Skip to main content

Comparisons between minimally invasive and open esophagectomy for esophageal cancer with cervical anastomosis: a retrospective study



As an extensive surgery, minimally invasive esophagectomy (MIE) has advantages in reducing morbidity and improving quality of life for patients suffering from esophageal cancer. This study aims to investigate differences between MIE and open esophagectomy (OE) for considerations of the safety of procedures, rate of tumor resection, postoperative complications, and quality of life. This paper also tends to provide some references for MIE on esophageal cancer therapy.


A retrospective data analysis was undertaken on 140 patients who either underwent MIE or OE for esophageal cancer with cervical anastomosis from March 2013 to May 2014 by our surgical team. Preoperative characteristics were analyzed for both groups. Differences in perioperative and oncologic outcomes were compared in operation time, intraoperative blood loss, lymph nodes retrieved, and R0-resection rate. Accordingly, a comparative analysis was conducted on complications namely anastomotic leakage, pulmonary infection, in-hospital mortality, and short-term (3 months) postoperative EORTC C30 Global health as well.


A total of 140 patients (87 with MIE and 53 with OE) were enrolled and the two groups were homogeneous in terms of patient- and tumor-related data. There was no difference on postoperative ICU stay (21.15 ± 1.54 h vs 21.75 ± 1.68 h, p = 0.07) and R0-resection rate (100% vs 100%, p = 1.00). The operation time for MIE was significantly shorter (146.08 ± 17.35 min vs 200.34 ± 14.51 min, p <  0.0001), the intraoperative blood loss was remarkably saved (MIE vs OE, 83.91 ± 24.72 ml vs 174.53 ± 35.32 ml, P <  0.0001) and more lymph nodes were retrieved (MIE vs OE, 38.89 ± 4.31 vs 18.42 ± 3.66, P <  0.0001). There was no difference between the groups to postoperative complications and mortality. However, pulmonary infection in MIE was higher than in OE and the difference was not statistically significant (MIE vs OE, 20.75% vs 31.03%, P = 0.24). Complications such as in-hospital mortality and short-term (3 months) postoperative EORTC C30 Global health displayed no difference between both groups as well.


The number of lymph nodes and intraoperative blood loss were significantly ameliorated in MIE. A 4–5 cm longitudinal incision below the xiphoid process was made to create the gastric conduit under direct vision assisting in shortening the total operation time significantly.

Peer Review reports


Esophageal carcinoma is a kind of digestive system tumor with high malignancy and poor prognosis. It has been reported that the overall survival rate of esophageal cancer in 5 years is only 15–20% [1], which turns into the sixth leading cause of cancer-related death worldwide [2]. Squamous cell carcinoma (SCC) and adenocarcinoma (AC) present to be the most common pathological types of esophageal cancer, among which squamous cell carcinoma develops as a principal pathological type. The distribution of esophageal cancer demonstrates significant regional differences [3]. The incidence of SCC mostly occurred in Asia, especially in China (more than half of global SCC cases), while the highest burden of AC was found in Western countries [4]. The incidence of AC in the Western world has been a marked and steady increase over recent decades which takes predominantly in esophagectomy patients [5]. Current treatment strategies for esophageal cancer have developed into two main directions: local-regional therapy and systemic treatment. At the same time, optimized individual therapeutic protocol should be achieved for patients with esophageal cancer based on the type of tumor, location, local infiltration, and individual physiological conditions. However, esophagectomy with radical lymph nodes dissection is recognized as one of the standard treatments for patients with localized and locally advanced disease [6]. Due to the complexity of surgical procedures, huge trauma, severe postoperative complications (especially pulmonary infection), and poor quality of life after operation [7], surgical treatment still has risks in a high mortality rate andother disadvantages as well, along with advances in both medical technology and postoperative care.

