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Outcomes similar between minimally invasive esophagectomy, open techniques in esophageal cancer
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Results from a recent meta-analysis indicated that minimally invasive esophagectomy had similar oncologic outcomes to open resection in patients with esophageal cancer.
Researchers performed a systematic literature review of 16 case-control studies comparing minimally invasive esophagectomy (MIE) with open resection techniques. The studies, 11 originating in Western countries and five in Eastern countries, included 1,212 patients who underwent either MIE (n=494) or open resection via transthoracic or transhiatal procedures (n=718).
Guy D. Eslick
“Since 2009, there have been four meta-analyses that have assessed complications associated with esophagectomy,” Guy D. Eslick, PhD, associate professor of surgery and cancer epidemiology and co-director of the Whiteley-Martin Research Centre, discipline of surgery, at the University of Sydney in Australia, told Healio.com. “Our study was specifically focused on oncological outcomes because there was no pooled data available in the medical literature; our study provided this new evidence.”
While lymph node (LN) retrieval varied across studies, MIE found a significantly higher overall median of 16 LNs (range 5.7-33.9) compared with 10 in open resection (range 3.0-32.8). Pathologic staging was not significantly different between procedures, although MIE patients underwent more neoadjuvant treatment (54.9% compared with 34.7%, P<.001).
Differences between the groups regarding survival at 30 days and 1, 2, 3 and 5 years were not statistically significant (P>.05 for all evaluable studies at all time points). Combined survival across all studies favored MIE (HR=0.87; 95% CI, –0.70-1.08), but not significantly.
Studies originating in Western countries indicated a significant, MIE-favoring difference between the procedures (P=.01), while Eastern studies did not (P=.56). A higher survival rate was observed among MIE patients compared with those receiving open resection in studies of both Eastern (HR=0.80; 95% CI, 0.54-1.20) and Western origins (HR=0.90; 95% CI, 0.70-1.17), but was not statistically significant.
The researchers concluded that MIE is a viable option that can improve LN yield without affecting survival rates.
“Although a lack of standardized and controlled data limits the methods used in this study, the evidence suggests that the use of MIE is no better or worse in achieving similar oncologic outcomes than are open techniques,” they wrote. “Further randomized controlled studies are needed to provide credible clinical evidence of the oncologic outcomes of open techniques vs. MIE.”
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