Hybrid Esophagectomy Results in Fewer Complications

Hybrid minimally invasive esophagectomy for esophageal cancer results in less intraoperative and postoperative major complications than open surgery, according to a new study.

Researchers at Claude Huriez University Hospital (CHRU; Lille, France), University Hospital of Besançon (France), and other institutions in France conducted a multicenter, randomized, controlled trial of 207 patients (18-75 years of age) with resectable cancer of the middle or lower third of the esophagus. Patients were randomly assigned to undergo transthoracic open esophagectomy or a hybrid minimally invasive esophagectomy, which involved laparoscopic gastric mobilization and open right thoracotomy (the Ivor–Lewis procedure).

The primary end point was intraoperative or postoperative complication of grade II or higher according to the Clavien–Dindo classification within 30 days. In all, 312 serious adverse events were recorded in 110 patients, with 36% of the hybrid-procedure group suffered major intraoperative or postoperative complications, compared to 64% in the open-procedure group. At three years, overall survival was 67% in the hybrid-procedure group, compared to 55% in the open-procedure group, and disease-free survival was 57% and 48%, respectively. The study was published on January 10, 2018, in the New England Journal of Medicine (NEJM).

“Postoperative complications, especially pulmonary complications, affect more than half the patients who undergo open esophagectomy for esophageal cancer,” concluded lead author Christophe Mariette, MD, PhD, of CHRU, and colleagues. “We found that a minimally invasive approach to the abdominal phase of an Ivor-Lewis two-field abdominal-thoracic esophagectomy was associated with substantially lower major morbidity, specifically pulmonary morbidity. This result was most probably mediated by the reduction in surgical trauma.”

The most common types of esophageal cancer are squamous cell carcinoma and adenocarcinoma, which develop in the cells that line the wall of the esophagus. Squamous cell carcinoma is more common in the upper part of the esophagus, and adenocarcinoma is more common in the lower. Cancers may manifest as a narrowing of the esophagus, a lump, an abnormal flat area (plaque), or a fistula. Less common types of esophageal cancer include leiomyosarcomas and metastatic cancer.

Related Links:
Claude Huriez University Hospital
University Hospital of Besançon