Long-term outcomes following minimally invasive and open esophagectomy in Finland: A population-based study

Background: Studies of long-term survival after minimally invasive and open esophagectomy are needed. The aim of this study was to compare long-term outcomes following minimally invasive and open esophagectomy for esophageal cancer at the population level. Methods: All patients undergoing minimally invasive (n =159) or open transthoracic (n = 431) esophagectomy for esophageal cancer in Finland between 2004 and 2014 were identified from nationwide registries. Propensity score matching was used to create groups of 150 minimally invasive and open esophagectomies with balanced baseline characteristics (sex, age, comorbidity, center volume, year of surgery, histology, stage (local or locally advanced), and neoadjuvant therapy). The primary outcome was 1-year survival after surgery. Secondary outcomes were the 3-year, 5-year, and 90-day survival. Results: The propensity matched 1-year survival rate was 85.3% after minimally invasive and 74.7% after open esophagectomy (adjusted HR 0.53, 95% CI 0.31-0.89; P = 0.0174). At 3 years, those were 68.7% and 55.6% (adjusted HR 0.62; 95% CI 0.43-0.91; P = 0.0144), respectively; at 5 years, survival rates were 61.8% and 51.9% (adjusted HR 0.68, 95% CI 0.47-0.97; P = 0.0347). The 30- and 90-day survival rates after minimally invasive and open surgery were 99.3% vs. 98.0% and 97.3% vs. 92.0%, respectively, without statistical significance. Conclusions: In this population-based propensity matched study, minimally invasive esophagectomy was associated with improved long-term survival. Due to multiple confounding factors replication studies are needed. (C) 2018 Elsevier Ltd, BASO - The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.