Comparison of oncological outcomes after laparoscopic transhiatal esophagectomy and open esophagectomy for pT1 esophageal adenocarcinoma

INTRODUCTION: This study compared pathological characteristics and patterns of disease recurrence for patients with pT1 esophageal adenocarcinoma treated with either laparoscopic transhiatal esophagectomy or open esophagectomy (Ivor Lewis or transhiatal).
METHODS: Case notes were reviewed for consecutive patients, who had esophagectomy with pT1 adenocarcinoma at final pathological staging, during January 2000-December 2006. No patient had neo-adjuvant treatment.
RESULTS: There were 44 patients, comprising 37 men (84%), median age 64 years (range, 35-80). 24 patients had an open Ivor Lewis operation, 4 had an open transhiatal operation and 16 had a laparoscopic transhiatal operation. Pre-operative, endoscopic ultrasound staging was T0 (2 patients, 5%), T1 (10, 23%) or T2 (32, 72%). Median lymph node yield was 19 (10-51) after an Ivor Lewis operation, 16 (3-28) after an open transhiatal operation and 15 (4-41) after a laparoscopic transhiatal operation. There was no R1 resection. There were two in-hospital deaths (5%), both of whom had an open operation. All patients in the laparoscopic group had N0 disease; none received adjuvant treatment. Two patients (7%) in the open group had N1 disease, of whom one patient received adjuvant chemotherapy. Alive patients had median follow-up of 36 months (5–87). One patient (6%) in the laparoscopic group had recurrent disease at 22 months after operation. This patient had N0 but poorly differentiated disease and died at 24 months. Two patients (7%) in the open group developed recurrence, at 6 or 8 months and died at 7 or 14 months, respectively. Both patients had poorly differentiated tumors. The patient who developed recurrence at 8 months had N1 disease; the second patient with N1 disease is alive and well at 14 months. Estimated survival (Kaplan-Meier) at 1 year or 3 years was 100% or 88%, respectively, for the laparoscopic group and 96% or 92% for the open group.
CONCLUSIONS: Oncological outcomes after laparoscopic esophagectomy or open esophagectomy for pT1 esophageal adenocarcinoma are similar.

Session: Podium Presentation

Program Number: S093