Hybrid Minimally Invasive Surgery Yields Fewer Complications for Esophageal Cancer Patients

Compared to open surgery, a hybrid minimally invasive surgery technique when treating esophageal cancer patients is associated with fewer postoperative complications and better three-year survival, according to a recent randomized trial.

Between October 2009 and April 2012, researchers randomized patients with resectable cancer of the middle or lower third of the esophagus to undergo transthoracic open esophagectomy (open procedure, n = 104) or hybrid minimally invasive esophagectomy (hybrid procedure, n = 103). The hybrid procedure was defined as “a two-field abdominal–thoracic operation (also called an Ivor–Lewis procedure) with laparoscopic gastric mobilization and open right thoracotomy.” Patients were aged from 18 to 75 years.

Thirty days postoperatively, one hybrid procedure patient died, compared to two open procedure patients; at 90 days, there were four and six deaths, respectively. Overall, 312 events occurred in 110 patients. Major intraoperative or postoperative complications were significantly more common in the open-procedure group (n = 67, 64%) than the hybrid-procedure group (n = 37, 36%) (odds ratio, 0.31; 95% confidence interval [CI], 0.18 to 0.55; P<0.001). Just under a fifth (n = 18/102, 18%) of hybrid procedure patients experienced a major pulmonary complication, versus 30% (n = 31/103) of open procedure patients. Three-year overall survival rates were higher in the hybrid-procedure group (67%; 95% CI, 57–75) than the open-procedure group (55%; 95% CI, 45–64), as well as disease free survival (57% [95% CI, 47 to 66] vs. 48% [95% CI, 38 to 57], respectively).

The study was published in the New England Journal of Medicine.

“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 researchers wrote.

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Sources: MedPage Today, NEJM