Hybrid Minimally Invasive Esophagectomy Confers Lower Complication Rate
Survival outcomes were not compromised by the less-invasive procedure.
Patients with esophageal cancer who underwent hybrid minimally invasive esophagectomy had a lower rate of major complication during or after surgery compared with those who underwent transthoracic open esophagectomy, a trial showed (ClinicalTrials.gov Identifier: NCT00937456).1 The results of the multicenter, open-label, randomized controlled trial were reported in the New England Journal of Medicine.
The trial enrolled patients aged 18 to 75 years with resectable cancer of the middle or lower third of the esophagus and randomly assigned them to receive 1 of 2 surgical procedures. A total of 103 patients underwent hybrid minimally invasive esophagectomy and 104 underwent transthoracic open esophagectomy. The primary end point was major complication during surgery or within 30 days after surgery.
The rate of major complication during or after surgery was lower for patients who underwent hybrid minimally invasive esophagectomy (36%) compared with those who underwent transthoracic open esophagectomy (64%; odds ratio [OR] = 0.31; 95% CI, 0.18-0.55; P < .001). A major pulmonary complication occurred in 18% of patients who underwent hybrid minimally invasive esophagectomy compared with 30% who underwent transthoracic open esophagectomy.
Survival outcomes were not compromised by the less-invasive procedure. The overall survival rate at 3 years was 67% (95% CI, 57-75) for patients in the hybrid minimally invasive esophagectomy group and 55% (95% CI, 45-64) in the transthoracic open esophagectomy group. Disease-free survival was 57% (95% CI, 47-66) in the hybrid minimally invasive esophagectomy group and 48% (95% CI, 38 to 57) in the transthoracic open esophagectomy group.
“We found that hybrid minimally invasive esophagectomy resulted in a lower incidence of intraoperative and postoperative major complications, specifically pulmonary complications, than open esophagectomy, without compromising overall and disease-free survival over a period of 3 years,” the study authors wrote in conclusion.
- Mariette C, Markar SR, Dabakuyo‑Yonli TS, et al. Hybrid minimally invasive esophagectomy for esophageal cancer. N Engl J Med. 2019;380:152-162. doi: 10.1056/NEJMoa1805101