Minimally invasive esophagectomy is a safe surgical treatment for locally advanced pathologic T3 esophageal squamous cell carcinoma

Background: Previous studies have shown that minimally invasive esophagectomy (MIE) is safe and feasible. However, several of these studies had selection bias because they included more patients with early-stage cancer, and no study has compared the outcomes of locally advanced pathologic T3 (pT3) esophageal carcinoma between MIE and open surgery. Methods: This retrospective analysis included 229 patients with stage pT3 esophageal squamous cell carcinoma (ESCC) who underwent esophagectomy from January 2013 to June 2015. The outcomes included operative outcomes, postoperative complications, recurrence, and mid-term survival. Results: Sixty-six patients underwent MIE and 163 patients underwent open surgery. No significant difference was noted in blood loss or resection completeness (R0) between the two groups. The operative duration was longer in the MIE than open surgery group (266.5 +/- 52.5 vs. 218.1 +/- 47.4, P<0.01), and the number of lymph nodes dissected was higher in the MIE than open surgery group (15.2 +/- 5.3 vs. 12.9 +/- 7.3, P=0.01). There was no significant difference in the length of stay or 30-day mortality rate between the two groups, but the intensive care unit stay was shorter in the MIE group (3 vs. 4, P=0.01). No difference in complications or recurrence was noted between the two groups. The 2-year overall survival (OS) rate was 72.8% for MIE and 69.4% for open surgery, and the 2-year disease-free survival (DFS) rate was 69.4% for MIE and 57.2% for open surgery. Conclusions: For patients with locally advanced stage pT3 ESCC, MIE has perioperative outcomes comparable to those of open surgery without compromising recurrence or survival.