Imran Siddiqui, MD, Andrew Gamentaler, MD, Christopher Senkowski, MD, Steven Brower, MD
Memorial University Medical Center, Savannah, Georgia
Oncological outcomes after minimally invasive esophagectomy
Aim
To determine actual long-term survival outcomes on a cohort of patients with locally advanced esophageal carcinoma who underwent minimally invasive esophagectomy and study the impact of neoadjuvant chemoradiation in their oncologic outcomes
Introduction
Minimally invasive esophagectomy is now a standard and safe procedure performed routinely for esophageal cancer. As compared to open, there is less morbidity, early postoperative mortality and equivalent oncologic outcomes in terms of completeness of surgery and lymph nodes harvested. However there is less data on the use of minimally invasive esophagectomy after induction therapy in locally advanced cancer.
Recent studies have incorporated neoadjuvant chemoradiation into the treatment algorithm to improve outcomes. Our single institution, tertiary center program has adopted this pathway early on and we have an experience of nearly a decade with longitudinal data followed over time.
Hypothesis
There is no difference in ontological completion between minimally invasive surgery for locally advanced esophageal cancer and long-term survival is equivalent between MIE and open techniques
Secondary hypothesis – Neoadjuvant chemo radiation does not preclude the ability to perform minimally invasive esophagectomy with equivalency as compared to open
Study Population and Sampling
All patients who have undergone esophagectomy at Memorial Health University Medical Center, Savannah , GA by surgical oncologists from 1997 to 2009. Excluded in the study are subpopulations with metastatic cancer undergoing palliative procedures in terms of dilations of strictures, diversions, etc.
Inclusion criteria : All patients undergoing esophagectomies from 2003-2010 for esophageal cancer
Exclusion criteria : Any patient undergoing palliative surgeries for esophageal cancer during the aforementioned period.
Methodology : Patients were divided into two subgroups – minimally invasive versus open surgery
Retrospective review of cases. Pathological reports on margins, lymph nodes stage was noted. Preoperative stage and neoadjuvant therapy if given was recorded. Morbidity and mortality in the early postoperative period in both groups were determined and survival over 5 years was plotted on Kaplan Meir curves. Statistics were done using Chi-square and Fisher test.
Results
50 patients received esophagectomy for cancer.
56 % MIE with the following findings in this cohort
1. Percentage of MIE Cases – 56%
2. Stage-wise Distribution –
T3N1 65% p-value: <0.0001
T3N2 4%
T3N0 15%
T4N0 4%
T0N0 12%
3. Neoadjuvant Chemoradiation
Received 62%
Not received 38%
4. Survival
Alive 46% p-value: <0.0001
Expired 46%
Unknown 8%
We found statistical significantly greater percentage of locally advanced tumors and survival benefits with MIE as compared to national averages
Conclusion
Minimally invasive esophagectomy plays a key role in the management of locally advanced esophageal cancer in patients undergoing induction therapy with good long-term actual survival rates comparable, if not better than open surgery, with less morbidity and equivalent oncologic outcomes.
Session: Poster Presentation
Program Number: P244
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