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Invited Commentary
February 17, 2021

True, True, and Unrelated—Complications and Survival After Hybrid Minimally Invasive Esophagectomy

Author Affiliations
  • 1Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
JAMA Surg. 2021;156(4):332-333. doi:10.1001/jamasurg.2020.7082

In this 5-year follow-up to the Multicentre Randomized Controlled Phase III (MIRO) trial, Nuytens and colleagues1 reported long-term outcomes of 207 patients who were randomized to undergo hybrid minimally invasive esophagectomy (HMIE; thoracotomy plus laparoscopic gastric mobilization) or open esophagectomy between 2009 to 2012 regarding survival, patterns of recurrence, and prognostic factors. Unlike other contemporary randomized clinical trials that compare an open approach with entirely minimally invasive esophagectomy (MIE),2,3 this study included open thoracotomy in both arms. Despite this, a surprising 50% reduction in major pulmonary complications was reported after HMIE (odds ratio, 0.50; 95% CI, 0.26-0.96), predominantly because of a reduction in incidence of pneumonia and major bronchial sputum that required bronchoscopy.4

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