Aim Primary aim is to evaluate the relationship between pathological response after CROSS regimen for locally advanced esophageal adenocarcinomas and overall and disease-free survival. Secondary endpoint is to analyze the principal sites of relapse after surgery in this group of patients. Background & Methods The CROSS trial showed an improvement of overall survival after neoadjuvant chemoradiation and subsequent surgical resection compared to surgery alone for patients with esophageal cancer, representing the benchmark [1]. Patients submitted to CROSS regimen for adenocarcinoma of the esophagus and cardia followed by esophagectomy with a transthoracic extended lymphadenectomy were analyzed. The patients were treated in 4 centers part of Italian Group for the Study of Esophageal Diseases (SISME). Actuarial Overall survival (OS) and actuarial disease-free survival (DFS) were analyzed and stratified according to yp Stage (1 – stage I and II; 2 – stage IIIA and IIIB and 3 - stage IVA) as described in the 8th edition of TNM. Kaplan-Meier method was used to estimate overall and progression-free survival, with the log-rank test to ascertain significance (p<0.05). Median and range were used. Statistical analysis was done with SPSS version 21.0. Results 132 patients, from January 2014 to February 2019, were analyzed. Median age was 63 years (range 42-82). The site of the neoplasm was the distal esoghagus-EGJ in 127 cases and the middle esophagus in 5. Ivor Lewis was the procedure adopted. Fifty-month OS and DFS were respectively 42% and 6.7% respectively. No difference emerged when overall survival was analyzed according to yp Stages. Time to relapse is significantly longer for ypStage I and II. Recurrence occurred in 48 cases (36.3%) with 9 months as median time to relapse. Local and distal relapse were 10 (paratracheal nodes) and 38 respectively (7.5% and 28.7%, p<0.001). Conclusion Pathological response after CROSS regimen doesn’t relate to OS and DFS. Time to recurrence is significantly longer for yp Stage 1 e 2 rather than other ypStages. Chemoradiotherapy in a neoadjuvant setting may influence the site of relapse.

Backgrounds and aim oesophagectomy is the mainstay of curative treatment for oesophageal cancer and post-oesophagectomy diaphragmatic hernia (PODH) represents a potentially life-threatening complication with an underestimated occurrence rate and unclear related risk factors. Aim of this study was to identify possible risk factors of PODH and results of surgical treatment from experience of two tertiary referral centers. Methods all patients affected by a clinically resectable oesophageal cancer (any T, any N and M0) and submitted to Ivor-Lewis oesophagectomy, regardless of technique (open, hybrid or totally minimally invasive) between 1997 and 2017 at our Institutions were selected for this study. Demographic, clinical pre, intra, post-operative, and follow-up data were prospectively collected in an electronic database. A retrospective analysis was conducted in order to evaluate the incidence of PODH, associated risk factors and surgical repair results. Results 414 patients underwent Ivor-Lewis oesophagectomy for cancer in the study period and 22 (5.3%) developed PODH at a median follow-up time of 16 months (6 - 177). Surgical repair was mainly conducted by laparoscopic approach (77%) with a conversion rate of 24%. Postoperative morbidity was 22.7% and mortality 4.5%. Median postoperative hospital stay was 6 days (2 - 95). 3 recurrences (13.6%) occurred at a median follow-up time of 10.1 months. A wide univariate analysis identified statistically significant associations between PODH occurrence and the administration of preoperative chemoradiation, a complete pathological response (CPR) and a harvested lymph-nodes number (HLN) larger than 33 (p-value 0.016, 0.001 and 0.024 respectively). A significant association with a large HLN number was confirmed by the multivariable analysis (0.026) along with CPR which could however be considered as a longer survival-related bias. Conclusions The minimally invasive surgery and the neoadjuvant chemoradiation, in contrast to results of other authors, in our experience are not associated with PODH development, while a HLN number larger than 33 resulted to be an independent risk factor, probably mirroring the extent of surgical demolition in oesophagectomy. Surgical repair can be safely and effectively performed trough laparoscopy but recurrences can frequently occur.

Aim Aim of this retrospective study is the comparison of the short-terms outcomes and QoL of Hybrid Ivor Lewis (HIL) and Totally Minimally Invasive Ivor Lewis (TMIIL). Background & Methods Minimally invasive techniques for esophagectomy represents a challenging procedure with aiming to decrease cardiopulmonary complications and guarantee better quality of life (QoL) compared to open techniques, without compromising oncological radicality. Patients with cancer of distal esophagus and EGJ were included into (HIL) and (TMIIL) groups in the period January 2017 – March 2019. General features, intraoperative and postoperative results were analyzed. For all the patients a feeding jejunostomy was performed. The surgical radicality and number of resected nodes were also evaluated. QoL was determined preoperatively, at 7 and 90 days postoperatively with EORTC QLQ-C30 questionnaire. Results Eighteen and 24 patients were submitted to TMIIL and HIL respectively. General features were similar in the two groups. Median intervention duration was 360 minutes [range: 240-420] in TMIIL group and 335 minutes [range: 150-400] for HIL group (p=0.0647). Median blood losses were similar for TMIIL and HIL group, 100 ml [range:50-400] and 175 ml [50-350] respectively (p=0.0831). No differences were observed in terms of postoperative complications CD≥2. One exitus occurred in HIL group (CD=5), none in TMIIL group (p=n.s). No differences were evidenced for median number of lymphnodes harvested in the two group as well for rate of R0 and R1 resections. Results obtained from the QoL questionnaires evidenced a reduction of postoperative pain during the first 7 postoperative day for patients in the TMIIL group compared to HIL; these data were confirmed by the analysis conducted on postoperative day 90, as well for the global health status, physical functioning and role functioning. Conclusion Our experience evidenced TMIIL esophagectomy seems to give the similar results, of HIL influencing positively the QoL within 90-day after surgery. Duration of surgery and anastomotic leaks are the key elements influencing the learning curve. Randomized controlled trials are necessary to confirm the good results obtained and to give recommendations to avoid a high rate of complications