Different Esophageal Cancer Surgery Types Have Similar Outcomes

Researchers have found “there is no evidence” that either open surgery or hybrid surgery for patients with esophageal cancer “makes a difference to patients’ experiences of recovery or complications after surgery,” as Kerry Avery told CURE®.

Avery is an associate professor in applied health and care research at the Bristol Medical School Department of Population Health Sciences University of Bristol in England.

Avery is the author of a study published in the British Journal of Surgery evaluating patients who underwent esophageal cancer surgery. In the study, a total of 267 had hybrid surgery and 266 had open surgery. All were treated in eight centers across the United Kingdom as part of the ROMIO randomized clinical trial.

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Open Surgery Versus Hybrid Surgery

Open and hybrid esophageal cancer surgery, Avery said, are the two most common ways to perform an esophagectomy (a surgery to remove some or most of the esophagus, as defined by the American Cancer Society). Avery explained that an open surgery involves two large cuts. These incisions can be in the abdomen, chest or both.

Meanwhile, hybrid surgery combines open surgery and keyhole surgery. It involves both large cut and several small cuts.

According to the American Cancer Society, there will be approximately 22,370 new cases of esophageal cancer diagnosed in the United States in 2024.

Researchers wrote in the study that “there was no evidence of a difference between hybrid and open surgery in average physical function over three months post-randomization.”

Complication rates, they noted, were similar. Thirty-four percent and 32% of patients in the open and hybrid groups, respectively, experienced pulmonary infections within 30 days. There was also no difference in cost effectiveness at three months between the two surgeries.

Avery also noted the similar pain outcomes for each of the esophageal cancer surgery groups. There was no difference in patient-reported pain in the week following surgery.

“This is interesting,” Avery said, “because one might assume that the bigger cuts used in open surgery would cause these patients more pain.

Patient-reported physical function also “provided no evidence of a difference in recovery time,” researchers stated.

Patient Choice for Esophageal Cancer Surgery

“Patients should feel free to choose, where possible, which surgical approach they wish to have, knowing that it should not affect their experience of recovery or complications (problems) after surgery,” said Avery.

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Avery discussed the impact of esophagectomy on patients’ quality of life, and that the authors of the ROMIO study learned about the role of different surgical approaches in this regard.

“Previous research has shown that having an esophagectomy can have a temporary, negative impact on most aspects of patients’ quality of life,” Avery said. “While this typically improves within the first year after surgery, some patients may experience persisting problems with physical function and increased breathlessness, diarrhea and reflux.

“In general, this previous research shows that patients who survive for more than around three years after esophagectomy can expect a generally good quality of life. The ROMIO study has found that the impact on patients’ physical function — an important aspect of quality of life — during the first three months after surgery is similar, regardless of the type of surgery they have.”

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