Population-based study of anastomotic stricture rates after minimally invasive and open oesophagectomy for cancer

Background The population-based incidence of anastomotic stricture after minimally invasive oesophagectomy (MIO) and open oesophagectomy (OO) is not known. The aim of this study was to compare rates of anastomotic stricture requiring dilatation after the two approaches in an unselected cohort using nationwide data from Finland and Sweden. Methods All patients who had MIO or OO for oesophageal cancer between 2007 and 2014 were identified from nationwide registries in Finland and Sweden. Outcomes were the overall rate of anastomotic stricture and need for single or repeated (3 or more) dilatations for stricture within the first year after surgery. Multivariable Cox regression provided hazard ratios (HRs) with 95 per cent confidence intervals, adjusted for age, sex, co-morbidity, histology, stage, year, country, hospital volume, length of hospital stay and readmissions. Results Some 239 patients underwent MIO and 1430 had an open procedure. The incidence of strictures requiring one dilatation was 16 center dot 7 per cent, and that for strictures requiring three or more dilatations was 6 center dot 6 per cent. The HR for strictures requiring one dilatation was not increased after MIO compared with that after OO (HR 1 center dot 19, 95 per cent c.i. 0 center dot 66 to 2 center dot 12), but was threefold higher for repeated dilatations (HR 3 center dot 25, 1 center dot 43 to 7 center dot 36). Of 18 strictures following MIO, 14 (78 per cent) occurred during the first 2 years after initiating this approach. Conclusion The need for endoscopic anastomotic dilatation after oesophagectomy was common, and the need for repeated dilatation was higher after MIO than following OO. The increased risk after MIO may reflect a learning curve.