Feasibility of Minimally Invasive Esophagectomy After Neoadjuvant Chemo-radiation

Charles Bakhos, MD, Tolutope Oyasiji, MD, Michael Kent, MD, Sidhu Gangadharan, MD, Jonathan Critchlow, MD, Tom Fabian, MD. Albany Medical Center (Albany NY), Beth Israel Deaconess Medical Center (Boston, MA)

 

INTRODUCTION
The impact of neoadjuvant chemo-radiation (NCR) on outcomes after esophagectomy is still debated. The choice of surgical approach can also be influenced by this treatment modality, including the performance of minimally invasive esophagectomy (MIE), a technically demanding procedure. We sought to inquire the outcomes of MIE after NCR.

METHODS & PROCEDURES
We conducted a retrospective analysis of consecutive MIEs performed at two institutions from January 2002 to January 2009. We analyzed the effect of NCR on peri-operative results including pulmonary complications, oncological outcomes, length of stay (LOS) and mortality.

RESULTS
A total of 105 patients were eligible for the study. Six patients (5.7%) were converted from MIE to an open approach and were excluded from the analysis. The causes for conversions were: bleeding (3), significant adhesions (2) and inadequate conduit length (1). Out of the 99 patients, 79 were male (80%), mean age was 63 ± 12 years (range 26-88) and 45 underwent NCR (46%, group 1). Anastomoses were performed in the neck in 79 patients (80%). Comparing both groups, the incidence of pneumonia (7 vs. 11), pleural effusions including chylothorax (7 vs. 3) and number of harvested lymph nodes (16 ± 9 vs. 19 ± 9) was comparable (group 1 vs. group 2, respectively, p=NS). More anastomotic leaks occurred in patients who did not undergo NCR (group 2, 1 vs. 8, p=0.04). Median LOS was also comparable between both groups (10 ± 10 vs. 11 ± 8 days). Overall, there were 3 patients (3%) with an R1 resection margin and 3 operative deaths (both exclusively in group 1, p=NS).

CONCLUSION
MIE can be safely performed after NCR in the management of esophageal cancer, with a low conversion rate. Outcomes seem comparable regardless of pre-operative NCR.
 

 Number of words: 287


Session Number: Poster – Poster Presentations
Program Number: P242
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