Single-incision versus multi-incision minimally invasive esophagectomy with different reconstruction routes for esophageal cancer: a retrospective propensity-weighted analysis.

Background: The treatment of esophageal cancer requires optimized surgical approaches to improve patient outcomes. Minimally invasive esophagectomy (MIE) has demonstrated advantages compared to open procedures, but the difference in efficacy of single-incision versus multi-incision techniques under various reconstruction routes remains unclear. This retrospective propensity-weighted study aimed to evaluate the perioperative outcomes and short-term functional recovery between single-incision laparo-thoracoscopic MIE with retrosternal reconstruction (SIMIE-RS) and multi-incision MIE with posterior mediastinal reconstruction (MIMIE-PM) in patients with esophageal cancer. Methods: This retrospective study included 339 patients with esophageal cancer who underwent McKeown esophagectomy. The inverse probability of the treatment weighting (IPTW) approach was employed to assess outcome between SIMIE-RS and MIMIE-PM. The primary endpoints included postoperative complications, functional recovery parameters, and perioperative outcomes. Secondary endpoints included oncological adequacy, hospital length of stay, and quality of life indicators. Results: Pulmonary complications were markedly reduced in the SIMIE-RS group as compared to the MIMIE-PM group, with a lower incidence of pneumonia (0.9% Conclusions: SIMIE-RS provides superior perioperative outcomes as compared to MIMIE-PM, with significant reductions in pulmonary complications, enhanced functional recovery, improved pain control, and shortened hospital stays, as well as comparable surgical safety and oncological adequacy. Our findings indicate that SIMIE-RS is a viable innovation in esophageal cancer surgery that concentrates operative trauma while optimizing reconstruction pathways.