P1.077. Lymph Node Yield and Perioperative Outcomes of Double Single-Port Minimally Invasive Esophagectomy: A Propensity Score-Matched Comparison With McKeown Esophagectomy

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Double single-port minimally invasive esophagectomy (ds-MIE) is an emerging non-transthoracic technique. However, its oncological thoroughness of lymphadenectomy remains debated compared to the minimally invasive McKeown esophagectomy (MIME). This study evaluates the oncological adequacy of ds-MIE by comparing lymph node harvest patterns and short-term perioperative outcomes against MIME. We conducted a retrospective propensity score-matched (PSM) analysis of patients who underwent ds-MIE (A non-transthoracic esophagectomy utilizing solitary cervical and abdominal incisions, each restricted to less than 5 cm.) or MIME at our institution between July 2025 and January 2026. A total of 33 patients received ds - MIE, and 66 patients received MIME. Covariates including age, sex, BMI, American Society of Anesthesiologists Physical Status Classification System (ASA), neoadjuvant therapy, tumor characteristics (location, size), and oxygenation index (OI) were balanced using a 1:2 ratio and a caliper of 0.02. The primary endpoint was LN harvest (AJCC 8th Edition). Secondary endpoints included operative time, blood loss, postoperative complications rates and grades (Clavien- Dindo Classification), and length of postoperative stay. Statistical analyses were performed using STATA 16.0. Normally distributed continuous variables were compared using Student’s t-test (x- ± s), while skewed data were analyzed using the Mann–Whitney U test [M (IQR)]. Following PSM, 82 patients were included (ds-MIE: n=27; MIME: n=55). No significant differences were observed between the ds-MIE and MIME groups in total LN count (27.0 ± 11.8 vs. 22.8 ± 8.9, P > 0.05) or station-specific yields, including mediastinal (12.8 ± 6.6 vs. 10.8 ±5.4), left recurrent laryngeal nerve (RLN) (1.3 ± 1.5 vs. 0.9 ± 1.7), right RLN(1.5 ± 1.7 vs. 1.8 ± 1.7), subcarinal (4.8 ± 4.2 vs. 3.7 ± 3.0), paraesophageal(3.8 ± 3.1 vs. 3.9 ± 3.3) and abdominal nodes (13.4 ± 8.2 vs. 11.8 ± 6.1) (all P > 0.05). While ds-MIE required a longer operative time (360.9 vs. 314.4 min, P < 0.01), no significant differences were found in blood loss, postoperative stay (14.7 ± 1.6 vs. 17.3 ± 1.7 days). Overall complication rates (44.4% vs. 56.4%, P > 0.05), with lower pneumonia rate (7.4% vs. 12.7%, P < 0.05). Our findings demonstrate that ds-MIE is oncologically comparable to MIME in terms of lymph node harvest and short-term perioperative outcomes. Once the learning curve is overcome, ds-MIE provides a safe and thorough alternative for esophageal cancer resection without compromising the extent of lymphadenectomy.