High BMI has no impact on the survival of Chinese patients with lower thoracic esophageal adenocarcinoma treated with curative esophagectomy: a propensity score-matched study.

Controversy still exists as to whether a high body mass index (BMI) has any impact on the long-term survival of esophageal cancer patients treated with curative esophagectomy. Therefore, we conducted this propensity score-matched (PSM) study to explore the prognostic value of high BMI in Chinese patients with lower thoracic esophageal adenocarcinoma for the first time. We retrospectively collected data of patients with lower thoracic esophageal adenocarcinoma who underwent curative esophagectomy in our department from January 2009 to December 2016. Patients were grouped into high BMI group (≥23 kg/m2) and normal BMI group (18.5-22.9 kg/m2) according to the Asian specific BMI cutoff value. Both Cox regression survival analysis and PSM analysis were applied. Finally, a total of 132 patients were included for analysis. Fifty-three patients were in the high BMI group while 79 patients were in the normal BMI group. There was no significant difference regarding age, gender, comorbidity, tumor differentiation, tumor site, lymphovascular invasion, or surgical approaches between the two groups. However, patients with a high BMI tended to have more stage III diseases but a lower rate of adjuvant therapy application than those with a normal BMI. For survival, there was no significant survival difference between patients with a high BMI and those with a normal BMI (5-year overall survival (OS): 40.8% vs. 48.1%; P = 0.398). In the multivariate analysis, high BMI was not found to be an independent prognostic factor (HR = 1.028, 95%CI: 0.621-1.667, P = 0.945). A total of 92 well-matched patients were included after PSM analysis. However, there was still no significant difference of survival between the two groups (5-year OS: 41.4% vs. 43.3%; P = 0.760). Therefore, high BMI has no impact on survival of Chinese patients with lower thoracic esophageal adenocarcinoma treated with curative esophagectomy.

Does robot-assisted minimally invasive esophagectomy really have the advantage of lymphadenectomy over video-assisted minimally invasive esophagectomy in treating esophageal squamous cell carcinoma? A propensity score-matched analysis based on short-term outcomes.

This study aims to investigate advantages of robot-assisted minimally invasive esophagectomy (RAMIE) over video-assisted minimally invasive esophagectomy (VAMIE) in treating esophageal squamous cell carcinoma by applying propensity score-matched analysis. From April 2016 to January 2018, consecutive patients undergoing a McKeown RAMIE or VAMIE for esophageal squamous cell carcinoma were prospectively included for analysis. Baseline data, pathological findings, and short-term outcomes of the two groups (RAMIE group and VAMIE group) were collected and compared. Propensity score-matched analysis was applied to generate matched pairs for further comparison. Finally, we included a total of 151 patients (RAMIE group: 79 patients, VAMIE group: 72 patients) for analysis. In the analysis of unmatched cohort, RAMIE yielded a significantly larger number of total dissected lymph nodes (mean: 20.6 ± 8.8 vs. 17.9 ± 7.7; P = 0.048) and abdominal lymph nodes (mean: 9.5 ± 6.8 vs. 7.4 ± 5.1; P = 0.039) than VAMIE. However, there was no significantly different risk of major complications between the two groups. In the analysis of matched cohort, RAMIE still yielded a significantly larger number of total dissected lymph nodes (P = 0.006) and abdominal lymph nodes (P = 0.042) than VAMIE. There was still no increased risk of postoperative major complications in the RAMIE group compared to the VAMIE group. Moreover, RAMIE was found to yield significantly more left recurrent laryngeal nerve lymph nodes (mean: 1.0 ± 1.8 vs. 0.4 ± 0.8; P = 0.033) than VAMIE without increasing the risk of recurrent laryngeal nerve paralysis. Therefore, RAMIE may have the advantage of lymphadenectomy over VAMIE without increasing any risk of postoperative major complications. Further well-conducted studies, however, are needed to confirm our conclusions.

Comparison of short-term outcomes between robot-assisted minimally invasive esophagectomy and video-assisted minimally invasive esophagectomy in treating middle thoracic esophageal cancer.

Whether the robot-assisted minimally invasive esophagectomy (RAMIE) has any advantages over the video-assisted minimally invasive esophagectomy (VAMIE) remains controversial. In this study, we tried to compare the short-term outcomes of RAMIE with that of VAMIE in treating middle thoracic esophageal cancer from a single medical center. Consecutive patients undergoing RAMIE or VAMIE for middle thoracic esophageal cancer from April 2016 to April 2017 were prospectively included for analysis. Baseline data and pathological findings as well as short-term outcomes of these two group (RAMIE group and VAMIE group) patients were collected and compared. A total of 84 patients (RAMIE group: 42 patients; VAMIE group: 42 patients) were included for analysis. The baseline characteristics between the two groups were comparable. RAMIE yielded significantly larger numbers of total dissected lymph nodes (21.9 and 17.8, respectively; P = 0.042) and the right recurrent laryngeal nerve (RLN) lymph nodes (2.1 and 1.2, respectively; P = 0.033) as well as abdominal lymph nodes (10.8 and 7.7, respectively; P = 0.041) than VAMIE. Even though RAMIE may consume more overall operation time, it could significantly decrease total blood loss compared to VAMIE (97 and 161 mL, respectively; P = 0.015). Postoperatively, no difference of the risk of major complications or hospital stay was observed between the two groups. In conclusion, RAMIE had significant advantage of lymphadenectomy especially for dissecting RLN lymph nodes over VAMIE with a comparable rate of postoperative complications. Further randomized controlled trials are badly needed to confirm and update our conclusions.