11 Jan Esophageal Cancer: HMIE Procedure Reduces Morbidity Without Sacrificing Efficacy

MedicalResearch.com Interview with:

Prof. Piessen

Guillaume Piessen, MD, PhD
University Hospital Centre
Lille, Franc

MedicalResearch.com: What is the background for this study?

Response: Patients requiring surgery for esophageal cancer fare better after undergoing a hybrid minimally invasive esophagectomy (HMIE) with a combined laparoscopy+thoracotomy procedure compared to an open esophagectomy (OE), according to results of the MIRO trial published in the last issue of the New England Journal Of Medicine (link article).

This French prospective multi-center randomized controlled study was funded by the French National Cancer Institute (Grant n° 1907). The study was conducted by Pr Mariette who sadely passed away in 2017 and Pr Piessen (Department of Digestive and Oncological Surgery, CHU Lille), under the hauspice of FRENCH (Fédération de Recherche EN Chirurgie) and FREGAT (French Eso-Gastric Tumors) working group (https://www.fregat-database.org/fr/).

Postoperative morbidity, especially pulmonary complications, affects more than half of patients after open esophagectomy for esophageal cancer.

Hybrid minimally invasive esophagectomy (HMIE) combines a laparoscopic abdominal phase with an open thoracotomy, which may have specific advantages including lower rate of pulmonary complications, without laparoscopic tumor dissection limiting potential tumor spillage and easier reproducibility of the technique [12].

Postoperative morbidity, especially pulmonary complications, affects more than half of patients after open esophagectomy for esophageal cancer.

Hybrid minimally invasive esophagectomy (HMIE) combines a laparoscopic abdominal phase with an open thoracotomy, which may have specific advantages including lower rate of pulmonary complications, without laparoscopic tumor dissection limiting potential tumor spillage and easier reproducibility of the technique [12].

MedicalResearch.com: What are the main findings?

Response: MIRO enrolled 207 adult patients from 13 centres with resectable cancers of the middle or lower third of the esophagus. They were randomised to undergo either HMIE or OE.

At 30-days, major postoperative morbidity occurred in significantly fewer patients in the HMIE compared to the OE group (35.9% versus 64.4%, odds ratio [OR] 0.31, 95%CI 0.18-0.55; p<0·001).

At three years, overall survival was 67.0% (95% CI 57% to 75.2%) in the HMIE group compared with 54.8% (95% CI 44.8% to 63.8%) for the OE group. Those favorable results in favor of the HMIE arm were confirmed at 5 years (HR=0.67 [95%CI 0.44 to 1.01]). 

MedicalResearch.com: What should readers take away from your report?

Response: This study demonstrates that HMIE significantly reduces postoperative morbidity and is an oncologically sound procedure. Based on these results, the HMIE should become the new standard operating procedure for patients with mid and low oesophageal cancer. Future studies comparing HMIE and totally miniinvasive esophagectomy are expected to specify the potential benefit of one or the other approach. 

Citation:

Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer
Christophe Mariette, M.D., Ph.D., Sheraz R. Markar, M.D., Ph.D., Tienhan S. Dabakuyo-Yonli, Pharm.D., Ph.D., Bernard Meunier, M.D., Denis Pezet, M.D., Ph.D., Denis Collet, M.D., Ph.D., Xavier B. D’Journo, M.D., Ph.D., Cécile Brigand, M.D., Ph.D., Thierry Perniceni, M.D., Nicolas Carrère, M.D., Ph.D., Jean-Yves Mabrut, M.D., Ph.D., Simon Msika, M.D., Ph.D., Frédérique Peschaud, M.D., Ph.D., Michel Prudhomme, M.D., Ph.D., Franck Bonnetain, Ph.D., and Guillaume Piessen, M.D., Ph.D. for the Fédération de Recherche en Chirurgie (FRENCH) and French Eso-Gastric Tumors (FREGAT) Working Group^*

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Last Updated on January 11, 2019 by Marie Benz MD FAAD