• Fangfang Liu, Wenlei Yang, Wei Yang, Ruiping Xu, Lei Chen, Yu He, Zhen Liu, Fuyou Zhou, Bolin Hou, Liqun Zhang, Lixin Zhang, Fan Zhang, Fen Cai, Huawen Xu, Miaoping Lin, Mengfei Liu, Yaqi Pan, Ying Liu, Zhe Hu, Huanyu Chen, Zhonghu He, and Yang Ke.
• Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China.
• Ann. Surg. 2023 Apr 1; 277 (4): e777e784e777-e784.

ObjectiveTo evaluate the long-term and short-term outcomes of MIE compared with OE in localized ESCC patients in real-world settings.BackgroundMIE is an alternative to OE, despite the limited evidence regarding its effect on long-term survival.MethodsWe recruited 5822 consecutive patients with resectable ESCC in 2 typical high-volume centers in southern and northern China, 1453 of whom underwent MIE. Propensity score-based overlap weighted regression adjusted for multifaceted confounding factors was used to compare outcomes in the MIE and OE groups.ResultsFive-year OS was 62.7% in the MIE group and 57.7% in the OE group. The overlap weighted Cox regression showed slightly better OS in the MIE group (hazard ratio 0.93, 95% confidence interval: 0.82-1.06). Although duration of surgery was longer and treatment cost higher in the MIE group than in the OE group, the number of lymph nodes harvested was larger, the proportion of intraoperative blood transfusions lower, and postoperative complications less in the MIE group. 30-day (risk ratio [RR] 0.77, 0.381.55) and 90-day (RR 0.79, 0.46-1.35) mortality were lower in the MIE group versus the OE group, although not statistically significant. These findings were consistent across different analytic approaches and subgroups, notably in the subset of ESCC patients with large tumors.ConclusionsMIE can be performed safely with OS comparable to OE for patients with localized ESCC, indicating MIE may be recommended as the primary surgical approach for resectable ESCC in health facilities with requisite technical capacity.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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