Laparoscopy versus laparotomy gastric pull-up following thoracoscopic esophagectomy: A propensity score-matched analysis

Background: Because of its capacity to reduce surgical trauma to the chest wall, thoracoscopic esoph-agectomy is considered paramount for decreasing the risk of pulmonary complications in the context of minimally invasive esophagectomy. Whether laparoscopy (LS) following thoracoscopic esophagectomy can further improve outcomes compared with open laparotomy (OL) is unknown. Materials and methods: We retrospectively reviewed the clinical and imaging records of 428 patients who received McKeown esophagectomy with a thoracoscopic approach for cancer. Using propensity score matching based on eight parameters (age, sex, body mass index, Charlson comorbidity index, tumor location, type of preoperative therapy, reconstruction route, and occurrence/severity of post-operative vocal cord palsy), 60 pairs were identified and compared with regard to perioperative com-plications and overall survival (OS). Result: Compared with OL, LS resulted in lower blood loss (mean: 171.21 versus 107.58 mL, respectively, p = 0.023) and a reduced incidence of pneumonia (13.3% versus 3.3%, respectively, p = 0.048), albeit at the expense of a longer operating time (mean: 399.37 versus 443.93 min, respectively, p = 0.003). Notably, lymph node yields and OS of patients who were treated with LS were similar to those observed in those who underwent OL. Conclusions: Patients who receive LS after thoracoscopic esophagectomy experience lower blood loss and have a reduced risk of pneumonia than those treated with OL. (c) 2021 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

Automated summary

Following thoracoscopic esophagectomy, performing laparoscopy can reduce blood loss and the risk of pneumonia, albeit with a longer operating time. The lymph node yield and overall survival for patients treated with laparoscopy are similar to those treated with open laparotomy.