As medical technologies advance rapidly, extensive attention and application of video-assisted thoracoscopic surgery with trauma reduction have gainedfrom thoracic surgeons, especially in China [8]. Numerous comparative studies on MIE and OE have revealed that MIE has produced satisfactory results in lower rate of postoperative complications, better relieved pain, less blood loss, more lymph nodes retrieved, shorter hospital stay, better postoperative short-term quality of life and lower overall mortality rates [9, 10]. However, no consensus has been reached on the indications for MIE treatment yet, which is generally determined by the surgeon’s clinical experience currently. More comparative studies between MIE and OE have been carried out focusing on safety of procedures, rate of the tumor resection, postoperative survival rate, and quality of life.

Data associated with MIE and OE has been obtained for the treatment of middle or upper esophageal carcinoma in this study. Analysis on the safety of procedures, rate of tumor resection, postoperative complications and quality of life has been performed in order to provide relevant references for MIE on esophageal cancer therapy.


Patient selection

A total of 140 patients (87 MIE and 53 OE) underwent surgeries for esophageal cancer were enrolled from March 2013 to May 2014 by our surgical team. All patients were performed preoperative histopathologic diagnoses of esophageal cancer by gastroscopy and pathological display. Moreover, locations of tumors were noticed in the middle or upper segment of the esophagus. By preoperative chest preparation and upper abdominal enhanced CT examination, the size of the tumor and the extent of surrounding lymph nodes invasion were assessedfor eliminating metastasis of distant tissues and organs. The study was approved by the Ethics Committee of The Third Affiliated Hospital of Nanjing University of Chinese Medicine.

Surgical approach

All sugeries in the two groups were performed by our surgical team and all patients underwent resection of the esophageal tumor, lymph nodes dissection, jejunostomy, and left neck anastomosis.

MIE: (1) Thoracic portion. The patient was positioned in a left lateral decubitus for the thoracic portion. A standard right video-assisted thoracoscopic surgery (VATS) 4-trocar approach with CO2 insufflation at 8 mmHg was implemented. Both ends of the azygos veins were closed with Hemolok and cut with an ultrasonic scalpel. Then apply ultrasonic scalpel complete resection of esophagus along the thoracic esophageal bed from the top of the right thoracic cavity to the hiatus of esophageal diaphragm, lymph nodes were dissected routinely (posterior superior vena cava, right recurrent laryngeal nerve, left-right recurrent laryngeal nerve, carina, paraesophageal, inferior pulmonary vein, and cardiac side), finally place a drainage tube and sew up the incisions. (2) Abdominal portion. The patient was positioned with a steep reverse Trendelenburg position. A standard laparoscopic 5-trocar approach with CO2 insufflation at 13 mmHg was implemented. The left gastric arteriovenous and partial of the short gastric artery were interrupted sequentially with ultrasonic scalpel, starting from the lesser curvature of stomach to fundus ventriculi. Lymph nodes were dissected in a routine manner (common hepatic artery, left gastric arteriovenous, and lesser curvature). Then, the omentum was opened between the stomach and colon transversum. Next, the left gastroepiploic artery and partial short gastric arteries were dissected and the operation directed to fundus until linked up with the lesser curvature of the stomach. It was worth noting that the right gastroepiploic artery arch should be well protected during the surgical processes. Dissect along the greater curvature to pylorus until the stomach was dissociated completely. Finally, laparoscopic jejunostomy was used for nutrition supply postoperatively and the instruments for minimally invasive surgery were removed. A 4-5 cm longitudinal incision was made below the xiphoid process to expose the stomach and a 4- to 5-cm-wide gastric conduit was made by multiple firings of a linear stapler. At last, the gastric conduit was retracted into the abdominal cavity and the incisions were sutured. (3) Cervical portion. A 3 cm transverse incision along the direction of dermatoglyph was performed in the left lateral cervical part, the organ was visible and the anastomosis was accomplished.

