Title :

Five-Year Survival Outcomes of Hybrid Minimally Invasive Esophagectomy in Esophageal Cancer

Author(s) :

Nuytens, Frederiek [Auteur]
Hôpital Claude Huriez [Lille]
Dabakuyo-Yonli, Tienhan Sandrine [Auteur]
Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] [UNICANCER/CRLCC-CGFL]
Lipides - Nutrition - Cancer [Dijon - U1231] [LNC]
Meunier, Bernard [Auteur]
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
Gagnière, Johan [Auteur]
Université Clermont Auvergne [UCA]
Service Hépato-Gastro-Entérologie [CHU Clermont-Ferrand]
Collet, Denis [Auteur]
Hôpital Haut-Lévêque [CHU Bordeaux]
d'Journo, Xavier [Auteur]
Service de chirurgie thoracique [Hôpital Nord - APHM]
Brigand, Cécile [Auteur]
Université de Strasbourg [UNISTRA]
Centre Hospitalier Universitaire [Strasbourg] [CHU Strasbourg]
Perniceni, Thierry [Auteur]
Institut Mutualiste de Montsouris [IMM]
Carrère, Nicolas [Auteur]
Université Toulouse III - Paul Sabatier [UT3]
Centre Hospitalier Universitaire de Toulouse [CHU Toulouse]
Mabrut, Jean-Yves [Auteur]
Hôpital de la Croix-Rousse [CHU - HCL]
Msika, Simon [Auteur]
Université Paris Diderot - Paris 7 [UPD7]
Université Paris Cité [UPCité]
Hôpital Louis Mourier - AP-HP [Colombes]
Peschaud, Frédérique [Auteur]
Service de chirurgie générale, digestive et oncologique [CHU Ambroise-Paré]
Prudhomme, Michel [Auteur]
Centre Hospitalier Universitaire de Nîmes [CHU Nîmes]
Markar, Sheraz [Auteur]
Karolinska Institutet [Stockholm]
Imperial College London
Piessen, Guillaume [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Hétérogénéité, Plasticité et Résistance aux Thérapies des Cancers = Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277 [CANTHER]
Hôpital Claude Huriez [Lille]

Journal title :

JAMA SURGERY

Pages :

323

Publisher :

American Medical Association

Publication date :

2021-04-01

ISSN :

2168-6254

HAL domain(s) :

Sciences du Vivant [q-bio]/Cancer

English abstract : [en]

Available data comparing the long-term results of hybrid minimally invasive esophagectomy (HMIE) with that of open esophagectomy are conflicting, with similar or even better results reported for the minimally invasive ...
Show more >Available data comparing the long-term results of hybrid minimally invasive esophagectomy (HMIE) with that of open esophagectomy are conflicting, with similar or even better results reported for the minimally invasive esophagectomy group.Objective: To evaluate the long-term, 5-year outcomes of HMIE vs open esophagectomy, including overall survival (OS), disease-free survival (DFS), and pattern of disease recurrence, and the potential risk factors associated with these outcomes.Design, setting, and participants: This randomized clinical trial is a post hoc follow-up study that analyzes the results of the open-label Multicentre Randomized Controlled Phase III Trial, which enrolled patients from 13 different centers in France and was conducted from October 26, 2009, to April 4, 2012. Eligible patients were 18 to 75 years of age and were diagnosed with resectable cancer of the middle or lower third of the esophagus. After exclusions, patients were randomized to either the HMIE group or the open esophagectomy group. Data analysis was performed on an intention-to-treat basis from November 19, 2019, to December 4, 2020.Interventions: Hybrid minimally invasive esophagectomy (laparoscopic gastric mobilization with open right thoracotomy) was compared with open esophagectomy.Main outcomes and measures: The primary end points of this follow-up study were 5-year OS and DFS. The secondary end points were the site of disease recurrence and potential risk factors associated with DFS and OS.Results: A total of 207 patients were randomized, of whom 175 were men (85%), and the median (range) age was 61 (23-78) years. The median follow-up duration was 58.2 (95% CI, 56.5-63.8) months. The 5-year OS was 59% (95% CI, 48%-68%) in the HMIE group and 47% (95% CI, 37%-57%) in the open esophagectomy group (hazard ratio [HR], 0.71; 95% CI, 0.48-1.06). The 5-year DFS was 52% (95% CI, 42%-61%) in the HMIE group vs 44% (95% CI, 34%-53%) in the open esophagectomy group (HR, 0.81; 95% CI, 0.55-1.17). No statistically significant difference in recurrence rate or location was found between groups. In a multivariable analysis, major intraoperative and postoperative complications (HR, 2.21; 95% CI, 1.41-3.45; P < .001) and major pulmonary complications (HR, 1.94; 95% CI, 1.21-3.10; P = .005) were identified as risk factors associated with decreased OS. Similarly, multivariable analysis of DFS identified overall intraoperative and postoperative complications (HR, 1.93; 95% CI, 1.28-2.90; P = .002) and major pulmonary complications (HR, 1.85; 95% CI, 1.19-2.86; P = .006) as risk factors.Conclusions and relevance: This study found no difference in long-term survival between the HMIE and open esophagectomy groups. Major postoperative overall complications and pulmonary complications appeared to be independent risk factors in decreased OS and DFS, providing additional evidence that HMIE may be associated with improved oncological results compared with open esophagectomy primarily because of a reduction in postoperative complications.Show less >

Language :

Anglais

Popular science :

Non

Collections :

• Centre d'Infection et d'Immunité de Lille (CIIL) - U1019 - UMR 9017

Source :

Harvested from HAL

Submission date :

2024-02-17T04:04:08Z