- In esophageal cancer in the middle or lower third of the esophagus, a hybrid, minimally invasive esophagectomy technique decreases morbidity while achieving similar efficacy to open esophagectomy.
- The technique combines a laparoscopic abdominal phase and an open thoracotomy, which has the potential to reduce pulmonary complications and tumor spillage, and to be more reproducible.
Why this matters
- It is unclear whether the greatest benefit of minimally invasive surgery stems from the abdominal or the thoracic surgical stage.
- 207 patients undergoing esophagectomy by an abdominal and right thoracic approach (Ivor-Lewis procedure) from 13 centers in France were randomly assigned to undergo hybrid minimally invasive esophagectomy or open esophagectomy.
- Funding: French National Cancer Institute.
- After adjustment for a range of factors, the hybrid procedure was associated with a lower risk of major intraoperative and 30-day postoperative complications (adjusted OR, 0.23; P<.001>
- The hybrid procedure was associated with a lower risk of 30-day postoperative pulmonary complications (OR, 0.50; 95% CI, 0.26-0.96).
- 5-year OS favored hybrid vs open: 60% vs 40% (HR for death, 0.67; 95% CI, 0.44-1.01).
- There was no between-group difference in disease-free survival.
- French population.
- Surgeons were experienced.