Recurrence and survival after minimally invasive and open esophagectomy for esophageal cancer: A post hoc analysis of the ensure study

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• dc.contributor.author Henckens, Sofie P. G.
• dc.contributor.author Schuring, Nannet
• dc.contributor.author Elliott, Jessie A.
• dc.contributor.author Johar, Asif
• dc.contributor.author Markar, Sheraz R.
• dc.contributor.author Gantxegi, Amaia
• dc.contributor.author Lagergren, Pernilla
• dc.contributor.author Hanna, George B.
• dc.contributor.author Pera Roman, Manuel Ramón
• dc.contributor.author Reynolds, John Vincent
• dc.contributor.author van Berge Henegouwen, Mark I.
• dc.contributor.author Gisbertz, Suzanne S.
• dc.contributor.author ENSURE Study Group
• dc.date.accessioned 2025-02-19T07:23:01Z
• dc.date.available 2025-02-19T07:23:01Z
• dc.date.issued 2024
• dc.description.abstract 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.
• dc.format.mimetype application/pdf
• dc.identifier.citation Henckens SPG, Schuring N, Elliott JA, Johar A, Markar SR, Gantxegi A, et al. Recurrence and survival after minimally invasive and open esophagectomy for esophageal cancer: A post hoc analysis of the ensure study. Ann Surg. 2024 Aug 1;280(2):267-73. DOI: 10.1097/SLA.0000000000006280
• dc.identifier.doi http://dx.doi.org/10.1097/SLA.0000000000006280
• dc.identifier.issn 0003-4932
• dc.identifier.uri http://hdl.handle.net/10230/69634
• dc.language.iso eng
• dc.publisher Lippincott Williams & Wilkins
• dc.relation.ispartof Ann Surg. 2024 Aug 1;280(2):267-73
• dc.rights © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0/
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Esophageal cancer
• dc.subject.keyword Esophagectomy
• dc.subject.keyword Minimally invasive surgery
• dc.subject.keyword Recurrence
• dc.subject.keyword Survival
• dc.title Recurrence and survival after minimally invasive and open esophagectomy for esophageal cancer: A post hoc analysis of the ensure study
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion