Esophageal cancer: hybrid surgical technique found safer

  • Mariette C & al.
  • N Engl J Med
  • 10/01/2019

  • Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • In esophageal cancer in the middle or lower third of the esophagus, a hybrid, minimally invasive esophagectomy technique decreases morbidity while achieving similar efficacy to open esophagectomy.
  • The technique combines a laparoscopic abdominal phase and an open thoracotomy, which has the potential to reduce pulmonary complications and tumor spillage, and to be more reproducible.

Why this matters

  • It is unclear whether the greatest benefit of minimally invasive surgery stems from the abdominal or the thoracic surgical stage.

Study design

  • 207 patients undergoing esophagectomy by an abdominal and right thoracic approach (Ivor-Lewis procedure) from 13 centers in France were randomly assigned to undergo hybrid minimally invasive esophagectomy or open esophagectomy.
  • Funding: French National Cancer Institute.

Key results

  • After adjustment for a range of factors, the hybrid procedure was associated with a lower risk of major intraoperative and 30-day postoperative complications (adjusted OR, 0.23; P<.001>
  • The hybrid procedure was associated with a lower risk of 30-day postoperative pulmonary complications (OR, 0.50; 95% CI, 0.26-0.96).
  • 5-year OS favored hybrid vs open: 60% vs 40% (HR for death, 0.67; 95% CI, 0.44-1.01).
  • There was no between-group difference in disease-free survival.

Limitations

  • French population.
  • Surgeons were experienced.