FROM ANNALS OF SURGERY
Minimally invasive esophagectomy can be performed with low perioperative morbidity and mortality in patients with esophageal cancer, according to results from a study conducted at 17 surgical centers.
Single-site studies have shown mortality and morbidity associated with MIE to be low, compared with historic rates for open procedures; the new study, led Dr. James D. Luketich of the University of Pittsburgh, and published in advance of print in Annals of Surgery (2015 Jan. 8 [ doi:10.1097/SLA.0000000000000993 ]), was the first to look at morbidity and mortality from minimally invasive esophagectomy (MIE) performed prospectively at multiple study sites.
Dr. Luketich and his colleagues recruited 104 patients with esophageal cancers or high-grade dysplasia and assigned them to MIE using video-assisted thorascopy and laparoscopy. Of the 95 patients who underwent the completely minimally invasive procedure as planned, 30-day mortality was 2.1%. For the broader study group, which included nine patients who received operations that differed from the study protocol, mortality was 2.9%.
Though single-site studies of MIE have seen mortality at below 2%, historic rates for open procedures have ranged from 8% to 23% in the United States, though mortality rates appear to be dropping. MIE has been shown in one randomized trial to be associated with significantly fewer pulmonary infections, compared with open procedures, and shorter hospital stays ( Dig. Dis. Sci. 2010;55:3031-40 ).
Patients in Dr. Luketich and colleagues’ study stayed a median of 2 days in intensive care and 9 days in the hospital. Serious adverse events included anastomotic leak (8.6%), acute respiratory distress syndrome (5.7%), pneumonitis (3.8%), and atrial fibrillation (2.9%).
Dr. Luketich and colleagues described the oncologic outcomes of their study as acceptable, compared with published results from open procedures. With a median follow-up of 35.8 months, estimated 3-year overall survival was 58.4% (95% confidence interval, 47.7%–67.6%), with locoregional recurrence seen in only seven patients (6.9%). This, the investigators reported, is comparable with survival results from open procedures.
“This study demonstrates the feasibility of this approach in a multicenter setting,” the investigators wrote in their analysis. “However, it should also be emphasized that the procedures were performed by credentialed surgeons with demonstrated experience in esophageal surgery and minimally invasive techniques.”
The minimally invasive approach can be adopted by other centers, Dr. Luketich and colleagues wrote, “provided that appropriate expertise with both open esophagectomy and minimally invasive techniques is available.”
The study was coordinated by the Eastern Cooperative Oncology Group and funded by grants from the National Cancer Institute, the National Institutes of Health, and the U.S. Department of Health & Human Services. Dr. Luketich and colleagues disclosed no conflicts of interest related to their research.