Outcomes, quality of life, and survival after esophagectomy for squamous cell carcinoma: A propensity score-matched comparison of operative approaches

Background: Minimally invasive esophagectomy (MIE) theoretically offers advantages compared with open esophagectomy (OE). However, the long-term outcomes have not been well studied, especially for esophageal squamous cell carcinoma. We retrospectively compared postoperative outcomes, quality of life (QOL), and survival in a matched population of patients undergoing MIE, with a control (OE) group. Methods: From May 2004 to August 2013, MIE was performed for a group of 735 patients, which was compared with a group of 652 cases of OE. Eventually, 444 paired cases, matched using propensity-score matching, were selected for further statistical analysis. Results: Compared with the OE group, the MIE group had shorter operation duration (191 +/- 47 minutes vs 211 +/- 44 minutes, P < .001); less blood loss (135 +/- 74 ml vs 163 +/- 84 ml, P < .001); similar lymph node harvest (24.1 +/- 6.2 vs 24.3 +/- 6.0, P = .607); shorter postoperative hospital stay (11 days [range: 7-90 days] vs 12 days [range: 8-112 days], P < .001); fewer major complications (30.4% vs 36.9%, P = .039); a lower readmission rate to the intensive-care unit (5.6% vs 9.7%, P = .023); and similar perioperative mortality (1.1% vs 2.0%, P = .281). At a median follow-up of 27 months, the 2-year overall survival rates in the MIE and OE group were: (1) stage 0 and I: 92% versus 90% (P = .864); (2) stage II: 83% versus 82% (P = .725); (3) stage III: 59% versus 55%(P = .592); (4) stage IV: 43% versus 43%(P = .802). The generalized estimating equation analysis showed that MIE had an independently positive impact on patients' postoperative QOL. Conclusions: In our experience, MIE is a safe and effective procedure for the treatment of esophageal squamous cell carcinoma. It may offer better perioperative outcomes, better postoperative QOL, and equal oncologic survival, compared with OE.