Open or Minimally Invasive Surgeries Equal for Esophageal Cancer

Minimally invasive esophagectomy (MIE) matched open surgery for survival in patients with esophageal cancer and led to examination of significantly more lymph nodes, according to a new study.


Researchers at the University of Sydney (Australia) conducted a systematic review of the literature using MEDLINE, PubMed, EMBASE, and the Cochrane databases (1950-2012). The researchers then compared all eligible published studies with adequate oncologic data comparing MIE with open resection for carcinoma of the esophagus or esophagogastric junction. The analysis includes the extent of lymph node (LN) clearance, number of LNs retrieved, staging, geographic variance, and mortality. In all, 16 case-control studies with 1,212 patients undergoing esophagectomy were included.

The results showed that the median number of LNs found in the MIE and open groups were 16 and 10, respectively, with a significant difference favoring MIE. In comparing LN retrieval in Eastern versus Western studies, the researchers found a significant difference in Western centers favoring MIE. No statistical significance in pathologic staging was found between the open and MIE groups. Generally, no statistically significant difference was found between the open and MIE groups for survival within each time interval (30 days and 1, 2, 3, and 5 years), although the difference favored the MIE group. The study was published in the August 2012 issue of Archives of Surgery.

“The evidence suggests the use of minimally invasive esophagectomy is no better or worse in achieving similar oncologic outcomes than are open techniques,” concluded lead author Guy Eslick, PhD, and colleagues. “Further randomized controlled studies are needed to provide credible clinical evidence of the oncologic outcomes of open techniques versus minimally invasive esophagectomy.”

Esophagectomy is the surgical removal of all or part of the esophagus. There are two main types of esophagectomy; a trans-hiatal esophagectomy (THE) is performed on the neck and abdomen simultaneously; a trans-thoracic esophagectomy (TTE) involves opening the thorax. In most cases, the stomach is transplanted into the neck and the stomach takes the place originally occupied by the esophagus. In some cases, the removed esophagus is replaced by another hollow structure, such as the patient's colon.

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