Implementation of Minimally Invasive Esophagectomy From a Randomized Controlled Trial Setting to National Practice

Area of Science:

• Surgical Oncology
• Gastroenterology
• Clinical Trials

Background:

• The TIME trial evaluated minimally invasive esophagectomy (MIE) versus open esophagectomy.
• Assessing MIE's real-world effectiveness after national implementation is crucial.

Purpose of the Study:

• To examine the external validity of the TIME trial's findings on MIE.
• To compare MIE and open esophagectomy outcomes using national registry data.

Main Methods:

• Retrospective analysis of data from the TIME trial and the Dutch Upper GI Cancer Audit (DUCA).
• Multivariate analysis adjusted for patient, tumor, and surgical year factors.
• Inclusion of 115 patients from the TIME trial and 4,605 from the DUCA dataset.

Main Results:

• In the TIME trial, MIE reduced pulmonary complications and hospital stay.
• In the DUCA dataset, MIE was linked to more complications and reoperations but improved R0 margins and reduced 30-day mortality.
• Multivariate analysis of the DUCA data showed MIE increased total complications, pulmonary complications, and reoperations.

Conclusions:

• Nationally implemented MIE outside the TIME trial was associated with increased complications and reoperations.
• This may indicate challenges with non-expert surgeons performing MIE outside controlled, high-volume settings.
• MIE adoption requires careful consideration of surgeon expertise and center volume for optimal outcomes.