Comparative Outcomes of Minimally Invasive Versus Open Esophagostomy for Distal Esophageal Cancer: A Retrospective Cohort Study from a Tertiary Referral Center

Introduction: Esophageal cancer is a leading cause of cancer-related mortality globally. While open esophagostomy (OE) remains a standard treatment, it is associated with considerable morbidity and mortality. Minimally invasive esophagostomy (MIE) has emerged as an alternative with potentially fewer complications and faster recovery. This study aimed to compare the outcomes and complications of MIE versus OE in patients with distal esophageal cancer. Materials and Methods: This retrospective cohort study included 196 patients with distal esophageal cancer treated between 2015 and 2021 at two tertiary hospitals in Tehran. Patients were equally divided into MIE (n=98) and OE (n=98) groups. Preoperative, intraoperative, and postoperative variables including surgical duration, pain intensity, intraoperative blood loss, transfusion requirements, hospital stay, and complication rates were collected and analyzed using SPSS version 23. Appropriate statistical tests were applied with a significance level set at p<0.05. Results: The mean duration of surgery was significantly shorter in the MIE group compared to the OE group (280.71±44.83 vs. 425.36±51.69 minutes, p<0.001). MIE patients experienced significantly less intraoperative blood loss (297.14 ± 89.29 vs. 503.57 ±122.02 mL, p<0.001), required fewer blood transfusions (2.14±0.52 vs. 2.64±0.90 units, p<0.001), and had a shorter hospital stay (14.14± 3.27 vs. 18.64±4.31 days, p<0.001). Postoperative pain was also lower in the MIE group (2.86±1.36 vs. 3.43±2.48, p=0.048). However, the number of lymph nodes dissected was significantly higher in the OE group (18.50±3.48 vs. 9.57±3.79, p<0.001), and the incidence of chylothorax was greater in the MIE group (7 vs. 1 cases, p=0.030). There was no statistically significant difference in tracheal injury between the groups (p=0.054). Conclusion: Minimally invasive esophagostomy offers several clinical benefits over open surgery, including reduced blood loss, lower postoperative pain, shorter operative time, and decreased hospital stay. However, it is associated with a higher incidence of chylothorax and a lower lymph node yield, possibly due to the learning curve and technical nuances. These findings support the use of MIE in selected patients, emphasizing the need for continued refinement of technique and surgical expertise to optimize outcomes.