P1.184. Impact of Abdominal Surgical Approach on Short-Term Outcomes After Esophagectomy for Lower Thoracic Squamous Cell Carcinoma: A Multicenter Cohort Study

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer We previously evaluated the clinical significance of supraclavicular lymph node dissection (SLND) for lower thoracic esophageal cancer and reported limited benefit. Using the same multicenter cohort, the present study investigated the impact of different abdominal surgical approaches on short-term outcomes. This retrospective multicenter study included patients with lower thoracic esophageal squamous cell carcinoma who underwent esophagectomy between 2013 and 2017 at 18 institutions. Cases reconstructed via routes other than the retrosternal or posterior mediastinal pathway, or using organs other than the gastric conduit, were excluded. Patients were classified according to the abdominal approach: open laparotomy (Open), hand-assisted laparoscopic surgery (HALS), or laparoscopic surgery (Lap). The primary outcomes were postoperative complications, including pneumonia and anastomotic leakage. Comparisons were performed using univariable analysis and inverse probability of treatment weighting (IPTW) based on propensity scores calculated from age, sex, BMI, ASA-PS, pulmonary function, clinical T and N stage, thoracic approach, reconstruction route, preoperative therapy, and supraclavicular lymph node dissection. Logistic regression models were then applied. A total of 696 patients were analyzed (Open: 257, HALS: 198, Lap: 241). Patients in the Open group had lower BMI and more advanced clinical stage. Preoperative therapy was administered in approximately 70%. Minimally invasive thoracic approaches were performed in 47.8, 73.2, and 90.5% in the Open, HALS, and Lap groups, respectively. Reconstruction routes differed among groups, with posterior mediastinal reconstruction in 33.9, 54.0, and 27.8%, and retrosternal reconstruction in 53.7, 41.4, and 63.1%; the remaining cases underwent intrathoracic anastomosis. SLND was performed in 47.9, 26.8, and 58.9%. After IPTW adjustment, pneumonia of Clavien–Dindo grade ≥2 did not differ significantly from Open (HALS: OR 0.84, p=0.49; Lap: OR 0.88, p=0.59). Grade ≥3 pneumonia tended to be less frequent in the Lap (OR 0.33, p=0.058), but not in the HALS (OR 0.74, p=0.36). No significant differences were observed in overall complications, anastomotic leakage, or respiratory complications other than pneumonia. In esophagectomy for lower thoracic esophageal cancer, laparoscopic abdominal procedures were associated with a trend toward fewer severe pneumonias compared with open surgery, whereas the benefit of HALS was limited. These findings suggest that a fully laparoscopic approach may contribute to reducing severe respiratory complications.