It’s been over two years since initial reporting of the MRIO trial demonstrated improved outcomes following a minimally-invasive versus open approach to oncologic mid-distal esophagectomy. We now have 5-year outcomes that suggest the improvement in the primary endpoint of major perioperative complications with the minimally-invasive approach translates to long term improved overall survival (59% versus 47% with open). Interestingly, in the setting of such a high-morbidity surgery, decreasing the invasiveness—which, by the way, still includes an open thoracotomy— appears to substantially improve survival by decreasing surgical, not cancer, mortality. | Nuytens, JAMA Surg 2021


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