Minimally invasive esophagectomy reduces morbidity

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Patients with resectable esophageal cancer may reap more short-term benefits from minimally invasive esophagectomy, including fewer pulmonary infections, significantly shorter hospital stays, and better short-term quality of life, than do patients who have undergone traditional open surgery.

These findings come from the first randomized trial to compare the two methods, recently reported in The Lancet and involving 115 participants, aged 18 to 75 years, with resectable cancer of the esophagus or the gastroesophageal junction. Prof. Miguel A. Cuesta of the Department of Surgery at VU University Medical Centre, Amsterdam, Netherlands, and colleagues randomized patients from five study centers in the Netherlands, Spain, and Italy to open transthoracic esophagectomy or to minimally invasive transthoracic esophagectomy. The latter avoids thoracotomy and laparotomy. As the authors explain, surgical resection is regarded as the only curative option for resectable esophageal cancer, but pulmonary complications occurring in more than half of patients after open esophagectomy are of great concern.

In the first 2 weeks postoperatively, 16 of the 56 patients (29%) in the open esophagectomy group developed pulmonary infections, compared with five of the 59 patients (9%) undergoing minimally invasive surgery. In-hospital pulmonary infections developed in 19 (34%) of the open surgery patients, compared with seven (12%) of the minimally invasive patients.

The minimally invasive group also had significantly less blood loss and shorter hospital stays as well as significantly less pain and vocal-cord paralysis.

The investigators noted no compromise in the quality of the resected specimen and no significant difference in the number of lymph nodes retrieved, the number of reoperations, or the rate of postoperative mortality between the two groups. One patient in the open surgery group died in the hospital as a result of anastomotic leakage, and two in the minimally invasive group died in the hospital as a result of aspiration and mediastinitis after anastomotic leakage. 

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