Postoperative morbidity, especially pulmonary complications, affects more than half of patients after open esophagectomy (OE). We assessed whether hybrid minimally invasive esophagectomy (HMIE) reduces morbidity compared with OE.
We performed a multicentre, open-label, randomised controlled trial at 13 study centres between October 2009 and April 2012. Patients aged 18-75 years old with resectable cancers of the middle or lower third of the oesophagus were assigned by randomisation to undergo either transthoracic OE or HMIE. Surgical quality assurance was implemented through credentialing surgeons before enrolment, standardisation of technique and monitoring of performance during the trial. HMIE comprised an Ivor Lewis procedure with laparoscopic gastric mobilisation and open right thoracotomy. The primary outcome was 30-day grade II-IV postoperative morbidity as defined by the Clavien-Dindo classification. Secondary outcomes were 30-day postoperative mortality, overall and disease free-survivals. Analysis was done by intention to treat.
We randomly assigned 104 patients to the OE group and 103 to the HMIE group. Sixty-seven (64.4%) patients in the OE group had major postoperative morbidity compared with 37 (35.9%) in the HMIE group (OR 0.31, 95%CI 0.18-0.55; p
These findings show that hybrid minimally invasive esophagectomy is an oncologically sound procedure, and reduces the incidence of major morbidity specifically pulmonary following esophagectomy for cancer.
Clinical trial identification
Legal entity responsible for the study
Lille University Hospital
The French National Cancer Institute INCa
All authors have declared no conflicts of interest.