OE: Standard three incisions were performed including: right thoracic incision, median abdominal incision and left cervical incision. Operation in the thoracic portion was implemented at the right thorax along the fifth intercostal posterolateral 15–20 cm incision. Surgical procedures and methods of lymph nodes resection were similar to those of MIE. Operation of the abdominal portion was carried out from the xiphoid to the umbilical abdominal median incision and remaining procedures were similar to MIE as well. In the end, the jejunostomy was performed under direct vision. The operation of the cervical portion was the same as MIE.

Statistical analysis

SPSS 18.0 software was adopted for data analysis (IBM, Armonk, NY). Continuous variables were expressed as mean ± standard deviation (SD). To evaluate differences between the groups, Chi-square (or Fisher exact) test was adopted for binomial variables. Mann-Whitney test was used for continuous variables that did not meet a normal distribution. A p-value of less than 0.05 was taken as a level of significance for all analyses.


Demographic clinical characteristics

Between March 2013 and May 2014, a total of 140 patients with middle or upper esophageal cancer were performed surgeries by our surgical team: 53 OE and 87 MIE. Majority of patients were male (77.14%). The median age in MIE was 64.75 ± 7.80 years old and 63.02 ± 6.84 in OE, which revealed no difference (P = 0.24). Body mass index (BMI) and the percentage of patients who had a history of smoking were also similar between two groups. The remaining indicators listed in the table displayed no statistically significant difference as well (Table 1).

Table 1 Preoperative Characteristics of Patient and Tumor

Operative and oncologic outcomes

Perioperative and oncologic outcomes were shown in Table 2. The operation time was 146.08 ± 17.35 min in MIE group and 200.34 ± 14.51 min) in OE (P <  0.0001). The intraoperative blood loss in MIE was significantly decreased compared with OE (83.91 ± 24.72 ml vs 174.53 ± 35.32 ml, P <  0.0001). Notably, there were more lymph nodes retrieved in MIE compared to OE (38.89 ± 4.31 vs 18.42 ± 3.66, P <  0.0001). Moreover, the postoperative hospital stay in MIE was shorter compared with OE (9.68 ± 2.97 days vs 15.64 ± 6.05 days, P <  0.0001). Other outcomes such as blood transfusion rate, postoperative ICU stay, R0-resection rate, and postoperative pathological staging were similar between the groups.

Table 2 Perioperative and oncologic outcomes

Postoperative complications and mortality

Postoperative complications and mortality were shown in Table 3. The incidence of anastomotic leakage in MIE was slightly higher compared with OE (8.05% vs 5.66%, P = 0.74). Moreover, the risk of pulmonary infection was also higher in MIE (24% vs 19%, P = 0.685), Disappointly, the results did not show a statistical significance. The rate of intestinal obstruction in both groups exhibited no significant difference (3.77% vs 1.15%, P = 0.56). All incomplete intestinal obstruction were cured by conservative treatments. Both groups were found equivalent to atrial fibrillation, vocal cord paralysis, regurgitation, chylothorax, and in-hospital mortality (P > 0.05). Furthermore, No patient had complications including diaphragmatic hernia and wound infection in MIE.

Table 3 Postoperative complications and mortality

Short-term (3 months) postoperative outcomes were shown in Table 4. The incidence of anastomotic stenosis (postoperative 3 months) was low in both groups (24% vs 19%, P = 0.685). However, the rate of regurgitation was as high as 29.89% in MIE and 26.42% in OE (P = 0.70). Patients with pneumonia in OE were fewer than those in MIE (20.75% vs 31.03%, P = 0.24) indicating no marked statistical difference. In addition, complications namely the risk of recurrence and mortality revealed no significant difference (P > 0.05). The short-term (3 months) EORTC C30 Global health in MIE was superior to OE, whileno significant difference exhibited between the two groups as well (66.42 ± 5.92 vs 66.10 ± 5.43, P = 0.05).

