A purely laparoscopic approach can reduce the incidence of postoperative pneumonia in esophageal cancer patients undergoing esophagectomy.

Background: Minimally invasive esophagectomy for esophageal cancer has become increasingly common to reduce postoperative pneumonia. However, the usefulness of pure laparoscopic abdominal manipulation without an upper abdominal incision remains unclear.
Methods: We evaluated the utility of pure laparoscopic surgery (LAP) vs. hand-assisted laparoscopic surgery (HALS) in esophagectomy. A total of 344 consecutive patients who underwent curative esophagectomy for esophageal cancer from 2019 to 2023 were enrolled; 235 patients were treated with HALS and 109 with LAP. The peri- and postoperative outcomes were compared between the two groups using a propensity score-matched analysis.
Results: Propensity score matching was used to compare 92 patients each in the HALS and LAP groups. Clinicopathological characteristics did not differ between the two groups. The incidence of postoperative pneumonia was significantly higher in the HALS group than in the LAP group (30% vs. 11%, respectively; P = 0.001). Multivariate logistic analysis showed that HALS was independently associated with postoperative pneumonia (odds ratio 3.82, P = 0.002), along with older age and male sex.
Conclusions: LAP may reduce the incidence of postoperative pneumonia in esophageal cancer patients who undergo esophagectomy.
Competing Interests: Declarations. Ethical approval: All procedures were performed in accordance with the Helsinki Declaration. The Ethical Review Board of Osaka University Hospital approved the protocol of this study. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. Consent to participate: Consent to participate was not considered necessary.
(© 2025. The Author(s) under exclusive licence to The Japan Esophageal Society.)