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Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer
- Source :
- New England Journal of Medicine, New England Journal of Medicine, Massachusetts Medical Society, 2019, 380 (2), pp.152-162. ⟨10.1056/NEJMoa1805101⟩
- Publication Year :
- 2019
- Publisher :
- HAL CCSD, 2019.
-
Abstract
- Postoperative complications, especially pulmonary complications, affect more than half the patients who undergo open esophagectomy for esophageal cancer. Whether hybrid minimally invasive esophagectomy results in lower morbidity than open esophagectomy is unclear.We performed a multicenter, open-label, randomized, controlled trial involving patients 18 to 75 years of age with resectable cancer of the middle or lower third of the esophagus. Patients were randomly assigned to undergo transthoracic open esophagectomy (open procedure) or hybrid minimally invasive esophagectomy (hybrid procedure). Surgical quality assurance was implemented by the credentialing of surgeons, standardization of technique, and monitoring of performance. Hybrid surgery comprised a two-field abdominal-thoracic operation (also called an Ivor-Lewis procedure) with laparoscopic gastric mobilization and open right thoracotomy. The primary end point was intraoperative or postoperative complication of grade II or higher according to the Clavien-Dindo classification (indicating major complication leading to intervention) within 30 days. Analyses were done according to the intention-to-treat principle.From October 2009 through April 2012, we randomly assigned 103 patients to the hybrid-procedure group and 104 to the open-procedure group. A total of 312 serious adverse events were recorded in 110 patients. A total of 37 patients (36%) in the hybrid-procedure group had a major intraoperative or postoperative complication, as compared with 67 (64%) in the open-procedure group (odds ratio, 0.31; 95% confidence interval [CI], 0.18 to 0.55; P0.001). A total of 18 of 102 patients (18%) in the hybrid-procedure group had a major pulmonary complication, as compared with 31 of 103 (30%) in the open-procedure group. At 3 years, overall survival was 67% (95% CI, 57 to 75) in the hybrid-procedure group, as compared with 55% (95% CI, 45 to 64) in the open-procedure group; disease-free survival was 57% (95% CI, 47 to 66) and 48% (95% CI, 38 to 57), respectively.We found that hybrid minimally invasive esophagectomy resulted in a lower incidence of intraoperative and postoperative major complications, specifically pulmonary complications, than open esophagectomy, without compromising overall and disease-free survival over a period of 3 years. (Funded by the French National Cancer Institute; ClinicalTrials.gov number, NCT00937456 .).
- Subjects :
- Adult
Lung Diseases
Male
medicine.medical_specialty
Esophageal Neoplasms
medicine.medical_treatment
Treatment outcome
030204 cardiovascular system & hematology
Adenocarcinoma
03 medical and health sciences
Young Adult
0302 clinical medicine
Postoperative Complications
Invasive esophagectomy
medicine
Carcinoma
Humans
Minimally Invasive Surgical Procedures
030212 general & internal medicine
Intraoperative Complications
ComputingMilieux_MISCELLANEOUS
Aged
business.industry
Incidence
Follow up studies
[SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology
General Medicine
Esophageal cancer
Middle Aged
medicine.disease
Survival Analysis
[SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology
3. Good health
Surgery
Intention to Treat Analysis
Clinical trial
Esophagectomy
Editorial Commentary
Treatment Outcome
Multicenter study
Thoracotomy
Carcinoma, Squamous Cell
Female
business
Follow-Up Studies
Subjects
Details
- Language :
- English
- ISSN :
- 00284793 and 15334406
- Database :
- OpenAIRE
- Journal :
- New England Journal of Medicine, New England Journal of Medicine, Massachusetts Medical Society, 2019, 380 (2), pp.152-162. ⟨10.1056/NEJMoa1805101⟩
- Accession number :
- edsair.doi.dedup.....673f50cbad9991e4a9637a992864f221