Long-Term Results of Single- and Multi-Incision Minimally Invasive Esophagectomy for Esophageal Cancer: Experience of 348 Cases

<b>Importance:</b> While minimally invasive esophagectomy is currently accepted as an effective treatment for patients with esophageal cancer, the long-term survival outcomes of single-incision minimally invasive esophagectomy in these patients are still unknown, particularly when compared to those of the more invasive multi-incision minimally invasive esophagectomy. <b>Objective:</b> To determine the long-term oncological outcomes of single-incision minimally invasive esophagectomy in patients with esophageal cancer and to compare these outcomes with those of multi-incision minimally invasive esophagectomy. <b>Design:</b> This was a prospective, randomized, and propensity score-matched study wherein we analyzed patients who underwent treatment from February 2005 to May 2022. <b>Setting:</b> Our study was carried out by a single surgical team in a tertiary medical center. <b>Participants:</b> We analyzed 348 patients with esophageal cancer who underwent single-incision minimally invasive esophagectomy and 469 who underwent multi-incision minimally invasive esophagectomy. <b>Main Outcomes and Measures:</b> We aimed to determine the long-term survival outcomes of single-incision minimally invasive esophagectomy and compare these to those of multi-incision minimally invasive esophagectomy in our study population, and further conducted a propensity score-matching (n = 251 in each arm) study. <b>Results:</b> The disease progression-free (DFS) and overall survival (OS) rates of patients who underwent single-incision minimally invasive esophagectomy (SIMIE) was significantly better than that of those who underwent by multi-incision minimally invasive esophagectomy (MIMIE) (<i>p</i> = 0.024 for OS and <i>p</i> = 0.027 for PFS). This trend of difference was observed in the subsequent propensity-score matching analysis (<i>p</i> = 0.009 and 0.016 for OS and PFS, respectively). <b>Conclusions and Relevance:</b> The single-incision technique applied in minimally invasive esophagectomy to treat esophageal cancer is feasible without compromising the patient's long-term oncological outcome, as opposed to that applied using multi-incision minimally invasive esophagectomy.