Minimally invasive vs. open esophagectomy in patients with a BMI > 35: a NSQIP analysis

Background In this analysis, we aim to examine the outcomes of minimally invasive and open esophagectomy in patients with a BMI > 35. Study design This is a retrospective cohort study utilizing the NSQIP Targeted Esophagectomy database from 2016 to 2023. We identified patients with a BMI > 35 who underwent minimally invasive esophagectomy (MIE) and open esophagectomy (OE) for malignancy. Primary outcome measures included morbidity, mortality, and incidence of anastomotic leak. Secondary measures included length of stay (LOS), unplanned return to OR, pneumonia, ventilator > 48 h, unplanned intubation, and SSI. Results 243 patients underwent MIE and 221 patients underwent OE. 30-day mortality was 2.87% in the MIE cohort and 4.32% in the open cohort [OR 1.53, 95% CI 0.45–5.45]. Overall morbidity was 41.1% in the MIE cohort vs 45.3% in OE [OR 1.18, 95% CI 0.80–1.74]. Anastomotic leak showed no significant difference between both cohorts [19% MIE vs 17% OE, OR 0.87, 95% CI 0.52–1.43]. LOS was significantly lower in the MIE cohort compared to OE (9.96 days vs. 11.31, 95% CI 2.69–0.02, P = 0.046). After logistic regression to adjust for confounding covariates, the estimated odds of experiencing each binary outcome, aside from pneumonia, were higher in the OE cohort. LOS increased by 1.41 days (95% CI 0.05–2.77) in the OE cohort after linear regression to adjust for confounding covariates. Conclusions We demonstrate that MIE has comparable outcomes to OE in several measures in patients with a BMI > 35. We also found significantly improved LOS in the MIE cohort. Our data suggest that in this patient population, MIE may demonstrate a comparable safety profile to the traditional open approach.