Minimally invasive esophagectomy non-inferior to open surgery: Can this be practice changing?

Hybrid minimally invasive esophagectomy may be preferred over open surgery for patients with esophageal carcinoma amenable to surgery, suggests a latest study.

Data from the MIRO study has shown that patients who underwent hybrid minimally invasive esophagectomy in patients with resectable cancer of the middle or lower third of the esophagus had fewer intraoperative and postoperative major complications, specifically pulmonary complications as compared to open esophagectomy. No adverse effects on the overall and disease-free survival were observed over the 3-year study period.

A major intraoperative or postoperative complication at 30 days was observed in 36% of patients in the hybrid-procedure group as compared to 64% in the open-procedure group.

Only 18% of patients in the hybrid surgery group developed a pulmonary complication at 30 days; but, this number was as high as 30% in patients who underwent open surgery.

The overall survival at 3 years in the hybrid-procedure group was non inferior to the open procedure group; 67% vs 55%, respectively. Likewise, the disease-free survival was also 57% and 48%, respectively in the two study groups.

The study randomized patients aged 18 to 75 years with resectable cancer of the middle or lower third of the esophagus to undergo hybrid procedure (n=103; hybrid minimally invasive esophagectomy) or open procedure (n=104; transthoracic open esophagectomy). The hybrid surgery included a two-field abdominal–thoracic surgery (Ivor–Lewis procedure) with laparoscopic gastric mobilization and open right thoracotomy.

The primary end point was intraoperative or postoperative complication of grade II or higher according to the Clavien–Dindo classification (indicating major complication leading to intervention) within 30 days

The study is reported in the New England Journal of Medicine, Jan. 10, 2019.

(Source: N Engl J Med. 2019;380:152-62; Medscape)

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