Kaitlyn D’Onofrio

DocwireNews

Patients requiring esophagectomy may have greater long-term survival odds with minimally invasive esophagectomy (MIE) than with open esophagectomy (OE), according to findings presented at the 65th Annual Meeting &amp; Exhibition of the Southern Thoracic Surgical Association.For their study, researchers collected data on esophagectomy patients from 2010 to 2014 with T1-4N1-3M0, adenocarcinoma, or squamous cell histology, in middle or lower esophagus using the National Cancer Database.&ldquo;Patients before this period do not have information on their surgical approach; patients after this period do not have survival outcomes,&rdquo; explained study author Mickey Ising, a surgery resident at the University of Louisville, during his presentation.Patients were classified by their surgical procedure: robotic assisted minimally invasive (RAMIE), laparoscopic (LMIE), or open esophagectomy (OE). The team compared postoperative and survival outcomes. In total, 7,435 were eligible for inclusion; a disproportionate percentage underwent OE (67.7%) as opposed to MIE (LMIE, 24.9%; RAMIE, 7.4%). Ising noted that this trend begun to shift during the study period. RAMIE and LMIE patients were propensity matched (1:1) to create a collective MIE group, which was matched to OE, resulting in a 1:1:2 matching of RAMIE-LMIE-OE.After matching, there were 527 RAMIE, 522 LMIE, and 1,044 OE patients. MIE patients had more nodes sampled than OE patients (16 vs 14, P &lt; 0.001) as well as more R0 resections (96.0% vs 93.6%, P = 0.013). The OE cohort had longer postoperative stays (10 vs 9 days, P = 0.04). Short-term survival rates were not different between the groups (30 days, P = 0.893; 90 days, P = 0.894). But median long-term survival was significantly increased after MIE than OE (4.98 vs 3.43 years, P = 0.001). In subgroup analyses, RAMIE and LMIE patients had similar survival rates (P = 0.698).The study had several limitations. One limitation was the viability of some data points, &ldquo;specifically tumor size, which was missing in about a quarter of our patients, which is why we didn&rsquo;t include it,&rdquo; Ising said. &ldquo;There is also no information on recurrence or cancer-related mortality, which may better characterize the overall survival.&rdquo;Center bias was cited as another limitation. Ising said that &ldquo;the majority of minimally-invasive patients were at larger centers,&rdquo; and that different protocols and better long-term follow-up at larger centers may &ldquo;ultimately lead to increased survival.&rdquo;The researchers concluded in their study that &ldquo;After propensity matching, patients undergoing MIE had better long but not short-term survival than OE [&hellip;]. This suggests MIE may have potential oncologic benefits over open esophagectomy. This benefit seems to be independent of the use of robotic technology.&rdquo;During the discussion portion of the presentation, a question about the quality of the procedure itself in conjunction with the surgeon&rsquo;s experience was raised by Mara B. Antonoff, MD, FACS, of the Anderson Cancer Center in Houston, Texas.&ldquo;One would typically expect that it takes a certain level of expertise and experience to perform minimally invasive esophagectomies, and I suspect that if the surgeons performing these minimally invasive operations also performed open operations, they&rsquo;d also have superior outcomes, regardless of their technique,&rdquo; Antonoff said. &ldquo;To what extent can we state that the MIE itself results in better long-term survival, and how do we know that this not a surrogate for some other mark of expertise among those surgeons?&rdquo;Ising agreed that the question of surgeon specificity is challenging to answer with database information, because most databases do not provide such details.&ldquo;Even though we can control for multiple other variables, ultimately the surgeons themselves are probably the ones we have the most trouble doing,&rdquo; he said. &ldquo;While we can&rsquo;t control for that, one thing we could do is &lsquo;control&rsquo; for surgical quality. We could have matched for R0 resection rates and number of lymph node sample. We haven&rsquo;t done that [here], but it would be interesting to see what the survival difference would be.&rdquo;

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Minimally Invasive Esophagectomy Presents Better Long-term Survival Rates Than Open Procedure

STSA 2018

Patients requiring esophagectomy may have greater long-term survival odds with minimally invasive esophagectomy (MIE) than with open esophagectomy (OE), according to findings ...

Minimally Invasive Esophagectomy Presents Better Long-term Survival Rates than Open Procedure

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