ArticleSurgical endoscopy2025
Comparison of utilization trends, outcomes, and costs between open and minimally invasive esophagectomy.
Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Robotic Ivor Lewis esophagectomy experience and outcomes from a high-volume cancer center with propensity-matched comparative assessment to the ACS-NSQIP database.Surgical endoscopy · 2026Article
- Minimally invasive vs. open esophagectomy in patients with a BMI > 35: a NSQIP analysis.Surgical endoscopy · 2026Article
- Epidurals in esophagectomy: end of an era?Journal of thoracic disease · 2026Article
- Modulation of Surgical Site Infection Risk in Spinal and Thoracic Surgeries Through Operative Parameters: A Narrative Review.Journal of clinical medicine · 2025Review
- Transthoracic versus Transhiatal Esophagectomy for Esophageal Squamous Cell Carcinoma.JSLS : Journal of the Society of Laparoendoscopic SurgeonsArticle
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8 authors.
Funding
Abstract
backgroundMany surgeons have adopted minimally invasive esophagectomy (MIE) as an alternative to open esophagectomy (OE). However, limited population-level data exist comparing clinical outcomes and costs by surgical approach. This study evaluated contemporary utilization trends, outcomes, and costs between MIE and OE using real-world data.
methodsWe conducted a retrospective cohort study of patients who underwent MIE or OE using data from the Healthcare Cost and Utilization Project Florida State Inpatient Database from 2016 to 2021. Utilization trends were analyzed using Cochran-Armitage tests. Multivariable regression models were utilized to evaluate the association of surgical approach with postoperative outcomes and hospitalization costs.
resultsOf 2550 total patients, 1218 (47.8%) and 1332 (52.2%) underwent MIE and OE, respectively. Utilization of MIE increased significantly over time, as MIE grew from 43.4% of annual esophagectomy volume in 2016 to 57.7% by 2021 (trend P < 0.001). MIE patients had a higher prevalence of esophageal or esophagogastric junction cancer compared to OE patients (75.7% vs. 60.1%; P < 0.001), but exhibited a comparable overall comorbidity burden (e.g., 2-3 comorbidities: 44.1% vs. 43.5%; P = 0.061). MIE patients had significantly shorter hospital stays (median: 8 vs. 10 days, P < 0.001). MIE was associated with reduced risk-adjusted odds of postoperative complications (adjusted odds ratio 0.560, confidence interval 0.474-0.661, P < 0.001). Operating room costs were significantly higher with MIE compared to OE (median: $13,964 vs. $10,618, P < 0.001), whereas intensive care unit costs were lower (median: $2325 vs. $5706, P < 0.001). Index hospitalization (median: $41,795 vs. $40,289, P = 0.340) and 90-day costs (median: $46,509 vs. $45,408, P = 0.550) were comparable between groups. In subgroup analyses, in-hospital mortality was significantly lower with MIE at low-volume (< 20 esophagectomies annually) hospitals (2.5% vs. 5.3%, P = 0.010). However, this difference was not statistically significant at high-volume (≥ 20 esophagectomies annually) hospitals (2.9% vs. 5.0%, P = 0.072).
conclusionMIE has had rapid growth in utilization. MIE appears to provide a viable, cost-effective alternative to OE, with fewer postoperative complications, shorter hospital stays, and comparable overall costs.
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