1. A hybrid minimally invasive esophagectomy approach (Ivor-Lewis esophagectomy) was found to have lower rates of intraoperative and postoperative complications after 30 days as compared to an open esophagectomy approach.
2. Disease-free survival and overall survival, though not statistically significant, trended towards higher rates with the minimally invasive hybrid approach.
Evidence Rating Level: 1 (Excellent)
Study Rundown: New surgical approaches to treat esophageal cancer have recently been proposed and are under study for their safety and efficacy. In this randomized control trial, researchers compared the efficacy of a hybrid minimally invasive surgical approach in which surgeons combine a laparoscopic abdominal access route and open thoracotomy to a traditional open esophagectomy procedure for patients that had squamous-cell carcinoma or adenocarcinoma of the middle or lower third of the esophagus. Both procedures were assessed for their rates of intraoperative or postoperative complications, with special attention given to rates of pulmonary complications. Overall, researchers found that the hybrid approach resulted in lower rates of intraoperative and postoperative complications, as well as lower rates of pulmonary complications. Overall survival and disease-free survival rates trended towards being higher in the in the hybrid surgery group, though not significant.
While more investigation is needed, these findings suggest there is merit in considering adoption of this minimally invasive approach when surgically treating esophageal cancer. Strengths of the study include its randomized design, measures taken in attempt to standardize surgical technique, and robust clinical follow-up. Limitations include the small sample size and inclusion of only notably experienced surgeons affecting generalizability.
Click to read the study in NEJM
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