Five-Year Survival Outcomes of Hybrid Minimally Invasive Esophagectomy in Esophageal Cancer

Abstract

for the Fédération de Recherche en Chirurgie (FRENCH) and French Eso-Gastric Tumors (FREGAT) Working Groups IMPORTANCE Available data comparing the long-term results of hybrid minimally invasive esophagectomy (HMIE) with that of open esophagectomy are conflicting, with similar or even better results reported for the minimally invasive esophagectomy group. OBJECTIVE To evaluate the long-term, 5-year outcomes of HMIE vs open esophagectomy, including overall survival (OS), disease-free survival (DFS), and pattern of disease recurrence, and the potential risk factors associated with these outcomes. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial is a post hoc follow-up study that analyzes the results of the open-label Multicentre Randomized Controlled Phase III Trial, which enrolled patients from 13 different centers in France and was conducted from October 26, 2009, to April 4, 2012. Eligible patients were 18 to 75 years of age and were diagnosed with resectable cancer of the middle or lower third of the esophagus. After exclusions, patients were randomized to either the HMIE group or the open esophagectomy group. Data analysis was performed on an intention-to-treat basis from November 19, 2019, to December 4, 2020. INTERVENTIONS Hybrid minimally invasive esophagectomy (laparoscopic gastric mobilization with open right thoracotomy) was compared with open esophagectomy. MAIN OUTCOMES AND MEASURESThe primary end points of this follow-up study were 5-year OS and DFS. The secondary end points were the site of disease recurrence and potential risk factors associated with DFS and OS.RESULTS A total of 207 patients were randomized, of whom 175 were men (85%), and the median (range) age was 61 (23-78) years. The median follow-up duration was 58.2 (95% CI, 56.5-63.8) months. The 5-year OS was 59% (95% CI, 48%-68%) in the HMIE group and 47% (95% CI, 37%-57%) in the open esophagectomy group (hazard ratio [HR], 0.71; 95% CI, 0.48-1.06). The 5-year DFS was 52% (95% CI, 42%-61%) in the HMIE group vs 44% (95% CI, 34%-53%) in the open esophagectomy group (HR, 0.81; 95% CI, 0.55-1.17). No statistically significant difference in recurrence rate or location was found between groups. In a multivariable analysis, major intraoperative and postoperative complications (HR, 2.21; 95% CI, 1.41-3.45; P < .001) and major pulmonary complications (HR, 1.94; 95% CI, 1.21-3.10; P = .005) were identified as risk factors associated with decreased OS. Similarly, multivariable analysis of DFS identified overall intraoperative and postoperative complications (HR, 1.93; 95% CI, 1.28-2.90; P = .002) and major pulmonary complications (HR, 1.85; 95% CI, 1.19-2.86; P = .006) as risk factors.CONCLUSIONS AND RELEVANCE This study found no difference in long-term survival between the HMIE and open esophagectomy groups. Major postoperative overall complications and pulmonary complications appeared to be independent risk factors in decreased OS and DFS, providing additional evidence that HMIE may be associated with improved oncological results c...

Comparison of Clinical Outcomes of Robot-Assisted, Video-Assisted, and Open Esophagectomy for Esophageal Cancer

“…Instead, it found that major intraoperative and postoperative complications, as well as major pulmonary complications, negatively affected OS and DFS on multivariable analysis. 62 In this study, we found that RAMIE was associated with a modest decrease in pulmonary complications compared with VAMIE. Accordingly, it is plausible that RAMIE may be associated with improved long-term oncologic outcomes.…”

“…Interestingly, the 5-year follow-up analysis of the Minimally Invasive vs Open Esophageal Resection trial 62 found no difference in long-term oncologic outcomes between patients who underwent a hybrid esophagectomy (laparoscopy and thoracotomy) and open transthoracic esophagectomy. Instead, it found that major intraoperative and postoperative complications, as well as major pulmonary complications, negatively affected OS and DFS on multivariable analysis.…”

Robotic Esophagectomy. A Systematic Review with Meta-Analysis of Clinical Outcomes

“…In the new era of minimally invasive laparoscopic surgery, minimally invasive esophagectomy started to be performed in the 2000s, providing the well-known advantages on recovery of the minimally invasive procedures. Safety and efficacy of minimally invasive esophagectomy has been reported in several experiences [ 4 , 5 , 6 , 7 ], further providing similar oncologic results and long term recurrence rate [ 8 , 9 , 10 ]. However, on a clinical point of view, the introduction of minimally invasive esophagectomy in the clinical practice is far to be considered as a standard of care.…”

Open versus hybrid versus totally minimally invasive Ivor Lewis esophagectomy: Systematic review and meta-analysis

“…[9][10][11][12][13][14] However, because a totally minimally invasive transthoracic esophagectomy is a challenging and demanding procedure, some esophageal surgeons still perform open (OE) or hybrid esophagectomy (HE). [15][16][17][18][19][20] The aim of this systematic review and meta-analysis was to compare surgical outcomes between OE, HE, and totally minimally invasive Ivor Lewis esophagectomy (TMIE).…”