Outcomes after totally minimally invasive versus hybrid and open Ivor Lewis oesophagectomy: results from the International Esodata Study Group
Authors: van der Wilk Berend J , Hagens Eliza R C , Eyck Ben M , Gisbertz Suzanne S , van Hillegersberg Richard , Nafteux Philippe , Schröder Wolfgang , Nilsson Magnus , Wijnhoven Bas P L , Lagarde Sjoerd M , van Berge Henegouwen Mark I ,   International Esodata Study Group Collaborators, van Lanschot J Jan B , Jezerskyte Egle , Eshuis Wietse J , Ruurda Jelle , van der Horst Sylvia , van der Veen Arjen , Kuiper Gino , Lerut Toni , Moons Johnny , Bludau Marc , Bruns Christiane J , Klevebro Fredrik , Hayami Masaru , D’Journo Xavier B , Trousse Delphine , Brioude Geoffrey , Hardwick Richard , Safranek Peter , Bennett John , Hindmarsh Andrew , Sujendran Vijay , O’Neill John R , Hoelscher Arnulf H , Hemmerich Martin , Piessen Guillaume , Messier Marguerite , Degisors Sebastien , Nuytens Frederiek , Jobe Blair A , Zaidi Ali H , Davies Andrew , Zylstra Janine , Gossage James , Baker Cara , Kelly Mark , Schneider Paul M , Schillinger Simone , Pera Manuel , Gimeno Marta , Kitagawa Yuko , Kawakubo Hirofumi , Matsuda Satoru , Hirata Yuki , Morse Christopher R , Garrity Julie , Hofstetter Wayne L , Tang Huawei , Molena Daniela , Bains Manjit , Dycoco Joe , Busalacchi Kristen , Carr Rebecca , Jones David R , So Jimmy B Y , Shabbir Asim , Immanuel Arul , Griffin Michael , Jaretzke Helen , Parsons Simon L , Welch Neil T , Vohra Ravinder , Catton James A , Saunders John H , Yanni Fady , Zanotti Daniela , Singh Pritam , Larsen Michael H , Nicolaj Larsen , Stilling Marcus , Dolan James P , Wood Stephanie G , Borzy Charlie C , Siemens Kayla , Maynard Nick , Findlay John , Ash Stephen , Smithers Mark , Thomson Iain , Barbour Andrew , Thomas Janine , Puig Sonia , Whiting John , Law Simon Y K , Wong Ian Y , Kwok Jeannette , Kennedy Andrew , Kennedy Raymond , Ning Wang K , Qiang Fang , YongTao Han , Lin Peng , WenGuang Xiao , Reynolds John V , King Sinead , Narayanasamy Ravi , Pramesh C S , Ashok Apurva , Ferguson Mark K , Durkin-Celauro Amy , Staub Catherine , Darling Gail E , Small Emma , Underwood Tim , Byrne James , Kelly Jamie , Noble Fergus , Sharland Donna , Fraser Rachel , Walker Rob , Rahman Saqib , Grace Ben , Chang Andrew C , Miller Judy , Barnett Shari , Cecconello Ivan , Ribeiro Ulysses , Sallum Rubens A A , de Manzoni Giovanni , Weindelmayer Jacopo , De Pasqual Carlo Alberto , Rosati Riccardo , Parise Paolo , Cossu Andrea , Puccetti Francesco , Massaron Simonetta , Kuppusamy Madhan K , Marston Bonnie , Low Donald E 
Published: November 2021

Abstract

Background
Large studies comparing totally minimally invasive oesophagectomy (TMIE) with laparoscopically assisted (hybrid) oesophagectomy are lacking. Although randomized trials have compared TMIE invasive with open oesophagectomy, daily clinical practice does not always resemble the results reported in such trials. The aim of the present study was to compare complications after totally minimally invasive, hybrid and open Ivor Lewis oesophagectomy in patients with oesophageal cancer.

Methods
The study was performed using data from the International Esodata Study Group registered between February 2015 and December 2019. The primary outcome was pneumonia, and secondary outcomes included the incidence and severity of anastomotic leakage, (major) complications, duration of hospital stay, escalation of care, and 90-day mortality. Data were analysed using multivariable multilevel models.

Results
Some 8640 patients were included between 2015 and 2019. Patients undergoing TMIE had a lower incidence of pneumonia than those having hybrid (10.9 versus 16.3 per cent; odds ratio (OR) 0.56, 95 per cent c.i. 0.40 to 0.80) or open (10.9 versus 17.4 per cent; OR 0.60, 0.42 to 0.84) oesophagectomy, and had a shorter hospital stay (median 10 (i.q.r. 8–16) days versus 14 (11–19) days (P = 0.041) and 11 (9–16) days (P = 0.027) respectively). The rate of anastomotic leakage was higher after TMIE than hybrid (15.1 versus 10.7 per cent; OR 1.47, 1.01 to 2.13) or open (15.1 versus 7.3 per cent; OR 1.73, 1.26 to 2.38) procedures.

Conclusion
Compared with hybrid and open Ivor Lewis oesophagectomy, TMIE resulted in a lower pneumonia rate, a shorter duration of hospital stay, but higher anastomotic leakage rates. Therefore, no clear advantage was seen for either TMIE, hybrid or open Ivor Lewis oesophagectomy when performed in daily clinical practice.