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

Henckens, Sofie P. G.; Schuring, Nannet; Elliott, Jessie A.; Johar, Asif; Markar, Sheraz R.; Gantxegi, Amaia; Lagergren, Pernilla; Hanna, George B.; Pera Román, Manuel; Reynolds, John Vincent; van Berge Henegouwen, Mark I.; Gisbertz, Suzanne S.; ENSURE Study Group

doi:http://dx.doi.org/10.1097/SLA.0000000000006280

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

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Citació

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

Resum

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.