The aim of the study was to evaluate short-term and oncological outcomes of left thoracoabdominal esophagectomy (LTE) compared to minimally invasive esophagectomy for cancer of the esophagus and gastroesophageal junction. LTE facilitates complete resection of esophageal cancer particularly for bulky tumors, but there are concerns that this approach is associated with significant morbidity. Methods Prospectively entered esophagectomy databases from two high volume North American centers were reviewed for patients undergoing LTE or MIE in the 2012–2018. Patient demographics, tumour characteristics, operative outcomes, postoperative outcomes, and pathologic surrogates of oncologic efficacy (R0 resection rate, and number of resected lymph nodes) were compared. In total 247 patients were included in the study, LTE was applied in 170 (68.8%) patients, and MIE in 77 (31.2%) patients. Results LTE patients had more neoadjuvant treatment (LTE = 78.2%, MIE = 34.2%, P < 0.001). There was no difference in overall postoperative complications (LTE = 56.9%, MIE = 55.0%, P = 0.799), severe complications (Clavien Dindo>2—LTE = 26.1%, MIE17.0%, P = 0.184), pulmonary complications (LTE = 31.9%, MIE = 20.0%, P = 0.085), pneumonia (LTE = 15.2%, MIE = 13.6%, P = 0.768), anastomotic leak (LTE = 7%, MIE = 10%, P = 0.396), or postoperative mortality (LTE = 0%, MIE = 1.3%, P = 0.140). Median length of stay was 7 days in both groups. R0 resection rate was 93.8% and 95.5% respectively (P = 0.631). Median number of resected lymph nodes was 24 for LTE and 22 for MIE (P = 0.226). LTE had more stage II-IV tumors (LTE = 67.8%, MIE = 40.7%, P < 0.001), and more node positive resections (LTE = 52.5%, MIE = 31.4%, P = 0.003). Conclusion LTE was used for larger tumors with greater lymph node burden in patients that were more likely to have received neoadjuvant treatment compared to MIE. Despite this the postoperative morbidity was equal to that of MIE, with no difference in short-term or oncological results in this cohort.

中文翻译：

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464 左开胸腹食管切除术是微创食管切除术时代的可行选择吗？

该研究的目的是评估左胸腹食管切除术 (LTE) 与食管和胃食管交界处癌的微创食管切除术相比的短期和肿瘤学结果。LTE 有助于完全切除食管癌，特别是对于大块肿瘤，但有人担心这种方法与显着的发病率有关。方法 回顾了来自两个大容量北美中心的前瞻性食管切除术数据库，用于 2012-2018 年接受 LTE 或 MIE 的患者。比较了患者的人口统计学、肿瘤特征、手术结果、术后结果和肿瘤疗效的病理替代指标（R0 切除率和切除的淋巴结数量）。该研究共纳入 247 名患者，170 名（68.8%）患者应用了 LTE，77 名 (31.2%) 患者的 MIE。结果 LTE 患者接受了更多的新辅助治疗（LTE = 78.2%，MIE = 34.2%，P < 0.001）。总体术后并发症（LTE = 56.9%，MIE = 55.0%，P = 0.799）、严重并发症（Clavien Dindo>2—LTE = 26.1%，MIE17.0%，P = 0.184）、肺部并发症（ LTE = 31.9%, MIE = 20.0%, P = 0.085), 肺炎 (LTE = 15.2%, MIE = 13.6%, P = 0.768), 吻合口漏 (LTE = 7%, MIE = 10%, P = 0.396),或术后死亡率（LTE = 0%，MIE = 1.3%，P = 0.140）。两组的中位住院时间均为 7 天。R0切除率分别为93.8%和95.5%（P=0.631）。LTE 切除淋巴结的中位数为 24，MIE 为 22（P = 0.226）。LTE 有更多的 II-IV 期肿瘤（LTE = 67.8%，MIE = 40.7%，P < 0.001）和更多的淋巴结阳性切除（LTE = 52.5%，MIE = 31.4%，P = 0.003）。结论 LTE 用于与 MIE 相比更可能接受新辅助治疗的患者中淋巴结负荷较大的较大肿瘤。尽管如此，术后发病率与 MIE 相同，该队列的短期或肿瘤学结果没有差异。