Table 4 Short-term (3 months) postoperative outcomes on morbidity, mortality and quality of life


For patients with esophageal cancer, surgical resection with the combination of neoadjuvant chemoradiotherapy or chemotherapy was considered as the only potential path for a radical cure currently [11, 12]. However, patients underwent OE were extremely traumatic and suffered from severe postoperative complications, including pulmonary infection and poor quality of life [7]. Since 1992 Cuschieri et al have reported [13] the first application of minimally invasive technique adopted for resection of esophageal cancer. As it produced great potential in minimizing invasions and accelerating rehabilitation, the application of this technique gained popularity in the medical front. However, many scholars hold a conservative attitude on MIE including the complexity of the procedure, adequacy of resection and nodal clearance in upper third tumors, and availability of MIE in patients who performed chemoradiotherapy [14]. As science and technology advance over the past 30 years, technologyies including high-definition imaging, novel energy devices, and enhanced stapling had been widely used in modern medicine. Meanwhile, a variety of modified MIE procedures had been widely implemented in major medical centers all over the world. No consensus has been reached on whether MIE tends to be superior to OE or notamong centers. However, many comparative studies on the clinical effects of MIE and OE, namely the clinical randomized controlled researches [10], Meta analyses [15] and retrospective studies [16], confirmed that there were no significant differences in both techniques. Contrary to general expectations, results in comparing MIE with OE had shown that MIE was associated with lower operative blood loss, shorter ICUand hospital stays, fewer postoperative respiratory complications, better relieved pain and short-term postoperative quality of life [17]. The outcome of postoperative hospital stay in MIE was significantly shorter than in OE (9.68 ± 2.97 vs 15.64 ± 6.05, P < 0.0001) in our study. A growing number of clinical trials of esophagectomy showed that MIE could shorten hospital stay [18,19,20].

A natural channel for early lymphatic returns and distant skip metastases were provided due to the extensive submucosal lymphatic plexus under the esophageal wall (i.e., lymph nodes adjacent to the primary tumor are not affected, but more distant-located lymph nodes contain metastases) [21]. Thus, the early metastases of lymph nodes were one of the characteristics of esophageal cancer. Studies had reported that about 20–40% of patients with submucosal esophageal cancer developed local lymph node metastasis [22, 23]. Consequently, extensive lymph nodes dissection can maximize the clearance of malignant lymph nodes which played an essential role in inhibiting tumor recurrence and facilicating a long survival time for patients with esophageal cancer. A retrospective study on 3572 cases of esophageal carcinoma from Worldwide Esophageal Cancer Collaboration Group (WECC) found that, patients with complete tumor R0 resection, the more lymph nodes extracted, the higher survival rate exhibited in patients. In addition, the total number of lymph nodes was an independent risk factor prognosticating patients’ survivals [24]. In our study, the number of lymph nodes, intraoperative blood loss, and operative time were significantly ameliorated in MIE when compared with OE. Research by Dhamija et al. emphasized that the extent and effect of lymph nodes dissection in MIE were closely linked with learning curve and surgeons’ experiences [25]. Our surgical team initiated the thoracic minimally invasive surgery combined with open surgery for resection of esophageal cancer since July 2012. Total minimally invasive esophagectomy was finally been developed in March 2013. We maintained that the learning curve had a practical impact on the lymph nodes resection (p < 0.0001), operation time (p < 0.0001) and intraoperative blood loss (p < 0.0001) in early stages of MIE. Recently, a clinical comparative study between HMIE (Hybrid minimally invasive esophagectomy) and OE has revealed that there were no significant differences on the number of lymph nodes resection (22 vs. 20, p = 0.459) and R0 resection rate (95 vs 93%, p = 0.500) [26]. However, the operation time (329 vs 407 min, p < 0.001), blood transfusion rate (18 vs 50%, p < 0.001), and length of hospital stay (14 vs 18 days, p = 0.002) in HMIE were significantly better than those in OE. We made a 4–5 cm longitudinal incision below the xiphoid process to pull out the stomach and a 4- to 5-cm-wide gastric conduit was built, which helped shorten the total operation time significantly with the best record of 88 min. However, both complexity and prolonged operation time of MIE procedures increased when patients were associated with pleural adhesions, enormous tumor mass and preoperative chemoradiotherapy. Patients who underwent OE and MIE for esophageal cancer in the Society of Thoracic Surgeons General Thoracic Surgery Database (STS Database) showed that approximately 50% of patients had preoperative radiation therapy, which contrasted dramatically with only 5.66% (OE) and 8.05% (MIE) of patients by esophagectomy in our study [27]. The procedure duration of OE (312.0 min) and MIE (443.0 min) in the STS Database was also higher than the operation time (OE vs MIE, 200.34 ± 14.51 vs 146.08 ± 17.35 min, P < 0.0001) in our study. We speculated that the absence of preoperative radiation therapy probably was the reason for the shortened operation time. The STS Database Task Force reported that most US patients with esophageal cancer had a BMI greater than 25.0 (66.2%, N = 4321) [28], while Chinese patients presented a BMI less than 25.0. Esophageal resection in overweight patients was associated with increased operative time [29]. This also indicated another possibility which significantly influenced outcomes of shorter operative time.

