Five-year survival outcomes of Hybrid minimally invasive Eso
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Findings from this study suggest that hybrid minimally invasive esophagectomy (HMIE) is associated with improved long-term oncological results compared with open esophagectomy primarily because of decreased postoperative complications.

This JAMA study was aimed 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.

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. 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.

A total of 207 patients were randomized. The median follow-up duration was 58.2 months.

--The 5-year OS was 59% in the HMIE group and 47% in the open esophagectomy group.

--The 5-year DFS was 52% in the HMIE group vs 44% in the open esophagectomy group. No statistically significant difference in recurrence rate or location was found between groups.

--In a multivariable analysis, major intraoperative and postoperative complications and major pulmonary complications were identified as risk factors associated with decreased OS.

--Similarly, multivariable analysis of DFS identified overall intraoperative and postoperative complications and major pulmonary complications as risk factors.

In particular, 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.

Source: https://jamanetwork.com/journals/jamasurgery/article-abstract/2776431
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