Minimally Invasive Esophagectomy for Esophageal Cancer: A 14-Year Experience of Over 1000 Consecutive Cases from a High-Volume Center in India.

UNLABELLED: Esophagectomy remains the cornerstone of curative treatment for esophageal and gastroesophageal junction (GEJ) cancers. This study presents a comprehensive analysis of perioperative outcomes, complications, and survival over a 14-year period at a high-volume tertiary cancer center in India. A retrospective review was conducted of 992 patients who underwent esophagectomy for esophageal or GEJ carcinoma at a Tertiary cancer care hospital in South India, from January 2010 to September 2024. Patients with upper esophageal malignancies, total/proximal gastrectomy, and palliative procedures were excluded. Data were extracted from a prospectively maintained database and analyzed for demographics, operative details, histopathology, complications, and survival outcomes. The cohort included 992 patients (56.8% female), with squamous cell carcinoma being the most common histology (66.8%). Neoadjuvant chemoradiotherapy (NACRT) was administered to 57.9% of patients. Transthoracic esophagectomy (TTE) was performed in 594 patients (59.8%), and transhiatal esophagectomy (THE) in 395 patients (39.8%). Overall, 64 patients (6.4%) required conversion to open surgery. This included 11 thoracic conversions and 53 abdominal conversions. Median operative time was 375 min, with a median blood loss of 100 mL. R0 resection was achieved in 94.3% of patients, with a median of 20 lymph nodes harvested. Postoperative pneumonia occurred in 14.4%, and anastomotic complications in 12.2%. Thirty-day and ninety-day mortality rates were 3.5% and 4.5%, respectively. Five-year disease-free survival (DFS) was 78% in the NACRT group compared to 49% in the upfront surgery group. Five-year overall survival (OS) was 62% in the NACRT group versus 35% in the upfront surgery group. This large series demonstrates the feasibility, safety, and oncologic efficacy of MIE in a high-volume Indian center with acceptable morbidity and R0 resection rates. Neoadjuvant therapy, especially NACRT, is associated with superior survival outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13193-025-02495-2.