A lot of studies have reported significantly lower pulmonary complications for those who underwent MIE versus OE [17, 18, 30]. Of note, there are several factors linked to pulmonary complications post procedure, including preoperative status, intraoperative details, and postoperative details [31]. In this study, rates of pulmonary infection in MIE were slightly higher than those in OE, although there was no significant difference demonstrated. And that the pulmonary infection rate of patients who underwent MIE (31.3%) was higher than that reported in other studies (17.1%) [18]. One reason may be that the location of the tumor was in the middle or upper segment of the esophagus. This probably enhanced the pain associated with their MIE procedure and produced a negative effect on the incidence of pulmonary complications. Another reason may be that the differences in BMI ranges between Asian and Western populations generating higher pulmonary infection. Mitzman et al. (2018) reported that among patients who were overweight BMI (25.0 to 34.9, accounting for 55% of all patients), there was a lower risk of having any major, pulmonary, infectious, or other complications when compared with BMI 21.5 [29]. In addition, the extensive lymph nodes dissection in MIE (OE vs MIE, 18.42 ± 3.66 vs 38.89 ± 4.31, P < 0.0001) may be considered as another cause. Researches discovered that [32, 33] extensive lymph nodes dissection significantly increased postoperative respiratory complications and delayed patients’ rehabilitation. However, contrary opinions proved that extensive lymph nodes dissection neither elevated the risk of postoperative morbidity nor affected the life quality of patients [34, 35]. Therefore, the relationship between the number of lymph nodes resection and postoperative complications may deserve further investigations.


Results from our retrospective analysis between MIE and OE showed that the clinical outcomes were similar in both procedures. While the number of lymph nodes and intraoperative blood loss were significantly ameliorated in MIE. Moreover, a 4–5 cm longitudinal incision below the xiphoid process was made to create the gastric conduit under direct vision helped to shorten the total operation time significantly.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.



Minimally invasive esophagectomy


Open esophagectomy


European Organization for Research and Treatment of Cancer Core Questionnaire


Intensive Care Unit


Computed tomography


Video-assisted thoracoscopic surgery


Standard deviation


Worldwide Esophageal Cancer Collaboration Group


  1. 1.

    Rustgi AK, El-Serag HB. Esophageal carcinoma. N Engl J Med. 2014;371:2499–509.

    Article  Google Scholar 

  2. 2.

    Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.

    CAS  Article  Google Scholar 

  3. 3.

    Hongo M, Nagasaki Y, Shoji T. Epidemiology of esophageal cancer: orient to occident. Effects of chronology, geography and ethnicity. J Gastroenterol Hepatol. 2009;24:729–35.

    Article  Google Scholar 

  4. 4.

    Zhang HZ, Jin GF, Shen HB. Epidemiologic differences in esophageal cancer between Asian and Western populations. Chin J Cancer. 2012;31:281–6.

