Introduction of laparoscopic Ivor Lewis esophagectomy as hybrid procedure and comparison with open esophagectomy. A propensity-matched retrospective study.

BACKGROUND

Esophagectomy is associated with increased rate of postoperative complications, making it one of the procedures with the highest impact on patients' quality of life. Hybrid Ivor Lewis esophagectomy (HMIE) has been introduced in our clinic with the aim to reduce postoperative morbidity, without compromising on oncological outcomes. We conducted this survey to evaluate the perioperative morbidity of the new method during the introduction phase compared to open esophagectomy in two similarly matched groups of patients.

METHODS

This study included the first 17 patients who underwent HMIE for esophageal cancer at a high-volume tertiary center. After generating propensity scores using the variables age, body mass index, pulmonary comorbidities, cardiac comorbidities, histologic type, and neoadjuvant treatment, 17 patients in the hybrid group were matched with 17 patients in the open group. Surgical outcomes, oncological outcomes, and postoperative complications according to the guidelines of the Esophageal Complications Consensus Group were compared between the two groups.

RESULTS

Surgical and oncological outcomes were comparable between the two approaches. The rate of postoperative complications, including surgical, gastrointestinal, and pulmonary complications, were similar in the two groups.

CONCLUSIONS

Our hypothesis that laparoscopy could reduce postoperative complications was not confirmed. HMIE is a safe procedure, resulting in radical oncological resection and similar morbidity with open esophagectomy. Surgeons, who are proficient in open approach and laparoscopic anti-reflux and gastric surgery, can safely adopt the hybrid approach without significant learning curve associated morbidity.