TY - JOUR
T1 - Recurrence and Survival after Minimally Invasive and Open Esophagectomy for Esophageal Cancer
T2 - A Post Hoc Analysis of the Ensure Study
AU - Henckens, Sofie P.G.
AU - Schuring, Nannet
AU - Elliott, Jessie A.
AU - Johar, Asif
AU - Markar, Sheraz R.
AU - Gantxegi, Amaia
AU - Lagergren, Pernilla
AU - Hanna, George B.
AU - Pera, Manuel
AU - Reynolds, John V.
AU - Van Berge Henegouwen, Mark I.
AU - Gisbertz, Suzanne S.
AU - Van Veer, Hans
AU - Depypere, Lieven
AU - Coosemans, Willy
AU - Nafteux, Philippe
AU - Carroll, Paul
AU - Allison, Frances
AU - Darling, Gail
AU - Findlay, John M.
AU - Everden, Serenydd
AU - Maynard, Nicholas D.
AU - Ariyarathenam, Arun
AU - Sanders, Grant
AU - Jaunoo, Shameen
AU - Singh, Pritam
AU - Parsons, Simon
AU - Saunders, John
AU - Vohra, Ravinder
AU - Sinha, Aaditya
AU - Tan, Benjamin H.L.
AU - Whiting, John G.
AU - Boshier, Piers R.
AU - Markar, Sheraz R.
AU - Zaninotto, Giovanni
AU - Hanna, George B.
AU - Phillips, Alexander W.
AU - Griffin, S. Michael
AU - Walker, Robert C.
AU - Underwood, Tim J.
AU - Piessen, Guillaume
AU - Theisen, Jorg
AU - Friess, Hans
AU - Bruns, Christiane J.
AU - Schröder, Wolfgang
AU - Elliott, Jessie A.
AU - Kingma, B. Feike
AU - Goense, Lucas
AU - Ruurda, Jelle P.
AU - Van Hillegersberg, Richard
N1 - Publisher Copyright:
© 2024 Wolters Kluwer Health. All rights reserved.
PY - 2024/8/1
Y1 - 2024/8/1
N2 - Objective: To determine the impact of operative approach [open (OE), hybrid minimally invasive (HMIE), and total minimally invasive (TMIE) esophagectomy] on operative and oncologic outcomes for patients treated with curative intent for esophageal and junctional cancer. Background: The optimum oncologic surgical approach to esophageal and junctional cancer is unclear. Methods: This secondary analysis of the European multicenter ENSURE study includes patients undergoing curative-intent esophagectomy for cancer between 2009 and 2015 across 20 high-volume centers. Primary endpoints were disease-free survival (DFS) and the incidence and location of disease recurrence. Secondary endpoints included among others R0 resection rate, lymph node yield, and overall survival (OS). Results: In total, 3199 patients were included. Of these, 55% underwent OE, 17% HMIE, and 29% TMIE. DFS was independently increased post-TMIE [hazard ratio (HR): 0.86 (95% CI: 0.76-0.98), P = 0.022] compared with OE. Multivariable regression demonstrated no difference in absolute locoregional recurrence risk according to the operative approach [HMIE vs OE, odds ratio (OR): 0.79, P = 0.257; TMIE vs OE, OR: 0.84, P = 0.243]. The probability of systemic recurrence was independently increased post-HMIE (OR: 2.07, P = 0.031), but not TMIE (OR: 0.86, P = 0.508). R0 resection rates (P = 0.005) and nodal yield (P < 0.001) were independently increased after TMIE, but not HMIE (P = 0.424; P = 0.512) compared with OE. OS was independently improved following both HMIE (HR: 0.79, P = 0.009) and TMIE (HR: 0.82, P = 0.003) as compared with OE. Conclusion: In this European multicenter study, TMIE was associated with improved surgical quality and DFS, whereas both TMIE and HMIE were associated with improved OS as compared with OE for esophageal cancer.
AB - Objective: To determine the impact of operative approach [open (OE), hybrid minimally invasive (HMIE), and total minimally invasive (TMIE) esophagectomy] on operative and oncologic outcomes for patients treated with curative intent for esophageal and junctional cancer. Background: The optimum oncologic surgical approach to esophageal and junctional cancer is unclear. Methods: This secondary analysis of the European multicenter ENSURE study includes patients undergoing curative-intent esophagectomy for cancer between 2009 and 2015 across 20 high-volume centers. Primary endpoints were disease-free survival (DFS) and the incidence and location of disease recurrence. Secondary endpoints included among others R0 resection rate, lymph node yield, and overall survival (OS). Results: In total, 3199 patients were included. Of these, 55% underwent OE, 17% HMIE, and 29% TMIE. DFS was independently increased post-TMIE [hazard ratio (HR): 0.86 (95% CI: 0.76-0.98), P = 0.022] compared with OE. Multivariable regression demonstrated no difference in absolute locoregional recurrence risk according to the operative approach [HMIE vs OE, odds ratio (OR): 0.79, P = 0.257; TMIE vs OE, OR: 0.84, P = 0.243]. The probability of systemic recurrence was independently increased post-HMIE (OR: 2.07, P = 0.031), but not TMIE (OR: 0.86, P = 0.508). R0 resection rates (P = 0.005) and nodal yield (P < 0.001) were independently increased after TMIE, but not HMIE (P = 0.424; P = 0.512) compared with OE. OS was independently improved following both HMIE (HR: 0.79, P = 0.009) and TMIE (HR: 0.82, P = 0.003) as compared with OE. Conclusion: In this European multicenter study, TMIE was associated with improved surgical quality and DFS, whereas both TMIE and HMIE were associated with improved OS as compared with OE for esophageal cancer.
KW - esophageal cancer
KW - esophagectomy
KW - minimally invasive surgery
KW - recurrence
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=85192954685&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000006280
DO - 10.1097/SLA.0000000000006280
M3 - Article
C2 - 38577796
AN - SCOPUS:85192954685
SN - 0003-4932
VL - 280
SP - 267
EP - 273
JO - Annals of surgery
JF - Annals of surgery
IS - 2
ER -