Postoperative innate immune function after minimally invasive transcervical esophagectomy (MICE) versus minimally invasive transthoracic esophagectomy (MIE)

Background
Recently, the minimally invasive transcervical esophagectomy (MICE) technique was introduced as a new approach for esophagectomy. The aim of this explorative study was to compare the effects of minimally invasive transthoracic esophagectomy (MIE), the most commonly used esophagectomy technique, versus MICE on postoperative immune function.

Methods
For this explorative cohort study, data regarding 42 F4S PREHAB trial participants (NL8699, International Clinical Trials Registry Platform) were analyzed. Immune function was assessed preoperatively and on postoperative day 1 (POD1) via plasma cytokines [interleukin (IL)-6, tumor necrosis factor (TNF), and IL-10], damage-associated molecular patterns (DAMPs) (S100A8/A9 and S100A12), and the Olink targeted proteomics inflammation panel. Ex vivo cytokine production was measured using whole blood stimulation with Escherichia coli lipopolysaccharides. Circulating C-reactive protein (CRP) concentrations (end of surgery until POD7) were analyzed in the F4S PREHAB cohort, supplemented with additional patients who underwent MICE or MIE in the same hospital.

Results
Concentrations of circulating cytokines and DAMPs, ex vivo cytokine production, and levels of additional inflammatory proteins on POD1 did not differ between groups (MIE, n=21; MICE, n=21). The dynamics of circulating CRP concentrations during the first week after surgery were also similar in the MICE (n=61) and MIE (n=66) groups.

Conclusions
This explorative study found no differences in postoperative inflammatory status between the two procedures. Limited statistical power and sample size warrant larger trials to further investigate potential differences in postoperative immune response and clinically relevant outcomes.