ESMO 2017: MIRO Trial: 3-Year Outcomes Favor Laparoscopic Surgery for Esophageal Cancer

Key Points

  • In addition to a 69% reduction in major intra- and postoperative morbidity, 3-year overall survival was improved in the laparoscopic group.
  • At 30-days, major postoperative morbidity occurred in significantly fewer patients in the hybrid minimally invasive esophagostomy compared to the open esophagostomy group (35.9% vs 64.4%).
  • At 3 years, there was also a trend in the hybrid minimally invasive esophagostomy group towards improved overall survival and disease-free survival (67.0% vs 55%).

Patients requiring surgery for esophageal cancer fare better after undergoing a hybrid minimally invasive esophagostomy compared to an open esophagostomy, according to long-term results of the MIRO trial presented at the European Society for Medical Oncology (ESMO) 2017 Congress in Madrid (Abstract 615O_PR).

Study Findings

Mature results of the phase III study, with follow-up to a median of 48.8 months, demonstrate that the reduced surgical trauma associated with a laparoscopic approach does not cut corners on safety, said investigator Guillaume Piessen, MD, PhD, of University Hospital C. Huriez, Lille, France. “In addition to a 69% reduction in major intra- and postoperative morbidity, 3-year overall survival was improved in the laparoscopic group, showing that it is an oncologically sound procedure,” he said.

While the survival difference between groups was not statistically significant, he called it “highly clinically relevant.”

MIRO enrolled 207 adult patients from 13 centers with with resectable cancers of the middle or lower third of the esophagus. They were randomized to undergo either hybrid minimally invasive esophagostomy or an open esophagostomy.

At 30 days, major postoperative morbidity occurred in significantly fewer patients in the hybrid minimally invasive esophagostomy group compared to the open esophagostomy group (35.9% vs 64.4%, odds ratio [OR] = 0.31, 95% confidence interval [CI] = 0.18–0.55; P < .001).

At 3 years, there was also a trend in the hybrid minimally invasive esophagostomy group towards improved overall survival and disease-free survival (67.0% vs 55%, P = .05 and 57% vs 48%, P = .15).

Commentary

Commenting on the trial, Ulrich Güller, MD, MHS, FEBS, of Kantonsspital St. Gallen, Switzerland said: “This represents an extremely important, well-designed, and well-conducted study demonstrating that hybrid minimally invasive esophagostomy is an oncologically sound procedure and significantly reduces postoperative morbidity. Based on these results, the hybrid minimally invasive esophagostomy should become the new standard operating procedure for patients with mid and low esophageal cancer.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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