• Christophe Mariette, Sheraz Markar, Tienhan Sandrine Dabakuyo-Yonli, Bernard Meunier, Denis Pezet, Denis Collet, Xavier Benoit D'Journo, Cécile Brigand, Thierry Perniceni, Nicolas Carrere, Jean Yves Mabrut, Simon Msika, Frédérique Peschaud, Michel Prudhomme, Franck Bonnetain, Guillaume Piessen, and FRENCH, FREGAT.
• Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, University Lille, Lille, France.
• Ann. Surg. 2020 Jun 1; 271 (6): 1023-1029.

BackgroundHybrid minimally invasive esophagectomy (HMIE) has been shown to reduce major postoperative complications compared with open esophagectomy (OE) for esophageal cancer.ObjectivesThe aim of this study was to compare short- and long-term health-related quality of life (HRQOL) following HMIE and OE within a randomized controlled trial.MethodsWe performed a multicenter, open-label, randomized controlled trial at 13 study centers between 2009 and 2012. Patients aged 18 to 75 years with resectable cancers of the middle or lower third of the esophagus were randomized to undergo either transthoracic OE or HMIE. Patients were followed-up every 6 months for 3 years postoperatively and global health assessed with EORTC-QLQC30 and esophageal symptoms assessed with EORTC-OES18.ResultsThe short-term reduction in global HRQOL at 30 days specifically role functioning [-33.33 (HMIE) vs -46.3 (OE); P = 0.0407] and social functioning [-16.88 (HMIE) vs -35.74 (OE); P = 0.0003] was less substantial in the HMIE group. At 2 years, social functioning had improved following HMIE to beyond baseline (+5.37) but remained reduced in the OE group (-8.33) (P = 0.0303). At 2 years, increases in pain were similarly reduced in the HMIE compared with the OE group [+6.94 (HMIE) vs +14.05 (OE); P = 0.018]. Postoperative complications in multivariate analysis were associated with role functioning, pain, and dysphagia.ConclusionsEsophagectomy has substantial effects upon short-term HRQOL. These effects for some specific parameters are, however, reduced with HMIE, with persistent differences up to 2 years, and maybe mediated by a reduction in postoperative complications.

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