{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:02:49Z","timestamp":1780736569510,"version":"3.54.1"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100022084","name":"Peter MacCallum Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022084","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012128","name":"Austin Medical Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012128","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011371","name":"Royal Australasian College of Surgeons","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011371","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000951","name":"Cancer Council Victoria","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000951","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008018","name":"Victorian Cancer Agency","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008018","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In Australian and Aotearoa New Zealand (ANZ), it is unclear whether minimally invasive transthoracic Ivor Lewis esophagectomy (MIO) is superior to open techniques with regards to perioperative and oncological outcomes. Most evidence on this topic have been derived from high\u2010volume centers prior to the advent of perioperative FLOT chemotherapy. How these findings are applicable to the ANZ context, where oesophagectomies are typically performed in low\u2010moderate volume centers, is unknown. This study compares perioperative outcomes and long\u2010term survival between patients undergoing transthoracic open versus hybrid and total MIO following neoadjuvant FLOT chemotherapy across multiple ANZ centers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective analysis of transthoracic oesophagectomies undertaken between 2017 and 2022 following neoadjuvant FLOT chemotherapy from 22 ANZ centers. The primary endpoint was the rate of major (Clavien\u2010Dindo grade\u00a0\u2265\u00a03) postoperative complication. Secondary endpoints included nodal yield, surgery time, length\u2010of\u2010stay, and rates of perioperative complications, positive resection margins, ICU readmissions, in\u2010hospital mortality, 30\u2010day hospital readmissions, textbook outcome, adjuvant chemotherapy delivered, as well as disease free (DFS) and overall survival (OS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Open esophagectomy, hybrid MIO and total MIO was performed in 155 (62.5%), 61 (24.6%), and 32 (12.9%) patients, respectively. From open to total MIO, there was a stepwise decrease in the rate of major postoperative complications (Open: 38.7%, hybrid MIO: 29.5%, total MIO: 15.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.032). This was associated with reduced length\u2010of\u2010stay [Median(IQR), Open: 14 (11\u201323), hybrid MIO: 13 (11\u201323), total MIO: 10 (8\u201312),\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.031], and lower rates of pulmonary (Open: 49.0%, hybrid MIO: 42.6%, total MIO: 28.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.031), cardiac (Open: 20.0%, hybrid MIO: 6.6%, total MIO: 3.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.006), sepsis (Open: 18.7%, hybrid MIO: 8.2%, total MIO: 3.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.022), and wound (Open: 12.3%, hybrid MIO: 3.3%, total MIO: 0.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.019) complications. No significant differences were observed in other perioperative endpoints. Moreover, institutional factors including enhanced recovery after surgery programs and hospital case volume interacted with surgical technique to influence postoperative complication rates. Importantly, adjusted DFS and OS were comparable between the three groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In ANZ, MIO was associated with fewer complications and comparable survival compared to open transthoracic esophagectomy. These findings support the safety of MIO in lower\u2010volume settings in the era of perioperative FLOT chemotherapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70391","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T13:07:09Z","timestamp":1777900029000},"page":"1650-1662","source":"Crossref","is-referenced-by-count":1,"title":["Open Versus Hybrid and Total Minimally Invasive Transthoracic Ivor Lewis Esophagectomy Following Neoadjuvant FLOT Chemotherapy: An Australian and New Zealand Cohort Study"],"prefix":"10.1002","volume":"50","author":[{"given":"Brendan","family":"Desmond","sequence":"first","affiliation":[{"name":"Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia and Procedural Medicine Austin Hospital  Heidelberg Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maneesha De","family":"Silva","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgery 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Hospital  Sydney New South Wales Australia"},{"name":"Northern Clinical School, Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Merrett","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgical Unit Bankstown\u2010Lidcombe Hospital  Bankstown New South Wales Australia"},{"name":"School of Medicine Western Sydney University  Campbelltown New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sivakumar","family":"Gananadha","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgery Unit Canberra Hospital  Canberra Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yick Ho","family":"Lam","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgery Unit Lyell McEwin Hospital  Adelaide South Australia 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Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krinal","family":"Mori","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgery Unit Northern Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary\u2010Ann","family":"Johnson","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgery Unit Box Hill Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2983-4768","authenticated-orcid":false,"given":"Enoch","family":"Wong","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgery Unit Box Hill Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah A.","family":"Martin","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgery Unit Monash Medical Centre  Melbourne Victoria 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