Patients with oesophageal cancer who undergo minimally invasive surgery to remove the oesophagus are almost three times less likely to develop pulmonary infections, and are more likely to have significantly shorter hospital stays and a better short-term quality of life compared with patients who have traditional open surgery, according to the first randomised trial to compare the two methods published in The Lancet.

The incidence of oesophageal cancer is rising rapidly worldwide, and has increased by 50% in the last 20 years.

The mainstay of treatment is surgery to remove part of or the entire oesophagus, a procedure called oesophagectomy.

Worryingly, more than half of patients develop pulmonary complications after open oesophagectomy (an operation that requires cutting through a patient’s chest).

These complications result in longer hospital stays and a poorer quality of life.

As such, minimally invasive oesophagectomy could have potential advantages over traditional open surgery.

Although two decades have passed since the first minimally invasive oesophagectomy was performed, here Miguel Cuesta from the VU University Medical Centre, Amsterdam and colleagues report results from the first randomised trial to compare the two techniques.

The study included 115 patients with resectable oesophageal cancer from five centres in the Netherlands, Spain, and Italy who were randomised to receive either open oesophagectomy (56 patients) or minimally invasive oesophagectomy (59).

In the first two weeks after surgery, significantly fewer patients in the minimally invasive oesophagectomy group developed pulmonary infections than in the open surgery group (5 [9%] vs 16 [29%]. Overall, seven (12%) of patients who had minimally invasive surgery developed a pulmonary infection in hospital compared with 19 (34%) in the open surgery group.

Patients who underwent the minimally invasive procedure also had significantly reduced blood loss and length of hospital stay, and a better quality of life (significantly less pain and vocal-cord paralysis) 6 weeks after surgery.

The authors say: “A shorter hospital stay in the minimally invasive group…indicates a faster postoperative recovery.”

They conclude: “Importantly, we noted no compromise in the quality of the resected specimen, no significant difference in the number of lymph nodes retrieved, or in the number of reoperations and postoperative mortality between the groups.”

In an accompanying Comment, Simon Law from the University of Hong Kong, China says: “If these results can be confirmed in other settings, minimally invasive oesophagectomy could truly become the standard of care.”

Source: The Lancet