Bilateral Transcervical Mediastinoscopic-Assisted Transhiatal Laparoscopic Esophagectomy versus Thoracolaparoscopic Esophagectomy: A Propensity Score-Matched Analysis

Background: This study aimed to compare the surgical outcomes of bilateral transcervical mediastinoscopic-assisted transhiatal laparoscopic esophagectomy (BTC-MATLE) and traditional thoracoscopic-laparoscopic esophagectomy (TLE) using propensity score matching (PSM) to minimize selection bias.Methods: From 2017 to 2022, 392 patients underwent R0 resection for esophageal cancer.After excluding open, salvage, conversion, and 2-stage cases, 32 BTC-MATLE and 360 TLE cases were identified.PSM was performed based on age, performance status, and clinical stage, resulting in 27 matched pairs.Results: Baseline characteristics were well balanced between the groups.Operative time was significantly shorter in the BTC-MATLE group (254104 minutes) compared to the TLE group (34255 minutes, p<0.001).Intensive care unit (ICU) stay was also significantly shorter in the BTC-MATLE group (median=1 day) than in the TLE group (median=3 days, p=0.002).There were no significant differences in blood loss, anastomotic method, complication rates, length of hospital stay, or readmission rates.Conclusion: BTC-MATLE demonstrated shorter operative time and ICU stay compared to TLE, with comparable safety outcomes.This technique may be a feasible minimally invasive approach for esophagectomy.Session 7