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Introduction:Esophagectomy is performed through various approaches, both open and minimally invasive (MIE). This study’s aim is to review the perioperative outcomes after all types of esophagectomy while quantifying patients’ preoperative comorbidities.Methods and Procedures:We retrospectively reviewed the charts of 97 patients who underwent either MIE (N=56) or open esophagectomy (N=41) between January 2007 and August 2010. Indications for esophagectomy included adenocarcinoma (N=73), squamous cell carcinoma (N=11), Barrett’s with high-grade dysplasia (N=8), end-stage achalasia (N=3), mesh erosion (N=1) and leiomyoma (N=1). In both groups males predominated (MIE:86%, open:83%) with a similar median age of 66 and 64 years, respectively. Neoadjuvant chemo/radiotherapy was administered to 20 (36%) and 19 (46%) patients respectively. All MIE were performed either in a 3-field, prone VATS technique (N=48), or a 2-field, laparoscopic extra-pleural technique (N=8). Open esophagectomy included trans-thoracic techniques: Ivor-Lewis (N=10), thoracoabdominal approach with cervical incision (N=11), and 3-field esophagectomy (N=8) and extra-pleural transhiatal technique (N=12). Using the Charlson Comorbidity Index, the MIE group had 3 patients categorized as low-risk, 41 as moderate-risk and 12 as high-risk while the open group had 33 moderate-risk and 8 high-risk patients. Postoperative complications were stratified using the Clavien Classification Scale, with minor complications classified as Class 1-2 and major complications as Class 3-5. Results:Average operative time for the MIE trans-thoracic was 333 minutes; for the MIE extra-pleural was 291 minutes, for the open trans-thoracic was 215 minutes and open extra-pleural was 192 minutes. Postoperative complications occurred in 42 MIE patients and 21 open patients; these were major in 19 (34%) MIE and 17 (41%) open (p=0.53). The predominant in-hospital complications were cardiac, mainly arrhythmias (32% vs. 41%, P=0.40), pulmonary (34% vs. 44%, P=0.40), and leaks (11% vs. 10%, P=1.00). Postoperative 30-day mortalities were 4% in the MIE group and 7% in the open group (P=0.65). Median length of stay was 8 days (range 5-51 days) for the MIE, 9 days (range 6-38 days) for the open technique. When looking at trans-thoracic versus extra-pleural techniques, there were significant differences in major complications (43% vs. 11%, P=0.013), pulmonary complications (43% vs. 17%, P=0.032), hoarseness (4% vs. 22%, P=0.027) and wound infections (4% vs. 22%, P=0.027).Conclusions:This series shows no differences in major complications and mortality between MIE and open esophagectomies in similar patient groups. If the pleural cavity is violated, regardless of approach, there are higher risks of pulmonary complications. Avoiding the pleural cavity however may increase the risk of hoarseness and wound infections.