New Standard Identified for Resection of Mid to Low Esophageal Cancers

The use of hybrid minimally invasive esophagectomy reduced postoperative morbidity in patients with esophageal cancers, according to the results of the MIRO trial (abstract 615O_PR) presented at the European Society for Medical Oncology (ESMO) 2017 Congress in Madrid.

According to investigator Guillaume Piessen, from University Hospital C. Huriez Place de Verdun in Lille, France, these results demonstrate that the reduced surgical trauma associated with the laparoscopic approach does not cut corners on safety.

“In addition to a 69% reduction in major intra- and postoperative morbidity, 3-year overall survival was improved in the laparoscopic group, showing that it is an oncologically sound procedure,” Piessen said in a press release.

Patients included in the trial were 18 to 75 years old and had resectable cancers of the middle or lower third of the esophagus. Patients were randomly assigned to undergo either transthoracic esophagectomy (n = 104) or hybrid minimally invasive esophagectomy (n = 103). The primary outcome was grade 2 to 4 postoperative morbidity at 30 days.

There was a significantly higher number of patients in the transthoracic esophagectomy group who had major postoperative morbidity compared with the group that underwent minimally invasive esophagectomy (64.4% vs 35.9%; odds ratio, 0.31; 95% CI, 0.18–0.55; P < .001). Patients who underwent transthoracic procedures had higher rates of major pulmonary complications compared with the hybrid minimally invasive procedure (30.1% vs 17.7%; P = .037).

With a minimum follow-up of at least 3 years, hybrid minimally invasive esophagectomy was associated with improved overall survival (67.0% vs 54.8%; P = .054) and disease-free survival (57% vs 48%; P = .15) rates compared with the transthoracic procedure. Piessen noted that although this survival difference was not statistically significant, it was “highly clinically relevant.”

Commenting on the trial, Ulrich Güller, from Kantonsspital St. Gallen in Switzerland said, “This represents an extremely important, well-designed, and well-conducted study demonstrating that hybrid minimally invasive esophagectomy is an oncologically sound procedure and significantly reduces postoperative morbidity. Based on these results, the hybrid minimally invasive esophagectomy should become the new standard operating procedure for patients with mid and low esophageal cancer.”