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Hybrid minimally invasive Ivor Lewis esophagectomy after neoadjuvant chemoradiation yields excellent long‐term survival outcomes with minimal morbidity
Author(s) -
Woodard Gavitt A.,
Crockard Jane C.,
ClaryMacy Carolyn,
ZoonBesselink Clara T.,
Jones Kirk,
Korn Wolfgang Michael,
Ko Andrew H.,
Gottschalk Alexander R.,
Rogers Stanley J.,
Jablons David M.
Publication year - 2016
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24409
Subject(s) - medicine , perioperative , esophagectomy , esophageal cancer , neoadjuvant therapy , stage (stratigraphy) , surgery , survival rate , cancer , paleontology , breast cancer , biology
Background There is a clear survival benefit to neoadjuvant chemoradiation prior to esophagectomy for patients with stages II–III esophageal cancer. A minimally invasive esophagectomy approach may decrease morbidity but is more challenging in a previously radiated field and therefore patients who undergo neoadjuvant chemoradiation may experience more postoperative complications. Methods A prospective database of all esophageal cancer patients who underwent attempted hybrid minimally invasive Ivor Lewis esophagectomy was maintained between 2006 and 2015. The clinical characteristics, neoadjuvant treatments, perioperative complications, and survival outcomes were reviewed. Results Overall 30‐ and 90‐day mortality rates were 0.8% (1/131) and 2.3% (3/131), respectively. The majority of patients 58% (76/131) underwent induction treatment without significant adverse impact on mortality, major complications, or hospital stay. Overall survival at 1, 3, and 5 years was 85.9%, 65.3%, and 53.9%. Five‐year survival by pathologic stage was stage I 68.9%, stage II 54.0%, and stage III 29.6%. Conclusions The hybrid minimally invasive Ivor Lewis esophagectomy approach results in low perioperative morbidity and mortality and is well tolerated after neoadjuvant chemoradiation. Good long‐term overall survival rates likely resulted from combined concurrent neoadjuvant chemoradiation in the majority of patients, which did not impact the ability to safely perform the operation or postoperative complications rates. J. Surg. Oncol. 2016;114:838–847 . © 2016 2016 Wiley Periodicals, Inc.