Minimally invasive procedure for oesophageal cancer shows promise

Patients with oesophageal cancer could gain substantial benefit from minimally invasive procedure. A new study published Online First in The Lancet reveals that removing the oesophagus via minimally invasive surgery is considerably more beneficial for individuals with oesophageal cancer than traditional open surgery. Results from the study indicate that oesophageal cancer patients who undergo the minimally invasive procedure have better short-term quality of life, considerably shorter hospitalizations and are nearly three times less likely to develop pulmonary infections. According to the researchers, over the last two decades the incidence of esophageal cancer has increased by 50%. At present, the mainstay of treatment is a procedure called open oesophagectomy which involves removing part of or the entire oesophagus by cutting through a patient's chest. However, over half of patients develop pulmonary complications after undergoing this invasive procedure. These complications result in poorer quality of life, as well as longer hospital stays. The researchers note that minimally invasive oesophagectomy could have potential benefits over traditional open surgery. Even though the first minimally invasive oesophagectomy was performed 20 years ago, this is the first randomized trial comparing the two procedures. Miguel Cuesta from the VU University Medical Center, Amsterdam and his team enrolled 115 individuals with resectable esophageal cancer from 5 centers in the Netherlands, Italy and Spain to participate in the study. The researchers randomly assigned 56 participants to receive open oesophagectomy and 59 patients to receive minimally invasive oesophagectomy. The researchers found that significantly more patients (16 [29%]) in the open surgery group developed pulmonary infections two weeks after surgery than in the minimally invasive oesophagectomy group (5 [9%]). Overall, 19 (34%) of participants in the open surgery group developed a pulmonary infection in hospital vs. 7 (12%) of participants who underwent minimally invasive surgery. In addition, the team found that at six weeks after the procedure, participants assigned to the minimally invasive group had better quality of life (significantly less pain and vocal-cord paralysis), shorter hospitalizations, and had significantly reduced blood loss. The researchers conclude: "A shorter hospital stay in the minimally invasive group... indicates a faster postoperative recovery. Importantly, we noted a compromise in the quality of the resected specimen, no significant difference in the number of lymph nodes retrieved, or in the number of re-operations and postoperative mortality between the groups." In an associated comment, Simon Law from the University of Hong Kong, China, explains: "If these results can be confirmed in other settings, minimally invasive oesophagectomy could truly become the standard of care."