LAUSR

Introduction Surgical resection is vital in the curative management of patients with esophageal cancer. However, a myriad of surgical procedures exists based on surgeon preference and training. We report on the perioperative outcomes based on esophagectomy surgical technique. Methods A prospectively managed esophagectomy database was queried for patients undergoing esophagectomy from 1996 and 2016. Basic demographics, tumor characteristics, operative details, and post-operative outcomes were recorded and analyzed by comparison of transhiatal vs Ivor-lewis and minimally invasive (MIE) vs open procedures. Results We identified 856 patients who underwent esophagectomy. Neoadjuvant therapy was administered in 543 patients (63.4%). There were 504 (58.8%) open esophagectomies and 302 (35.2%) MIE. There were 13 (1.5%) mortalities and this did not differ among techniques ( p  = 0.6). While there was no difference in overall complications between MIE and open, complications occurred less frequently in patients undergoing RAIL and MIE IVL compared to other techniques ( p  = 0.003). Pulmonary complications also occurred less frequently in RAIL and MIE IVL ( p  < 0.001). Anastomotic leaks were less common in patients who underwent IVL compared to trans-hiatal approaches ( p  = 0.03). MIE patients were more likely to receive neoadjuvant therapy ( p  = 0.001), have lower blood loss ( p  < 0.001), have longer operations ( p  < 0.001), and higher lymph node harvests ( p  < 0.001) compared to open patients. Conclusion Minimally invasive and robotic Ivor Lewis techniques demonstrated substantial benefits in post-operative complications. Oncologic outcomes similarly favor MIE IVL and RAIL.