MIRO: Minimally Invasive Surgery for Esophageal Cancer

Liam Davenport

September 08, 2017

MADRID ― A minimally invasive laparoscopic procedure to resect esophageal cancer dramatically reduces postoperative morbidity in comparison with open surgery, and also appears to improve survival. The new results from MIRO, a randomized, controlled trial in which the two procedures were compared, have led experts to recommend that the minimally invasive procedure be the new standard of care.

"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," said study coauthor Guillaume Piessen, MD, PhD, from University Hospital C. Huriez Place de Verdun in Lille, France.

Although the difference in survival was not statistically significant, it was "highly clinically relevant," he added.

The research was presented here at the European Society of Medical Oncology (ESMO) 2017 Congress.

Commenting in an ESMO press release, Ulrich Güller, MD, from Kantonsspital St. Gallen, Switzerland, described the study as "extremely important, well-designed, and well-conducted."

"Based on these results, HIME [hybrid minimally invasive esophagectomy] should become the new standard operating procedure for patients with mid and low oesophageal cancer,” he said

Study Details

The MIRO study was a multicenter, open-label, randomized controlled trial in which 207 patients aged 18 to 75 years who had resectable tumors in the middle or lower third of the esophagus were randomly assigned to undergo either transthoracic open esophagectomy (OE) (n = 104) or HIME (n = 103). Thirteen centers participated in the trial.

HIME consists of a Ivor Lewis procedure with laparoscopic gastric mobilization and open right thoracotomy. All surgeons were accredited prior to enrollment, and all procedures involved standardized techniques and monitoring.

The primary outcome was 30-day postoperative grade II-IV morbidity, determined in accordance with the Clavien-Dindo classification. Secondary outcomes were 30-day postoperative mortality, overall survival, and disease-free survival.

Postoperative morbidity was observed in significantly more OE than HIME patients, at 64.4% vs 35.9% (odds ratio, 0.31; P < .001). OE patients were also significantly more likely to experience pulmonary complications, at 30.1% vs 17.7% of patients in the HIME group (P = .037).

There was a trend for improved survival at 3-year follow-up among HIME patients. The overall survival rate after a median follow-up of 48.8 months was 67.0% in the HIME group vs 54.8% in the OE group (P = .054).

"These findings show that hybrid minimally invasive esophagectomy is an oncologically sound procedure and reduces the incidence of major morbidity, specifically pulmonary, following oesophagectomy for cancer," the authors concluded.

In discussing the research, Dr Güller paid tribute to lead researcher Christophe Mariette, MD, PhD, from Lille University Hospital, France, who passed away 1 month before the study's presentation at the ESMO 2017 Congress.

"Professor Mariette was a model of a surgical scientist and an opinion leader in the field, and his contribution to the MIRO trial was of cardinal importance," he said.

The study was funded by the French National Cancer Institute INCa. No relevant financial relationships have been disclosed.

European Society for Medical Oncology (ESMO) 2017 Congress. Abstract 615O_PR, presented September 8, 2017.


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