Comparing survival between neoadjuvant chemoradiotherapy followed by open or thoracoscopic oesophagectomy in patients with oesophageal squamous cell carcinoma

OBJECTIVES: The goal of this study was to investigate the overall survival between open and thoracoscopic oesophagectomy in patients with oesophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant chemoradiotherapy (NCRT). METHODS: The Taiwan Cancer Registry was queried for ESCC from 2008 to 2016. We enrolled 2250 patients with ESCC receiving NCRT plus open (n = 487) or thoracoscopic (n = 1763) oesophagectomy. One-to-two propensity score matching between open and thoracoscopic oesophagectomy was performed. Overall survival was compared between the 2 groups before and after propensity score matching. Univariable analysis and multivariable analysis were performed to identify prognostic factors. RESULTS: After one-to-two propensity score matching, 353 patients were in the open group and 706 patients were in the thoracoscopic group. The 3-year overall survival rates for matched patients treated with open or thoracoscopic oesophagectomy were similar (39.18% vs 44.33%, p = 0.11). Better overall survival was associated with thoracoscopic oesophagectomy for the patients in the y-pathological complete response stage (pCR) (57.26% vs 65.19%, p = 0.045), y-pathological III stage (12.78% vs 22.31%, p = 0.028) and y-pathological T0N+ stage (15.79% vs 41.01%, p = 0.010). In multivariable analysis, surgical approach was an independent prognostic factor only before propensity score matching. After matching, surgical approach was not an independent prognostic factor. CONCLUSIONS: This propensity-matched study demonstrated that open and thoracoscopic oesophagectomies are associated with similar long-term survival in patients with ESCC undergoing NCRT. Stage-specific comparisons showed that thoracoscopic oesophagectomy is associated with better survival than open oesophagectomy in patients with the pathological complete response, y-pathological III and y-pathological T0N+ stages and with similar survival in y-pathological I/II patients.