الفهرس 
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Abstract
Esophageal cancer is the eighth most common malignant tumor and is ranked sixth in cancer-related deaths worldwide. About 80 % of esophageal cancer patients and mortality occur in developing countries, and nearly 90 % are squamous cell carcinomas in the high-incidence areas.
Esophageal cancer is a complex disease and represents the sixth leading cause of worldwide cancer deaths. Esophageal squamous cell carcinoma (ESCC) and adenocarcinoma (EADC) are completely different regarding primary risk factors and geographic patterns. Both of the histological types have a poor prognosis due to late-stage at diagnosis for the majority of patients.
Compete resection of the esophageal tumor remains the gold standard of therapy and surgery almost offers the best chance for cure.
Resection usually includes subtotal esophagectomy and radical lymphadenectomy. R0 resection is crucial to give the patient the best chance for cure.
Most of the studies conducted to compare between open and minimally invasive esophagectomy have reported that minimally invasive esophagectomy is associated with better perioperative morbidity and short-term outcomes with no difference regarding tumor recurrence or survival among patients.
Patients who receive minimally invasive esophagectomy have fewer postoperative complications especially pulmonary complications related to thoracotomy and laparotomy incisions like chest infections, pleural effusion, and atelectasis.
Our study included 70 consecutive patients who received esophagectomy as a curative treatment for esophageal cancer starting from September 2017 to September 2018.
50 patients have received MIE (group A) and open esophagectomy was performed for 20 patients (group B).
The results of our study showed no significant difference between MIE and open esophagectomy regarding the demographic data as the mean age was 61.48 ± 9.06 and 61.3 ± 7.52 for the MIE group and open esophagectomy group respectively.
Most of the patients in the two groups were males representing 68% and 85% for the MIE group and open esophagectomy group respectively.
Regarding the location of the tumor, most of the tumors in group A were located in the middle thoracic area (56%) and middle to the lower thoracic area (20%). In group B, most of the tumors were located in the lower thoracic esophagus and the esophagogastric junction (50%) or involving the esophagogastric junction alone (25%). The distribution of the tumor location in both study groups shows a significant difference (p=0.001) and this could explain the problem of selection bias on many of the studies that compare open and minimally invasive esophagectomy.
Concerning the histological type of the tumor, 70% of the patients in group B were diagnosed as adenocarcinoma. On the other hand, all the patients in group A were diagnosed histologically as squamous cell carcinoma.
Regarding the clinical stage of the tumor in the MIE group, 50% of the patients were diagnosed as T3N0M0 and 32% were diagnosed as T2N0M0. On the other hand, 80% of the patients in group B were diagnosed as T3N0M0 and 15% as T2N0M0.
Neoadjuvant therapy was received in 48% of the patients in group A and 15% of the patients in group B.
Our study included 70 patients diagnosed with esophageal cancer. 5 patients have received MIE and 20 patients have received open esophagectomy. Among group B, 17 patients received a left thoracotomy approach and 3 patients received three incision esophagectomy approaches.
Regarding the operative variables found in our study, there was a significant difference between the two groups regarding the number of resected lymph nodes as the mean number of lymph nodes was 28.8 ± 7.8 versus 24.4 ± 7.7 for group A and group B respectively (p= 0.003).
The mean operative bleeding amount was 80 ml ± 34.6 and 185 ml± 46.2 for group A and group B respectively (p=0.001).
However, the mean operative time was found to be significantly shorter in the open esophagectomy group (199 minutes ± 69.1) versus (236.6 minutes ± 39.2) in the MIE group (p=0.005).
Most of our patients did not require postoperative ICU stay, so there was no significant difference between the two groups regarding the mean days of postoperative ICU stay (0.5 days ±0.7) versus (0.4 ± 0.6) for group A and group B respectively (p=0.4).
However, the postoperative hospital stay was significantly shorter in the MIE group (mean = 8 days ±3) versus (mean =14 ± 3) for the open esophagectomy group (p=0.001).
Regarding the postoperative complications, there was a significant difference between the two study groups as in group A only 2 patients (4%) experienced postoperative complications in the form of chest infection.
While in group B, 7 patients (23%) have experienced complications in the postoperative period. 3 patients had a postoperative chest infection, one patient experienced pleural effusion, 2 patients had hydropneumothorax and one patient suffered from wound infection.
There was no difference between the two groups regarding postoperative anastomotic leakage as none of our patients have been complicated by anastomotic leakage.