Totally Versus Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer

Inclusion criteria

Inclusion criteria

for screening - part A (for patients receiving a neo-adjuvant treatment)

• Age ≥ 18 years and ≤ 80 years For patients between 70 and 80 years old : score G8 ≥ 14 or oncogeratrician approval
• Squamous cell carcinoma or adenocarcinoma of the esophagus or esogastric junction
• Clinical stage T1, T2, T3, T4a, N0-N3, M0 before any treatment
• Tumors of the middle or lower third of the esophagus, or tumor of the esogastric junction Siewert 1 or 2
• With or without neoadjuvant (radio) chemotherapy ± targeted therapy
• Disease deemed curatively resectable preoperatively
• Requiring a 2-stage Ivor-Lewis esophagectomy
• Performance status 0, 1 or 2
• Patient capable of receiving either surgical treatment
• Patient informed of the terms of the study and having given written consent
• Patient able to read and understand the language and content of the study documents and agreeing to adhere to the protocol requirements.
• Covered by a medical/health insurance
• Willingness and ability to comply with scheduled visits and study procedures

Inclusion criteria

before surgery (after neo-adjuvant treatment or for patients receiving primary surgery)

• Age ≥ 18 years and ≤ 80 years For patients between 70 and 80 years old : score G8 ≥ 14 or oncogeratrician approval
• Squamous cell carcinoma or adenocarcinoma of the esophagus or esogastric junction
• Clinical stage T1, T2, T3, N0-N3, M0 before surgery
• Tumors of the middle or lower third of the esophagus, or tumor of the esogastric junction Siewert 1 or 2
• With or without neoadjuvant (radio) chemotherapy ± targeted therapy
• Disease deemed curatively resectable preoperatively
• Requiring a 2-stage Ivor-Lewis esophagectomy
• Performance status 0, 1 or 2
• Patient capable of receiving either surgical treatment
• Patient informed of the terms of the study and having given written consent
• Patient able to read and understand the language and content of the study documents and agreeing to adhere to the protocol requirements.
• Covered by a medical/health insurance
• Willingness and ability to comply with scheduled visits and study procedures

Exclusion criteria

Non inclusion criteria for screening - part A (for patients receiving a neo-adjuvant treatment)

Patient-related non-inclusion criteria

• Performance status 3 or 4
• Documented liver cirrhosis or portal hypertension
• Recent myocardial infarction (less than 6 months old) or progressive coronary artery disease
• Distal arteritis from stage IIb (200 m) of Leriche and Fontaine
• Synchronous cancer, other than subcarinal esophageal
• Neoplasic history except for cancers without recurrence after at least 5 years of surveillance
• History of xyphopubic laparotomy
• Patients with prior thoracic surgery or thoracic traum of the right hemithorax
• Patient refusal
• Patient under guardianship or curatorship
• Pregnant or breastfeeding woman or patient expecting to conceive or father children within the projected duration of the study, starting with the screening visit through 6 months after the last dose of adjuvant chemotherapy
• ASA score> 3

Disease-related non-inclusion criteria

• Histology other than squamous cell carcinoma or adenocarcinoma
• Tumors of the upper third of the thoracic esophagus, cervical esophagus or pharyngo-esophageal junction or tumor of the esogastric junction Siewert 3
• Supraclavicular nodes invaded clinically or on puncture
• Recurrent nerve paralysis
• Evidence of extension to the tracheobronchial tree
• Signs of mediastinal invasion (vertebral adhesion, aortic overlap > 90°, invasion of unresectable neighboring organs such as the aorta, trachea…)
• Distant metastatic extension

Non inclusion criteria before surgery (after neo-adjuvant treatment or for patients receiving primary surgery)

• Performance status 3 or 4
• Forced expiratory volume in 1 second < 1000 ml
• Documented liver cirrhosis or portal hypertension
• Recent myocardial infarction (less than 6 months old) or progressive coronary artery disease
• Distal arteritis from stage IIb (200 m) of Leriche and Fontaine
• Weight loss of more than 15% of body weight, not recovered after appropriate nutritional management
• Synchronous cancer, other than subcarinal esophageal
• Neoplasic history except for cancers without recurrence after at least 5 years of surveillance
• History of xyphopubic laparotomy
• Patients with prior thoracic surgery or thoracic traum of the right hemithorax
• Patient refusal
• Patient under guardianship or curatorship
• Pregnant or breastfeeding woman or patient expecting to conceive or father children within the projected duration of the study, starting with the screening visit through 6 months after the last dose of adjuvant chemotherapy
• ASA score> 3
• IESG ≤ -5 (Very high risk patients)

Disease-related non-inclusion criteria

• Histology other than squamous cell carcinoma or adenocarcinoma
• Tumors of the upper third of the thoracic esophagus, cervical esophagus or pharyngo-esophageal junction or tumor of the esogastric junction Siewert 3
• Supraclavicular nodes invaded clinically or on puncture
• Recurrent nerve paralysis
• Evidence of extension to the tracheobronchial tree
• Signs of mediastinal invasion (vertebral adhesion, aortic overlap > 90°, invasion of unresectable neighboring organs such as the aorta, trachea…)
• Distant metastatic extension