Comparison of minimally invasive oeosphagectomy (MIO) with open oesophagectomy for cancer in a newly established oesophagogastric surgical unit. — The Association Specialists
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  3. Comparison of minimally invasive oeosphagectomy (MIO) with open oesophagectomy for cancer in a newly established oesophagogastric surgical unit.

Comparison of minimally invasive oeosphagectomy (MIO) with open oesophagectomy for cancer in a newly established oesophagogastric surgical unit. (275)

Ada Ng 1 , Richard JE Skipworth 1 , Peter Stiven , Anthony Clough , Ralph Staerkle 1 , Steven Leibman 1 , Ross Smith 1 , Garett S Smith 1
  1. Royal North Shore Hospital, St Leonards, NSW, Australia

BACKGROUND

Various different minimally invasive techniques have been described in an attempt to reduce the surgical morbidity of oesophagectomy. There is emerging evidence to suggest that minimally invasive techniques are associated with less postoperative morbidity without compromising oncological outcome (1-6). 


AIM

The aim of this study is to compare results of a hybrid minimally invasive oesophagectomy  (Thoracoscopic-Assisted 3 Stage Oesophagectomy - MIO) with Open Oesophagectomy at our institution.

METHODS

Clinical, operative and pathological data for patients undergoing oesophagectomy at our institution were recorded prospectively on an electronic database.
Operative morbidity and mortality, unscheduled return to operating theatre and histopathological parameters were compared.
Continuous data were compared using the Mann-Whitney U test, ordinal data with Fischer’s exact test. Survival was analysed by the Kaplan-Meier method, and comparison made using the log-rank test. P<0.05 was considered significant.


RESULTS

Between December 2001 and May 2012, 134 patients underwent oesophagectomy for primary malignancy of the oesophagus. Two patients who underwent totally minimally invasive surgery (laparoscopy and thoracoscopy) were excluded. Thus a total of 132 patients were included, 72 patients in Open group, 60 in MIO. Patient demographics, tumour location and histology showed no significant difference (p>0.05).  There was no significant difference in median length of stay, peri-operative morbidity (42% v 36% p=0.92), operative/ 30 day mortality (2.8% v 1.7% p=1.00). Oncological parameters of lymph node yield (17 v 17 p=0.70) and circumferential margin positivity (16 v 12 p=0.86) were also not significantly different. There was no difference in overall (p=0.33) or disease-specific survival (p=0.69). The only significant difference found was rate of stricture formation requiring dilatation with patients in the MIO group having higher rates (10 v 21 p=0.03)


CONCLUSION

At our institution the short term outcomes and survival following MIO were comparable to Open oesophagectomy and therefore, is an acceptable operative approach in patients with primary malignancy of the oesophagus or OGJ.