Minimally invasive esophagectomy viable alternative to open surgery

By Sally Robertson, B.Sc.Sep 11 2012

Patients undergoing surgery for esophageal cancer may benefit from minimally invasive techniques as much as they do from open surgery, say researchers.

Surgeons can perform an adequate lymphadenectomy using minimally invasive esophagectomy (MIE) and may even be able to retrieve more lymph nodes this way than with standard open surgery, they say.

"Despite the length of time since the first MIE was performed, debate continues as to the safety, efficacy, and oncologic benefit of MIE techniques," explain Guy Eslick (The University of Sydney, Australia) and colleagues. "The extent of lymphadenectomy and the optimum level of dissection required to optimize patient long-term survival rates and rates of recurrence remain controversial," they explain.

In an analysis of 16 case-control studies including 1212 patients, the researchers found that among 494 (40.8%) who underwent MIE, significantly more lymph nodes were retrieved than among 718 (59.2%) who underwent open surgery, with a median of 16 versus 10 lymph nodes resected, respectively.

As reported in the Archives of Surgery, survival analysis showed no significant difference in 30-day, 1-year, 2-year, 3-year, and 5-year survival rates with either technique.

The team notes that there was no significant difference in pathologic staging between the open surgery and MIE patients, and the prevalence of different cancer types (adenocarcinoma, squamous cell carcinoma, and high-grade dysplasia/carcinoma in situ) was similar between the groups.

As previous studies have reported variations in the surgical techniques used between Eastern and Western countries, the researchers went on to compare patient outcomes between those treated in Eastern and Western centers.

In four studies constituting the Eastern group, there was no significant difference in lymph node retrieval between the open and MIE procedures. However, among the 11 Western studies, a significant difference favoring MIE was observed.

"Overall it can be concluded that surgeons performing MIE have similar or greater capability for lymphadenectomy compared with those using standard open techniques," say Eslick and team.

Again, survival analysis showed no significant survival advantage for either technique, although a trend for survival across all time intervals was found for MIE in both Eastern and Western centers.

"Further randomized controlled studies are needed to provide credible clinical evidence of the oncologic outcomes of open techniques vs MIE," concludes the team.

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