Long-term outcomes after thoracoscopic versus open surgery for congenital esophageal atresia: propensity-score overlap weighting analysis.

Purpose: Congenital esophageal atresia requires neonatal surgery. Although short- and medium-term outcomes of thoracoscopic and open surgery have been investigated, long-term outcomes remain unclear. This study aimed to compare the long-term outcomes of these approaches using a Japanese national inpatient database.

Methods: We identified neonates who underwent open or thoracoscopic surgery for congenital esophageal atresia between April 2016 and March 2022. Patients with prior palliative surgery were excluded. Propensity score overlap weighting analyses were used to compare the outcomes between the groups. The primary outcome was the long-term (1 year after definitive surgery) anastomotic strictures. Secondary outcomes included long- and medium-term (within 30 days to 1 year after definitive surgery) gastroesophageal reflux and medium-term anastomotic strictures.

Results: Among 395 patients, 67 underwent thoracoscopic surgery and 328 underwent open surgery.　Propensity score overlap weighting analyses revealed no significant differences in long-term anastomotic stricture (5.8% vs. 8.7%; risk difference (RD), - 2.9%; 95% confidence interval (CI), - 10.9 to 5.1), long-term gastroesophageal reflux (2.9% vs. 3.0%; RD, -0.1%; 95% CI - 7.1 to 4.9), medium-term anastomotic stricture (29.4% vs. 18.8%; RD, 10.6%; 95% CI - 2.5 to 23.7), or medium-term gastroesophageal reflux (4.9% vs. 6.0%; RD, - 1.1; 95% CI -7 .1 to 4.9).

Conclusions: Long-term outcomes did not differ significantly between thoracoscopic and open surgery for congenital esophageal atresia.