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Short-Term Outcomes Following Open Versus Minimally Invasive Esophagectomy for Cancer in England: A Population-Based National Study

Mamidanna, Ravikrishna MBBS, MRCS*; Bottle, Alex PhD; Aylin, Paul MBChB, FFPH; Faiz, Omar MBBS, FRCS*; Hanna, George B. FRCS, PhD*

doi: 10.1097/SLA.0b013e31823e39fa

Objective: To compare short-term outcomes of open and minimally invasive esophagectomy (MIE) for cancer.

Background Data: Numerous studies have demonstrated the safety and possible advantages of MIE in selected cohorts of patients. The increasing use of MIE is not coupled with conclusive evidence of its benefits over “open” esophagectomy, especially in the absence of randomized trials.

Methods: Hospital Episode Statistics data were analyzed from April 2005 to March 2010. This is a routinely collected database of all English National Health Service Trusts. Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures, 4th revision (OPCS-4), procedure codes were used to identify index resections and International Statistical Classification of Diseases, 10th Revision (ICD-10), diagnostic codes were used to ascertain comorbidity status and complications. Thirty-day in-hospital mortality, medical complications, and surgical reinterventions were analyzed. Unadjusted and risk-adjusted regression analyses were undertaken.

Results: Seven thousand five hundred and two esophagectomies were undertaken; of these, 1155 (15.4%) were MIE. In 2009–2010, 24.7% of resections were MIE. There was no difference in 30-day mortality (4.3% vs 4.0%; P = 0.605) and overall medical morbidity (38.0% vs 39.2%; P = 0.457) rates between open and MIE groups, respectively. A higher reintervention rate was associated with the MIE group than with the open group (21% vs 17.6%, P = 0.006; odds ratio, 1.17; 95% confidence interval, 1.00–1.38; P = 0.040).

Conclusions: Minimally invasive esophagectomy is increasingly performed in the United Kingdom. Although the study confirmed the safety of MIE in a population-based national data, there are no significant benefits demonstrated in mortality and overall morbidity. Minimally invasive esophagectomy is associated with higher reintervention rate. Further evidence is needed to establish the long-term survival of MIE.

Supplemental digital content is available in the text.This population-based national study showed no significant difference in mortality and overall morbidity between open and minimally invasive esophagectomy for cancer. Minimally invasive esophagectomy is associated with a higher reintervention rate. Further evidence is required to establish its long-term outcomes.

*St Mary's Hospital

Dr Foster Unit, Imperial College London, United Kingdom.

Reprints: George B. Hanna, PhD, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, 10th Floor, QEQM Wing, Praed St, London W2 1NY, United Kingdom. E-mail:

Disclosure: The authors declare that they have nothing to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2012 Lippincott Williams & Wilkins, Inc.