Minimally invasive esophagectomy carries drawbacks in the real world

  • Markar SR & al.
  • J Clin Oncol
  • 18 May 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • In a real-world analysis, minimally invasive esophagectomy (MIE) was associated with increased pulmonary complications and reoperations compared with open procedures.

Why this matters

  • These results conflict with those of the TIME trial, which found fewer pulmonary complications with MIE.

Study design

  • Analysis from the original TIME trial (n=115), along with data from the Dutch Upper GI Cancer Audit (DUCA) data set (n=4605).
  • Funding: National Institutes of Health Research.

Key results

  • In the TIME trial, MIE was associated with fewer pulmonary complications (OR, 0.19; 95% CI, 0.06-0.61).
  • After adjustment for patient and tumor factors and year of surgery, an analysis of the DUCA national data set showed that compared with open surgery, MIE was associated (ORs; 95% CIs) with more postoperative complications (1.36; 1.19-1.57), specifically:
    • Pulmonary complications: 1.50 (1.29-1.74).
    • Reoperation: 1.74 (1.42-2.14).
    • Complications graded Clavien-Dindo ≥3: 1.63 (1.15-2.31). 
    • Length of hospital stay: coefficient, 4.80 (4.15-5.45).
  • MIE was associated with greater average lymph node harvest (coefficient, 3.31; 95% CI, 1.62-5.00).
  • Patients who received neoadjuvant chemoradiotherapy had similar trends with MIE compared with open surgery.

Limitations

  • Retrospective analysis.