Minimally invasive esophagectomy attenuates the postoperative inflammatory response and improves survival compared with open esophagectomy in patients with esophageal cancer: a propensity score matched analysis

Surg Endosc. 2018 Nov;32(11):4443-4450. doi: 10.1007/s00464-018-6187-z. Epub 2018 Apr 11.


Background: Minimally invasive esophagectomy (MIE) for patients with esophageal cancer has recently spread worldwide. However, whether MIE is less invasive has not yet been fully evaluated.

Methods: We retrospectively analyzed data from 551 patients who underwent curative esophagectomy for esophageal cancer from 2005 to 2014: 145 patients underwent minimally invasive esophagectomy (MIE) and 406 patients underwent open transthoracic esophagectomy (OE). We compared postoperative CRP levels with propensity score matching. In addition, long-term outcomes were also compared between the groups.

Results: Operative time was significantly longer, and intraoperative blood loss was significantly less in the MIE group compared with the OE group. Although the incidence of postoperative complications was similar between the 2 groups, postoperative serum CRP levels during the first 3 and 5 postoperative days and peak postoperative CRP levels were significantly lower after MIE versus OE (MIE vs. OE, median, 15.21 vs. 19.50 mg/dl; P < 0.001). The MIE group had significantly more favorable disease-free survival (DFS) and overall survival (OS) rates than the OE group (3-year DFS rate, 81.7 vs. 69.3%, log-rank P = 0.021; 3-year OS rate, 89.9 vs. 79.2%, log-rank P = 0.007). MIE was an independent prognostic factor for patients with esophageal cancer. The incidence of regional lymph node recurrence was lower in the MIE group.

Conclusions: MIE significantly attenuated postoperative serum CRP levels compared with OE. MIE could contribute to improved survival.

Keywords: Disease-free survival; Inflammatory response; Minimally invasive esophagectomy; Serum C-reactive protein.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Esophageal Neoplasms / mortality
  • Esophageal Neoplasms / surgery*
  • Esophageal Squamous Cell Carcinoma / mortality
  • Esophageal Squamous Cell Carcinoma / surgery*
  • Esophagectomy / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Laparoscopy / methods*
  • Male
  • Middle Aged
  • Propensity Score
  • Retrospective Studies
  • Survival Rate
  • Thoracoscopy / methods*
  • Treatment Outcome