University Of Pittsburgh Cancer Institute Study Finds Minimally Invasive Esophagectomy Results In Improved Survival And Shorter Hospital Stays
PITTSBURGH, April 24, 2003 — Findings from the largest study to date evaluating minimally invasive esophagectomy, or removal of the esophagus to treat esophageal cancer , indicate that the procedure results in lower mortality rates and shorter hospital stays compared with most open procedures. The results of the study, conducted by James D. Luketich, M.D., associate professor of surgery and chief, division of thoracic surgery, University of Pittsburgh Medical Center (UPMC) and co-director, Lung and Esophageal Cancer Program, University of Pittsburgh Cancer Institute, and Chrish Fernando, M.D., also of UPMC, will be presented at the 123rd Annual Meeting of the American Surgical Association (ASA), April 24-26, at the J.W. Marriott in Washington, D.C.
Minimally invasive esophagectomy, or MIE, was evaluated in 221 patients at UPMC from June 1996 through August 2002. Average hospital stays and mortality rates were compared with similar-size studies of open methods including thoracotomy (surgical opening of the chest wall) and laparotomy (surgical opening of the abdomen), or both. The study found that the median hospital stay was seven days for patients who underwent MIE compared with typical hospital stays in excess of 10 days for patients who underwent open procedures. The study also found that mortality occurred in 1.3 percent of the MIE cases compared with typical mortality rates of up to 5 percent or higher as reported for open procedures.
MIE is a video-assisted surgical procedure that utilizes instruments introduced into the body through very small incisions and a laparoscope, or tiny camera. Patients who are candidates for MIE undergo extensive preoperative evaluation involving laparoscopic staging, endoscopic ultrasound and CT scans to assess the extent of the disease.
“Our study demonstrates that minimally invasive esophagectomy offers results as good as, if not better than, open esophageal procedures,” said Dr. Luketich, who is also co-director of the Mark Ravitch/Leon C. Hirsch Center for Minimally Invasive Surgery at UPMC. “These results are encouraging and demonstrate that MIE can improve patient outcomes without compromising accepted standards of care.” Dr. Luketich stressed, however, that the success of esophagectomy, whether done through standard open approaches or minimally invasively, largely depends on surgical expertise in the procedure and volume of procedures performed annually. He also noted that excellent results using open approaches have been reported from centers that specialize in esophagectomy.
The study included 186 men and 35 women with a median age of 66 years who underwent MIE for esophageal cancer. MIE was successfully completed in 93 percent (205) of the patients. Median stay in the intensive care unit was one day and median hospital stay was seven days. At a mean follow-up of 13.4 months, 90 percent of stage I, 65 percent of stage II and 25 percent of stage III patients had survived their cancer.
These findings have led to the formation of an intergroup trial to assess the results of MIE in a multi-site setting that will include several cancer centers. The multi-site study will be coordinated by the Eastern Cooperative Oncology Group (ECOG) and the primary site for the study will be the University of Pittsburgh Cancer Institute.
The American Cancer Society estimates that in 2003, approximately 13,900 people will develop esophageal cancer in the United States, and 13,000 will die from the disease. It also has been noted that esophageal cancer is rapidly rising in the United States. The only known risk factor for esophageal cancer is chronic heartburn. Esophageal cancer can develop in any part of the esophagus and often spreads to the windpipe, large blood vessels in the chest, lungs, liver and stomach. Symptoms of esophageal cancer include difficulty swallowing, weight loss, loss of appetite, coughing, hoarseness, bone pain and shortness of breath.
Co-authors for the study include Chrish Fernando, M.D., Miguel Alvelo-Rivera, M.D., Philip Schauer, M.D., Percival O. Buenaventura, M.D., Neil A. Christie, M.D., James McCaughan, M.D., and Rodney Landreneau, M.D., all with the University of Pittsburgh. The study was sponsored by ASA member Timothy R. Billiar, M.D., professor and chairman of surgery, University of Pittsburgh.
The ASA was founded in 1880 and is the nation’s oldest and most prestigious surgical organization. Membership includes leading surgeons from around the world. The primary mission of the ASA is to provide a national forum for presenting the developing state of the art and science of surgery and the elevation of the standards of the medical/surgical profession.