Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: A multicentre, open-label, randomised controlled trial

Surya S A Y Biere, Mark I. Van Berge Henegouwen, Kirsten W. Maas, Luigi Bonavina, Camiel Rosman, Josep Roig Garcia, Suzanne S. Gisbertz, Jean H G Klinkenbijl, Markus W. Hollmann, Elly S M De Lange, H. Jaap Bonjer, Donald L. Van Der Peet, Miguel A. Cuesta

Research output: Contribution to journalArticle

Abstract

Surgical resection is regarded as the only curative option for resectable oesophageal cancer, but pulmonary complications occurring in more than half of patients after open oesophagectomy are a great concern. We assessed whether minimally invasive oesophagectomy reduces morbidity compared with open oesopha gectomy. Methods We did a multicentre, open-label, randomised controlled trial at five study centres in three countries between June 1, 2009, and March 31, 2011. Patients aged 18-75 years with resectable cancer of the oesophagus or gastro-oesophageal junction were randomly assigned via a computer-generated random isation sequence to receive either open transthoracic or minimally invasive transthoracic oesophagectomy. Randomisation was stratified by centre. Patients, and investigators undertaking interventions, assessing outcomes, and analysing data, were not masked to group assignment. The primary outcome was pulmonary infection within the first 2 weeks after surgery and during the whole stay in hospital. Analysis was by intention to treat. This trial is registered with the Netherlands Trial Register, NTR TC 2452. Findings We randomly assigned 56 patients to the open oesophagectomy group and 59 to the minimally invasive oesophagectomy group. 16 (29%) patients in the open oesophagectomy group had pulmonary infection in the first 2 weeks compared with five (9%) in the minimally invasive group (relative risk [RR] 0·30, 95% CI 0·12-0·76; p=0·005). 19 (34%) patients in the open oesophagectomy group had pulmonary infection in-hospital compared with seven (12%) in the minimally invasive group (0·35, 0·16-0·78; p=0·005). For in-hospital mortality, one patient in the open oesophagectomy group died from anastomotic leakage and two in the minimally invasive group from aspiration and mediastinitis after anastomotic leakage. Interpretation These findings provide evidence for the short-term benefits of minimally invasive oesopha gectomy for patients with resectable oesophageal cancer.

Original languageEnglish
Pages (from-to)1887-1892
Number of pages6
JournalLancet
Volume379
Issue number9829
DOIs
Publication statusPublished - May 2012

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: A multicentre, open-label, randomised controlled trial'. Together they form a unique fingerprint.

  • Cite this

    Biere, S. S. A. Y., Van Berge Henegouwen, M. I., Maas, K. W., Bonavina, L., Rosman, C., Garcia, J. R., Gisbertz, S. S., Klinkenbijl, J. H. G., Hollmann, M. W., De Lange, E. S. M., Bonjer, H. J., Van Der Peet, D. L., & Cuesta, M. A. (2012). Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: A multicentre, open-label, randomised controlled trial. Lancet, 379(9829), 1887-1892. https://doi.org/10.1016/S0140-6736(12)60516-9