Minimally Invasive Esophagectomy Improves Short-Term Outcomes

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(ChemotherapyAdvisor) – For patients with resectable esophageal cancer, minimally invasive esophagectomy offers short-term benefits vs. traditional open transthoracic surgery, the first randomized trial to compare the two procedures concluded in The Lancet online April 30.

Over the past two decades, the global incidence of esophageal cancer has increased by 50%, from 316,000 cases in 1990 to 482,000 new diagnoses in 2008. “Surgical resection with radical lymphadenectomy, usually after neoadjuvant chemotherapy or chemoradiotherapy, is regarded as the only curative option for resectable esophageal cancer,” they noted. While mortality rates with this method are <5%, at least 50% of patients are at risk for developing pulmonary complications that necessitate lengthy hospital stays and result in poor quality of life during convalescence.

Between June 2009 and March 2011, the open-label trial randomly assigned 115 patients to either open transthoracic (n=56) or minimally invasive transthoracic esophagectomy (n=59) in 5 study centers in Netherlands, Spain, and Italy. The primary outcome was pulmonary infection within the first 2 weeks postsurgery and during the entire hospital stay.

In the first 2 weeks after surgery, 16 patients (29%) in the open esophagectomy group had pulmonary infection vs. 5 (9%) in the minimally invasive group (RR 0.30; P=0.005). During the hospital stay, 19 patients (34%) in the open esophagectomy group had pulmonary infection vs. 7 (12%) in the minimally invasive group (RR, 0.35; P=0.005). “For in-hospital mortality, 1 patient in the open esophagectomy group died from anastomotic leakage and 2 in the minimally invasive group from aspiration and mediastinitis after anastomotic leakage,” they noted.

Patients who underwent the minimally invasive procedure had significantly reduced blood loss and length of hospital stay, and significantly less pain and vocal-cord paralysis 6 weeks after surgery.

“Our results show that patients undergoing the minimally invasive procedure have an improved short-term outcome for pulmonary infections, hospital stay, and quality of life than do those undergoing open esophagectomy, with no compromise of the quality of the resected specimen, no significant difference in the number of lymph nodes retrieved, or in the number of reoperations and postoperative mortality between the groups,” the investigators wrote.

An accompanying Comment noted, “If these results can be confirmed in other settings, minimally invasive esophagectomy could truly become the standard of care.”


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