Short-term outcomes of the McKeown esophagectomy for thoracic esophageal cancer: a multiple-center study

Objective. To analyze short-term outcomes of the McKeown esophagectomy in 4 cancer centers of the Russian Federation. Material and methods. The study included 175 patients who underwent open, hybrid or minimally invasive McKeown esophagectomy between 2016 and 2023 in 4 cancer centers of the Russian Federation. Traditional open esophagectomy was performed in 69 (39.4%) patients, hybrid — in 78 (44.6%), minimally invasive — in 28 (16%) patients. Results. Median time of minimally invasive surgery was 395 min 358.25; 436.25, hybrid procedure — 357.5 min 300.00; 403.75, open esophagectomy — 315 min 265.00; 390.00 (p<0.001). Mean blood loss was 175, 150 and 300 ml, respectively (p<0.001). Conversion rate for hybrid interventions was 2.5%, for minimally invasive esophagectomy — 3.5%. Mean number of resected lymph nodes was higher in minimally invasive groups (open — 19.7±7.5; hybrid — 21.3±13.1; minimally invasive esophagectomy — 21.7±12.4 p=0.007). Major postoperative complications (TMM classification) comprised 8.7% in open surgeries and 20.7% in hybrid and minimally invasive procedures (p=0.031). Pulmonary complications were more common after open esophagectomy (17.4%) compared to hybrid and minimally invasive procedures (7.5%) (p=0.041). Incidence of type 2 and 3 anastomotic leaks was 6.4% in hybrid surgery, 8.6% in open surgery and 10.7%in minimally invasive procedures (p=0.387). Postoperative in-hospital mortality was 8.6% for open esophagectomy, 5.1% for hybrid esophagectomy and 3.5% for minimally invasive procedures (p=0.049). Hospital-stay was 19 days for open esophagectomy and 14 days for hybrid and minimally invasive procedures (p=0.219). Conclusion. Minimally invasive esophagectomy for thoracic esophageal cancer significantly reduces the incidence of postoperative pulmonary complications and intraoperative blood loss, as well as increases the number of removed lymph nodes.