Single-Incision Minimally Invasive Esophagectomy (Simie) Prevents Postoperative Muscle Wasting in Esophageal Cancer Patients Compared to Multi-Incision Minimally Invasive Esophagectomy (Mimie)

Background Minimally invasive esophagectomy (MIE) has been adopted as an effective surgical treatment of choice for patients of esophageal cancer. Single-incision approach to perform MIE (SIMIE) has been reported and demonstrated its feasibility in perioperative outcome before. However, the long-term clinical impact of SIMIE is unclear currently. Methods This is a prospective randomized study comparing the postoperative nutritional and survival status in the patients of esophageal cancer undergoing minimally invasive esophagectomy with single-incision (SIMIE) or multi-incision (MIMIE) in the laparoscopic and thoracoscopic procedures. There were 100 patients enrolled including 50 patients in each arm respectively. The nutritional status was evaluated with the degree of muscle wasting by the change of psoas muscle index (PMI) at the L3 level after surgery. Results There was a significant trend of better overall survival in the patients of SIMIE (56% vs 35% of 5-year OS, p = 0.18). There was a significant difference of postoperative muscle wasting between the two groups of patients with mean PMI change of 2.75% and 6.38% for SIMIE as compared to −5.06% and − 3.69% for MIMIE at 6 and 12 months (p = 0.006) with the reference before surgery. For the whole patient, muscle wasting presence at postoperative 12 months was associated with a worse overall survival (adjusted OR (95% CI): 3.43 (1.33–8.86)). Conclusion SIMIE mitigates postoperative muscle wasting as compared to MIMIE and persistent muscle wasting for 12 months after surgery is associated worsening overall survival for the patients of esophageal cancer after MIE.