Minimal invasive versus open esophagectomy for patients with esophageal squamous cell carcinoma after neoadjuvant treatments

Abstract

Background Although previous studies have discussed whether the minimally invasive esophagectomy (MIE) is superior to open surgery, the data concerning esophageal squamous cell carcinoma (ESCC) patients underwent neoadjuvant treatment followed by radical resection is limited. The purpose of our study was to compare the short- and long-term clinical outcomes of the two surgical approaches in treating ESCC patients. Methods Between January 2010 and December 2016, ESCC patients who had received neoadjuvant therapy and underwent Mckeown esophagectomy at our institute were eligible. The baseline characteristics, pathological data, short-and long-term outcomes of these patients were collected and compared based on the surgical approach. Results A total of 195 patients was included in the current study. Compared to patients underwent open surgery, patients underwent MIE had shorter operative time and less intraoperative bleeding (390 min vs 330 min, P = 0.001; 204 ml vs 167 ml, P = 0.021). In addition, the risk of anastomotic leakage was decreased in MIE group (20.0% vs 3.3%, P < 0.001), while the occurrence of other complications did not have statistical significance between two groups. Overall survival (OS) and disease-free survival (DFS) was no difference in patients received neoadjuvant chemotherapy between the two approaches. For the patients underwent neoadjuvant chemoradiotherapy, OS was significantly better in the MIE group (log rank = 6.197; P = 0.013). Conclusion Minimally invasive Mckeown esophagectomy is safe and feasible for ESCC patients who underwent neoadjuvant therapy. MIE approach presented better perioperative results than open esophagectomy. The effect of surgical approaches on survival was depending on the scheme of neoadjuvant treatment.

Minimally invasive versus open esophagectomy after neoadjuvant therapy for esophageal cancer: a meta-analysis

“…Excluding 67 non-neoadjuvant or single-arm studies, 6 articles remained. The 6 articles were retrospective studies, among which two were propensity score matching studies [12][13][14][15][16][17]. The literatures were evaluated according to the Newcastle-Ottawa Scale and all literatures were of medium to high quality (7-8 score, Supplementary table 1).…”

Feasibility, safety and oncological outcomes of minimally invasive oesophagectomy following neoadjuvant chemoradiotherapy for oesophageal squamous cell carcinoma – Experience from a tertiary care centre

“…[ 24 25 ] Further, in patients with OSCC receiving nCRT, MIO is an independent predictor of OS, compared to open surgery. [ 17 ] In this study, we have analysed the operative and oncological safety of MIO following nCRT for thoracic OSCC.…”

“…A minimally invasive total 2F-LND, though feasible following nCRT, is technically more challenging, often prolongs the surgical duration and may carry higher morbidity, when compared to standard LND. [ 12 17 ] Due to these reasons, in Japan and the East, nCT, rather than nCRT, is still the standard pre-operative therapy for OSCC, which allows the performance of a total mediastinal LND.…”

“…There is an on-going debate about the optimal extent of LND following the application of nCRT. [ 17 27 28 ] Although the survival effects of an extended lymphadenectomy following nCRT is debated, it does increase the LNY, resulting in the accurate staging of the disease. [ 26 29 30 31 32 ] In addition, thoracic OSCC frequently metastasises to supracarinal nodes, especially along the RLN chains, and the persistence of occult disease in these regions is not uncommon despite pre-operative nodal irradiation.…”

“…[ 10 11 12 ] Although majority of the initial publications which have looked at nCRT for OC have employed open oesophagectomy approaches, there is emerging evidence showing the feasibility and safety of minimally invasive approaches following nCRT. [ 4 5 10 11 12 13 14 15 16 17 18 19 ] However, there is heterogeneity in the tumour characteristics, types of operations performed, approaches and the extent of lymphadenectomy in the reported literature. Moreover, studies incorporating MIO following nCRT have been predominantly reported from the West, where adenocarcinoma involving the distal oesophagus or gastro-oesophageal junction (GOJ) is the dominant histological type.…”