    Article  Google Scholar 

  5. 5.

    McColl KEL. What is causing the rising incidence of esophageal adenocarcinoma in the west and will it also happen in the east? J Gastroenterol. 2019;54:669–73.

    Article  Google Scholar 

  6. 6.

    Sohda M, Kuwano H. Current status and future prospects for esophageal Cancer treatment. Ann Thorac Cardiovasc Surg. 2017;23:1–11.

    Article  Google Scholar 

  7. 7.

    Scarpa M, Valente S, Alfieri R, et al. Systematic review of health-related quality of life after esophagectomy for esophageal cancer. World J Gastroenterol. 2011;17:4660–74.

    Article  Google Scholar 

  8. 8.

    Zhu C, Jin K. Minimally invasive esophagectomy for esophageal cancer in the People's Republic of China: an overview. Onco Targets Ther. 2013;6:119–24.

    PubMed  PubMed Central  Google Scholar 

  9. 9.

    Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379:1887–92.

    Article  Google Scholar 

  10. 10.

    Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg. 2012;256:95–103.

    Article  Google Scholar 

  11. 11.

    Sjoquist KM, Burmeister BH, Smithers BM, et al. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol. 2011;12:681–92.

    Article  Google Scholar 

  12. 12.

    van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84.

    Article  Google Scholar 

  13. 13.

    Cuschieri A, Shimi S, Banting S. Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb. 1992;37:7–11.

    CAS  PubMed  Google Scholar 

  14. 14.

    Law S. Is minimally invasive preferable to open oesophagectomy? Lancet. 2012;379:1856–8.

    Article  Google Scholar 

  15. 15.

    Nagpal K, Ahmed K, Vats A, et al. Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc. 2010;24:1621–9.

    Article  Google Scholar 

  16. 16.

    Maas KW, Cuesta MA, van Berge Henegouwen MI, et al. Quality of life and late complications after minimally invasive compared to open Esophagectomy: results of a randomized trial. World J Surg. 2015;39:1986–93.

    CAS  Article  Google Scholar 

  17. 17.

    van den Berg JW, Luketich JD, Cheong E. Oesophagectomy: the expanding role of minimally invasive surgery in oesophageal cancer. Best Pract Res Clin Gastroenterol. 2018;36-37:75–80.

    Article  Google Scholar 

  18. 18.

    Yibulayin W, Abulizi S, Lv H, Sun W. Minimally invasive oesophagectomy versus open esophagectomy for resectable esophageal cancer: a meta-analysis. World J Surg Oncol. 2016;14:304.

    Article  Google Scholar 

  19. 19.

    Jiang Y, Han Y. Minimally invasive esophagectomy. Zhonghua Wei Chang Wai Ke Za Zhi. 2015;18:864–6.

    PubMed  Google Scholar 

  20. 20.

    Treitl D, Hurtado M, Ben-David K. Minimally invasive Esophagectomy: a new era of surgical resection. J Laparoendosc Adv Surg Tech A. 2016;26:276–80.

    Article  Google Scholar 

  21. 21.

    Akiyama H, Tsurumaru M, Kawamura T, Ono Y. Principles of surgical treatment for carcinoma of the esophagus: analysis of lymph node involvement. Ann Surg. 1981;194:438–46.

    CAS  Article  Google Scholar 

  22. 22.

    Stein HJ, Feith M, Bruecher BL, Naehrig J, Sarbia M, Siewert JR. Early esophageal cancer: pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection. Ann Surg. 2005;242:566–73 discussion 573-565.

    PubMed  PubMed Central  Google Scholar 

  23. 23.

    Westerterp M, Koppert LB, Buskens CJ, et al. Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction. Virchows Arch. 2005;446:497–504.

    Article  Google Scholar 

  24. 24.

    Rizk NP, Ishwaran H, Rice TW, et al. Optimum lymphadenectomy for esophageal cancer. Ann Surg. 2010;251:46–50.

