To examine esophagectomy outcomes in patients with a BMI greater than 35, comparing minimally invasive esophagectomy (MIE) and open esophagectomy (OE).
Approach:
Study Design: Retrospective cohort study utilizing the NSQIP Targeted Esophagectomy database from 2016 to 2023.
Patient Selection: Identified patients with BMI > 35 who underwent MIE and OE, excluding those with hybrid approaches or nonmalignant pathologies.
Outcome Measures: Primary outcomes included morbidity, mortality, and leak rate; secondary outcomes included length of stay (LOS), unplanned return to OR, pneumonia, ventilator use, unplanned intubation, and surgical site infection (SSI).
Statistical Analysis: Outcomes compared using odds ratios and t-tests; logistic regression and Gaussian linear regression models adjusted for confounding covariates.
Key Findings:
30-day mortality was 2.87% in the MIE cohort and 4.32% in the OE cohort [OR 1.53, 95% CI 0.66–6.64].
Overall morbidity was 41.15% in the MIE cohort vs 45.25% in OE [OR 1.18, 95% CI 0.804–1.737].
Anastomotic leak rates were 19.34% in MIE and 17.19% in OE [OR 0.866, 95% CI 0.52–1.43], with no significant difference.
Length of stay was significantly lower in the MIE cohort (9.96 days) compared to OE (11.31 days) [95% CI −2.69 to 0.02, P = 0.046].
Operative time was longer in the MIE cohort (444.5 min) compared to OE (341.5 min).
Interpretation:
MIE has comparable outcomes to OE in several measures among patients with a BMI > 35, with significantly improved length of stay for MIE.
Limitations:
Retrospective design may introduce selection bias.
Exclusion of patients with hybrid approaches or nonmalignant pathologies may limit generalizability.
Conclusion:
MIE is a safe and effective surgical option for obese patients undergoing esophagectomy, with improved length of stay compared to OE.
