Long-Term Results of Single- and Multi-Incision Minimally Invasive Esophagectomy for Esophageal Cancer: Experience of 348 Cases

TL;DR

This study compares long-term cancer outcomes of two minimally invasive esophagectomy techniques and finds the single-incision method is as effective as the multi-incision approach.

Contribution

The study provides the first long-term oncological comparison of single- and multi-incision minimally invasive esophagectomy for esophageal cancer.

Findings

Single-incision minimally invasive esophagectomy showed better overall and progression-free survival than the multi-incision approach.

Propensity score-matched analysis confirmed the survival advantage of the single-incision technique.

The single-incision method is feasible without compromising long-term cancer outcomes.

Abstract

Importance: While minimally invasive esophagectomy is currently accepted as an effective treatment for patients with esophageal cancer, the long-term survival outcomes of single-incision minimally invasive esophagectomy in these patients are still unknown, particularly when compared to those of the more invasive multi-incision minimally invasive esophagectomy. Objective: To determine the long-term oncological outcomes of single-incision minimally invasive esophagectomy in patients with esophageal cancer and to compare these outcomes with those of multi-incision minimally invasive esophagectomy. Design: This was a prospective, randomized, and propensity score-matched study wherein we analyzed patients who underwent treatment from February 2005 to May 2022. Setting: Our study was carried out by a single surgical team in a tertiary medical center. Participants: We analyzed 348 patients with esophageal cancer who underwent single-incision minimally invasive esophagectomy and 469 who underwent multi-incision minimally invasive esophagectomy. Main Outcomes and Measures: We aimed to determine the long-term survival outcomes of single-incision minimally invasive esophagectomy and compare these to those of multi-incision minimally invasive esophagectomy in our study population, and further conducted a propensity score-matching (n = 251 in each arm) study. Results: The disease progression-free (DFS) and overall survival (OS) rates of patients who underwent single-incision minimally invasive esophagectomy (SIMIE) was significantly better than that of those who underwent by multi-incision minimally invasive esophagectomy (MIMIE) (p = 0.024 for OS and p = 0.027 for PFS). This trend of difference was observed in the subsequent propensity-score matching analysis (p = 0.009 and 0.016 for OS and PFS, respectively). Conclusions and Relevance: The single-incision technique applied in minimally invasive esophagectomy to treat esophageal cancer is feasible without compromising the patient’s long-term oncological outcome, as opposed to that applied using multi-incision minimally invasive esophagectomy.

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