Document Detail

Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial.
MedLine Citation:
PMID:  22552194     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: 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 oesophagectomy.
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 randomisation 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 oesophagectomy for patients with resectable oesophageal cancer.
FUNDING: Digestive Surgery Foundation of the Unit of Digestive Surgery of the VU University Medical Centre.
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
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-05-01
Journal Detail:
Title:  Lancet     Volume:  379     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-21     Completed Date:  2012-06-08     Revised Date:  2012-09-10    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  1887-92     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Elsevier Ltd. All rights reserved.
Department of Surgery, VU University Medical Centre, Amsterdam, Netherlands.
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MeSH Terms
Esophageal Neoplasms / surgery*
Esophagectomy / methods*
Esophagogastric Junction / surgery*
Esophagoscopy / methods*
Length of Stay
Lung Diseases / etiology
Middle Aged
Postoperative Complications / etiology
Quality of Life
Respiratory Tract Infections / etiology
Treatment Outcome
Young Adult
Comment In:
Lancet. 2012 Sep 8;380(9845):885; author reply 885-6   [PMID:  22959381 ]
Lancet. 2012 Sep 8;380(9845):883; author reply 885-6   [PMID:  22959377 ]
Lancet. 2012 Sep 8;380(9845):884; author reply 885-6   [PMID:  22959380 ]
Lancet. 2012 May 19;379(9829):1856-8   [PMID:  22552193 ]
Lancet. 2012 Sep 8;380(9845):884; author reply 885-6   [PMID:  22959379 ]
Nat Rev Clin Oncol. 2012 Jul;9(7):369   [PMID:  22585003 ]
Lancet. 2012 Sep 8;380(9845):883; author reply 885-6   [PMID:  22959378 ]

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