Comparative Outcomes of Minimally Invasive Versus Open Esophagectomy for Distal Esophageal Cancer: A Retrospective Cohort Study from a Tertiary Referral Center

Introduction:This study aimed to compare the outcomes and complications of MIE versus OE in patients with distal esophageal cancer.Materials and Methods:This retrospective cohort study included ۱۹۶ patients with distal esophageal cancer treated between ۲۰۱۵ and ۲۰۲۱ at two tertiary hospitals in Tehran. Patients were equally divided into MIE (n=۹۸) and OE (n=۹۸) groups. Preoperative, intraoperative, and postoperative variables including surgical duration, pain intensity, intraoperative blood loss, transfusion requirements, hospital stay, and complication rates were collected and analyzed using SPSS version ۲۳. Appropriate statistical tests were applied with a significance level set at p<۰.۰۵.Results:The mean duration of surgery was significantly shorter in the MIE group compared to the OE group (۲۸۰.۷۱ ± ۴۴.۸۳ vs. ۴۲۵.۳۶ ± ۵۱.۶۹ minutes, p<۰.۰۰۱). MIE patients experienced significantly less intraoperative blood loss (۲۹۷.۱۴ ± ۸۹.۲۹ vs. ۵۰۳.۵۷ ± ۱۲۲.۰۲ mL, p<۰.۰۰۱), required fewer blood transfusions (۲.۱۴ ± ۰.۵۲ vs. ۲.۶۴ ± ۰.۹۰ units, p<۰.۰۰۱), and had a shorter hospital stay (۱۴.۱۴ ± ۳.۲۷ vs. ۱۸.۶۴ ± ۴.۳۱ days, p<۰.۰۰۱). Postoperative pain was also lower in the MIE group (۲.۸۶ ± ۱.۳۶ vs. ۳.۴۳ ± ۲.۴۸, p=۰.۰۴۸). However, the number of lymph nodes dissected was significantly higher in the OE group (۱۸.۵۰ ± ۳.۴۸ vs. ۹.۵۷ ± ۳.۷۹, p<۰.۰۰۱), and the incidence of chylothorax was greater in the MIE group (۷ vs. ۱ cases, p=۰.۰۳۰). There was no statistically significant difference in tracheal injury between the groups (p=۰.۰۵۴).Conclusion:Minimally invasive esophagectomy offers several clinical benefits over open surgery, including reduced blood loss, lower postoperative pain, shorter operative time, and decreased hospital stay. However, it is associated with a higher incidence of chylothorax and a lower lymph node yield, possibly due to the learning curve and technical nuances.

کلیدواژه ها:

Esophageal Cancer ، Minimally invasive esophagectomy (MIE) ، Open esophagectomy (OE) ، Surgical outcomes ، Chylothorax