Minimally Invasive Surgery a Viable Option for Esophageal Cancer
by C.H. Weaver M.D. (07/2018)
Minimally invasive surgery may provide short-term benefits in resectable esophageal cancer, reducing the risk of pulmonary infection and improving quality of life, according to the results of a study published in The Lancet.
The esophagus is a muscular tube that food and liquids pass through on their on their way to the stomach. Each year in the United States, more than 17,000 people are diagnosed with cancer of the esophagus and more than 15,000 die of the disease.
Treatment of esophageal cancer often involves esophagectomy, which is surgical removal of the entire esophagus. Although surgery is regarded as the only curative option for resectable esophageal cancer, it does carry the risk of pulmonary (lung) complications. More than half of patients who undergo open esophagectomy experience pulmonary complications. Minimally invasive esophagectomy usually involves several small incisions and a camera to see inside the body, whereas open esophagectomy involves fewer (but larger) incisions and is a more invasive procedure.
To compare open esophagectomy with minimally invasive esophagectomy, researchers conducted a randomized, multi-center trial at five hospitals in three countries between 2009 and 2011. The study included 115 patients ages 18 to 75 with resectable esophageal cancer (esophageal cancer that could be surgically removed). Patients were randomly assigned to undergo open transthoracic esophagectomy (56 patients) or minimally invasive transthoracic esophagectomy (59 patients).
The primary endpoint of the study was to assess whether pulmonary infection occurred within the first 2 weeks after the surgery and during the whole stay in the hospital. During the first 2 weeks after surgery, 29 percent of patients in the open esophagectomy group experienced pulmonary infection, compared with 9 percent in the minimally invasive group. Overall, 34 percent of patients in the open esophagectomy group had pulmonary infection during their hospital stay, compared with 12 percent in the minimally invasive group. Secondary endpoints of the study were pain score, intraoperative blood loss, length of hospital stay, and quality of life 6 weeks after surgery—all of which were significantly better with the minimally invasive procedure.
Based on these results, the researchers concluded that minimally invasive esophagectomy may provide some short-term benefits for patients with resectable esophageal cancer.
Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. The Lancet. 2012; 379: 1887-1892.