Minimally invasive superior to open esophagectomy for esophageal cancer
MedWire News: Minimally invasive esophagectomy may be better than traditional open esophagectomy for treating patients with resectable esophageal cancer, suggest study findings showing fewer pulmonary infections, shorter hospital stays, and better short-term quality of life.
Furthermore, minimally invasive esophagectomy resulted in surgical outcomes comparable to those with open esophagectomy.
Over the past 20 years, the incidence of esophageal cancer has increased by 50%, with esophagectomy the current gold standard of treatment. However, over half of patients who undergo this procedure develop pulmonary complications associated with long hospital stays and poor quality of life.
To assess the efficacy of minimally invasive esophagectomy, Miguel Cuesta (VU Medical Centre, Amsterdam, the Netherlands) and colleagues compared surgical outcomes among 115 patients randomly assigned to open esophagectomy or minimally invasive esophagectomy at five study centers in three countries.
In the first 2 weeks following surgery, significantly fewer patients who underwent minimally invasive esophagectomy had pulmonary infections than those who underwent open esophagectomy (9 vs 29%; relative risk [RR]=0.30).
In addition, fewer patients in the minimally invasive esophagectomy group had in-hospital pulmonary infections that did those in the esophagectomy group (12 vs 34%; RR=0.35). Hospital stay was also significantly shorter for patients who underwent a minimally invasive procedure (11 vs 14 days).
Patients who underwent minimally invasive esophagectomy showed significantly improved short-term quality of life, scoring significantly better on the physical component of the Short Form 36 Health Survey (42 vs 36), for global health on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (61 vs 51), and for the domains of talking and pain in the Oesophagus Specific Quality of Life 18 (18 vs 37 and 8 vs 19, respectively).
Despite operating times being significantly longer in the minimally invasive group than in the open esophagectomy group (329 vs 299 minutes), patients who underwent the minimally invasive procedure experienced significantly less blood loss (200 vs 475 mL).
In addition, patients who underwent the minimally invasive procedure experienced significantly less pain in the first 10 days after surgery than did those who underwent open surgery (Visual Analogue Scale score=2 vs 3).
Rates of postoperative complications were similar between the groups, except for vocal-cord paralysis, which was significantly more common among patients who underwent open surgery that those who underwent the minimally invasive procedure (14 vs 2%).
When the researchers performed a pathologic examination of resected specimens, they found no significant differences in the number of retrieved lymph nodes and the completeness of resection.
No significant differences were found between the groups regarding 30-day and in-hospital mortality rates or reoperation rates.
In an accompanying comment, published in The Lancet, Simon Law (University of Hong Kong, China) says: "If these results can be confirmed in other settings, minimally invasive esophagectomy could truly become the standard of care."
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By Ingrid Grasmo