Thoracoscopic oesophagectomy non-inferior to open surgery in thoracic oesophageal cancer

Thoracoscopic oesophagectomy (TO) was non-inferior to open oesophagectomy (OO) with respect to overall survival (OS) in patients with thoracic oesophageal cancer. Moreover, patients undergoing TO showed an improved relapse-free survival (RFS) and fewer respiratory complaints at 3 months post-surgery compared with patients receiving open surgery.

The multicentre, phase 3 JCOG1409 trial (UMIN000017628) randomised 300 participants with stage 1–3 thoracic oesophageal cancer 1:1 to TO or to OO to confirm the non-inferiority of TO to OO regarding OS. Prof. Hiroya Takeuchi (Hamamatsu University, Japan) presented the primary findings of the trial [1].

TO was non-inferior to OO in terms of OS, with 3-year OS rates of 82.0% and 70.9% (HR 0.64; 95% CI 0.34–1.21; P=0.00073). Furthermore, the 3-year RFS rates appeared to favour the TE arm over the OO arm (72.9% vs 61.9%; HR 0.68; 95% CI 0.46–1.01).

The rate of grade 4 post-operative complications was somewhat higher in the OO arm than in the TO arm (5.4% vs 1.3%). Re-operation was needed in 4.1% of the participants in the OO arm and 2.0% of those in the TO arm. “We noted that respiratory function at 3 months post-surgery, measured by vital capacity, forced vital capacity, and forced expiratory volume, was significantly better in patients who underwent TO compared with those who underwent OO,” added Prof. Takeuchi. “TO was shown to be a standard treatment for patients with stage 1–3 thoracic oesophageal cancer,” he concluded.

1. Takeuchi H, et al. A randomized controlled phase III trial comparing thoracoscopic esophagectomy and open esophagectomy for thoracic esophageal cancer, JCOG1409 (MONET trial). Abstract 249, ASCO Gastrointestinal Cancers Symposium 2024, 18–20 January, San Francisco, CA, USA.

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Posted on 13 February, 202427 March, 2024