Ctr, Dept Surg, Los Angeles, CA 90048 USA
关键词
ESOPHAGEAL CANCER; MULTICENTER; OUTCOMES; TRIAL;
D O I
10.1016/j.athoracsur.2018.08.039
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Our objective was to determine how surgical approach impacts overall survival and postoperative outcomes when comparing robotic-assisted minimally invasive esophagectomy (RAMIE), minimally invasive esophagectomy (MIE), and open esophagectomy (OE). Methods. The National Cancer Database was queried for patients diagnosed with pathologic Stage 0 to III esophageal cancer from 2010 to 2015. Primary outcome measures evaluated were length of stay, 30-day unplanned readmissions, mortality rates at 30 and 90 days, and overall survival rates. The surgical cohorts underwent 1:1 propensity score matching, and Kaplan-Meier survival estimates were compared by surgical approach. Cox proportional hazards regression was utilized to estimate factors associated with overall survival. Results. Of 5,553 patients that met criteria, 28.4% were MIE, 7.8% RAMIE, and 63.8% OE. From 2010 to 2015, an increasing trend was seen for both minimally invasive approaches, with MIE surpassing the number of OEs. Unplanned 30-day readmissions and 30-day and 90-day mortality rates were not significantly different between the different groups. Median length of stay was significantly shorter in MIE (9 [interquartile range (IQR), 8 to 14] days) and RAMIE (9 [IQR, 7 to 14] days), compared with OE (10 [IQR, 8 to 15] days; p < 0.001). MIE and RAMIE had comparable survival rates compared with OE, with no significant differences in median overall survival estimates after propensity score matching (log-rank p = 0.603), with a trend for increased survival in MIE (adjusted hazard ratio, 0.97; 95% confidence interval, 0.89 to 1.06; p = 0.530) and RAMIE (hazard ratio, 0.81; 95% confidence interval, 0.69 to 0.95; p = 0.012). Both minimally invasive approaches had a significantly higher median lymph node counts (MIE: 15 [IQR, 9 to 22]; RAMIE: 17 [IQR, 11 to 24]; OE: 13 [IQR, 8 to 20]), which may highlight important differences in postoperative upstaging. Conclusions. Trends in MIE use is surpassing the open approach. Minimally invasive approaches are becoming the preferred approach, with noninferior long-term results compared with OEs. A significantly higher lymph node yield was seen for RAMIE and MIE. (C) 2019 by The Society of Thoracic Surgeons
引用
收藏
页码:378 / 385
页数:8
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