Thoracoscopic esophagectomy was found to be non-inferior in terms of overall survival (OS) to conventional esophagectomy among patients with thoracic esophageal squamous cell carcinoma.

These results were presented by Hiroya Takeuchi, MD, Hamamatsu University School of Medicine, Shizuoka, Japan, at the 2024 American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium on Thursday, January 18, 2024, in San Francisco, California.

In this phase 3 trial, 300 patients with stage I to III thoracic esophageal squamous cell carcinoma were randomized on a 1-to-1 basis to undergo either thoracoscopic esophagectomy (n = 150) or conventional esophagectomy (n = 150). The primary end point was OS with secondary end points including relapse-free survival (RFS), rate of patients who achieved R0 resection, rate of patients needing conversion from thoracoscopic esophagectomy to conventional open transthoracic esophagectomy, adverse events, rate of patients requiring re-operation, changes in postoperative respiratory dysfunction, and postoperative quality-of-life score.

The median follow-up duration was 2.6 years. The 3-year OS was 82.0% in the thoracoscopic esophagectomy arm and 70.9% in the conventional esophagectomy arm. The 3-year RFS was also significantly better in the thoracoscopic esophagectomy arm (72.9%) vs the conventional esophagectomy arm (61.9%; hazard ratio, 0.68). Of the patients in the thoracoscopic esophagectomy arm, 95.3% had an R0 resection compared with 90.0% in the conventional esophagectomy arm. There was 1 patient who required conversion to conventional esophagectomy intraoperatively. Rate of re-operation was 2.0% vs 4.1%, respectively. The rate of respiratory dysfunction 3 months post-surgery was significantly lower in the thoracoscopic esophagectomy arm than in the conventional esophagectomy group.

Dr Takeuchi and coauthors concluded thoracoscopic esophagectomy “was shown to be a standard treatment for patients with clinical stage I-III thoracic esophageal cancer.”

Source:

Takeuchi H, Ando M, Tsubosa Y, et al. A randomized controlled phase III trial comparing thoracoscopic esophagectomy and open esophagectomy for thoracic esophageal cancer: JCOG1409 (MONET trial). Presented at 2024 ASCO Gastrointestinal Cancer Symposium; January 18-20, 2024; San Francisco, California. Abstract 249