Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer

To the Editor: The multicenter trial conducted by Mariette et al. (Jan. 10 issue)(1) comparing a hybrid Ivor Lewis esophagectomy with transthoracic open esophagectomy showed a lower incidence of major and pulmonary complications in the hybrid-procedure group than in the open-procedure group. Had the authors defined a major complication as one of Clavien-Dindo grade III or higher (this five-grade system includes subgrades in grades III and IV, and higher grades indicate more life-threatening complications), no significant difference in outcomes would have been noted (21% in the hybrid-procedure group and 28% in the open-procedure group). This definition arguably represents what most . . .