OA06-LBA01.3. Real-World Survival Outcomes of Mediastinoscopic Esophagectomy for Thoracic Esophageal Cancer: A Multicenter Retrospective Study in Japan
Abstract
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes With advances in endoscopic surgery, mediastinoscopic radical esophagectomy has become feasible, but remains less widely adopted than the transthoracic approach. Institutional experience and surgical indications vary, and long-term outcomes are unclear. This study evaluates real-world practice in Japan, including survival outcomes. We conducted a multicenter retrospective observational study of patients who underwent mediastinoscopic esophagectomy between 2019 and 2021. Eligible patients had resectable thoracic esophageal cancer and underwent one-stage resection and reconstruction with lymph node dissection including the upper mediastinum. Salvage cases and R2 resections were excluded. Clinicopathological characteristics, perioperative outcomes including complications, and overall survival (OS) and recurrence-free survival (RFS) were analyzed. A total of 392 patients from 10 institutions were analyzed. Seven institutions (357 cases) used mediastinoscopy as a standard approach. The median age was 70 years, with 314 males and 78 females. ASA-PS classification was I/II/III in 58/272/62 patients. Squamous cell carcinoma accounted for 348 cases (88.8%). Tumor location (Ut/Mt/Lt) was 66/161/165 cases. Clinical stage (I/II/III/IV) was 120/109/129/34 cases. Two-field and three-field lymphadenectomy were performed in 250 and 142 cases, respectively. Median operative time was 405 minutes, median blood loss was 140 mL, and median number of retrieved lymph nodes was 44. R0 resection rate was 95.2%, and conversion to thoracotomy occurred in 1.3%. The rates of anastomotic leakage, pneumonia, and recurrent laryngeal nerve palsy were 14.0%, 11.5%, and 36.7%, respectively. In-hospital mortality was 0.51%. Three-year OS and RFS were 79.0% and 61.2%, respectively. Although surgical experience, learning curves, and indications varied among institutions, mediastinoscopic esophagectomy was performed safely. The long-term outcomes appear to be comparable to those of transthoracic minimally invasive esophagectomy.