    Article  Google Scholar 

  25. 25.

    Dhamija A, Rosen JE, Dhamija A, et al. Learning curve to lymph node resection in minimally invasive esophagectomy for cancer. Innovations (Phila). 2014;9:286–91.

    Article  Google Scholar 

  26. 26.

    Glatz T, Marjanovic G, Kulemann B, Sick O, Hopt UT, Hoeppner J. Hybrid minimally invasive esophagectomy vs. open esophagectomy: a matched case analysis in 120 patients. Langenbeck’s Arch Surg. 2017;402:323–31.

    Article  Google Scholar 

  27. 27.

    Sihag S, Kosinski AS, Gaissert HA, Wright CD, Schipper PH. Minimally invasive versus open Esophagectomy for esophageal Cancer: a comparison of early surgical outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg. 2016;101:1281–8 discussion 1288-1289.

    Article  Google Scholar 

  28. 28.

    Society of Thoracic Surgeons General Thoracic Surgery Database Task Force. The Society of Thoracic Surgeons Composite Score for Evaluating Esophagectomy for Esophageal Cancer. Ann Thorac Surg. 2017;103:1661–7.

    Article  Google Scholar 

  29. 29.

    Mitzman B, Schipper PH, Edwards MA, Kim S, Ferguson MK. Complications after Esophagectomy are associated with extremes of body mass index. Ann Thorac Surg. 2018;106:973–80.

    Article  Google Scholar 

  30. 30.

    Briez N, Piessen G, Torres F, Lebuffe G, Triboulet JP, Mariette C. Effects of hybrid minimally invasive oesophagectomy on major postoperative pulmonary complications. Br J Surg. 2012;99:1547–53.

    CAS  Article  Google Scholar 

  31. 31.

    D'Amico TA. Outcomes after surgery for esophageal cancer. Gastrointest Cancer Res. 2007;1:188–96.

    PubMed  PubMed Central  Google Scholar 

  32. 32.

    D'Journo XB, Doddoli C, Michelet P, et al. Transthoracic esophagectomy for adenocarcinoma of the oesophagus: standard versus extended two-field mediastinal lymphadenectomy? Eur J Cardiothorac Surg. 2005;27:697–704.

    Article  Google Scholar 

  33. 33.

    Lerut T, Moons J, Coosemans W, et al. Postoperative complications after transthoracic esophagectomy for cancer of the esophagus and gastroesophageal junction are correlated with early cancer recurrence: role of systematic grading of complications using the modified Clavien classification. Ann Surg. 2009;250:798–807.

    Article  Google Scholar 

  34. 34.

    Lagergren J, Mattsson F, Davies A, Lindblad M, Lagergren P. Lymphadenectomy and risk of reoperation or mortality shortly after surgery for oesophageal cancer. Sci Rep. 2016;6:36092.

    CAS  Article  Google Scholar 

  35. 35.

    Schandl A, Johar A, Lagergren J, Lagergren P. Lymphadenectomy and health-related quality of life after oesophageal cancer surgery: a nationwide, population-based cohort study. BMJ Open. 2016;6:e012624.

    Article  Google Scholar 

Download references


Not applicable.


This study was no funding supported.

Author information




ZJL designed and performed the research and wrote the paper; GHD designed the research and supervised the report; CHL, YGL contributed to the analysis; CHL, SY provided clinical advice; BX, GHD supervised the report. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Guohua Dong.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Ethics Committee of The Third Affiliated Hospital of Nanjing University of Chinese Medicine.

Consent for publication

All patients in this study provided their informed consent for publication.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, Z., Liu, C., Liu, Y. et al. Comparisons between minimally invasive and open esophagectomy for esophageal cancer with cervical anastomosis: a retrospective study. J Cardiothorac Surg 15, 128 (2020).

Download citation


  • Minimally invasive esophagectomy
  • Open esophagectomy
  • Esophageal carcinoma
  • Cervical anastomosis
  • Retrospective analysis