F-149
LONG-TERM OUTCOME OF OPEN VERSUS LAPAROSCOPIC IVOR LEWIS OESOPHAGECTOMY: A PROPENSITY MATCH SCORE STUDY

Objectives: Laparoscopic Ivor Lewis (IL) oesophagectomy has been suggested to reduce postoperative morbidity and mortality. However, long-term outcomes of this hybrid minimally invasive procedure have been poorly reported.

Methods: All patients who had an IL oesophagectomy for cancer were extracted from a prospective database. Patients were matched one-to-one according to the surgical approach (laparoscopy versus laparotomy) and on the basis of a propensity score including 8 variables: age, gender, FEV1, neoadjuvant treatment, salvage surgery, histology, location and p stage. The first end-point was the assessment of the five year survival and disease-free survival (DFS) rates. The secondary end-points were: 1) the quality of the surgery (R0 resection rate, number resected lymph nodes (LN); 2) the patterns of recurrence.

Results: Over a 12-year period, 379 oesophagectomies were performed among whom 272 were done using IL technique. Hundred and forty patients were matched in two homogeneous groups: laparotomy (n = 70) and laparoscopy (n = 70). The median follow-up for those alive and without recurrence at study end was 32 months (range 1–104). The five year overall and DFS survival rates were 65% and 48% in laparotomy group and 73% and 51% in the laparoscopy group (P = 0.891; P = 0.912). R0 resection rates were respectively 93% vs 97% (P = 0.441). At the time of review, 32 patients (23%) had developed a recurrence, and 33 patients (24%) had died. According to the surgical approach, the patterns of recurrence were similar in both groups.

Conclusion: Laparoscopic approach to IL oesophagectomy does not compromise the long-term oncologic outcome compared to open one. The quality of surgery seems similar in both techniques excepted for the number of resected LN at the level of the celiac trunk. Further randomized controlled trials are necessary to confirm these results.

Disclosure: No significant relationships.