Background

The abdominal approach for esophageal cancer is commonly performed using either hand-assisted laparoscopic surgery (HALS) or conventional laparoscopic surgery (LAP).
While HALS may offer tactile feedback and facilitate tissue manipulation, comparative evidence regarding short-term outcomes remains limited.

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Aim

To compare short-term postoperative outcomes between HALS and LAP for the abdominal phase of esophageal cancer surgery using propensity score matching.

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Methods

• Retrospective analysis of 328 patients (January 2018–July 2024)

• HALS: 136 cases

• LAP: 192 cases

• Propensity score matching (1:1, n=119 per group)

• Covariates: age, sex, BMI, cT, cN, thoracic approach, preoperative therapy

• Primary outcomes: operative time and postoperative complications

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Results

After propensity score matching:

• Operative time was significantly shorter in the HALS group
  (531.9 ± 80.1 min vs 580.6 ± 80.5 min, p < 0.001)

• No significant differences were observed in:

  • ICU stay

  • Hospital stay

  • Pneumonia

  • Recurrent laryngeal nerve palsy

  • Anastomotic leakage

  • Chylothorax

Short-term postoperative outcomes were comparable between groups.

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Conclusion

HALS significantly reduced operative time while maintaining comparable short-term postoperative outcomes compared with conventional laparoscopy.

The choice of approach may therefore be tailored according to surgeon experience and intraoperative conditions.