299. Left Thoracophrenotomy Oesophagogastrectomy as an Alternative Approach in Oesophageal Cancer

Abstract

The left thoracophrenotomy approach to oesophagectomy-also known as Sweet Oesophagectomy (SO)—for oesophageal cancer is performed by many centres worldwide but seldom used in the UK, owing to concerns over the extent of lymphadenectomy compared with the Ivor-Lewis oesophagectomy (ILO) approach. This study aims to compare the oncological and clinical outcomes following the Sweet approach with ILO. A retrospective, single centre study was conducted, analysing all patient data following the SO approach and ILO for oesophageal cancer between August 2012 and March 2021. Total number offered the Sweet and ILO were 72 and 197 patients respectively. 91.7% vs 80.2%, p = 0.071 were distal tumours. Median node count were 22 and 23 respectively, p = 0.980. The Sweet was associated with 69.4% circumferential, 94.4% proximal and 95.8% distal R0 resections compared with 72.6% (p = 0.365), 98% (p = 0.132) and 96% (p = 0.330) with ILO resection, respectively. Median operative time was 169 vs. 301 minutes for Sweet and ILO respectively, p < 0.001. Overall complication rate was 29.2% with Sweet and 45.7% with ILO, p = 0.015, including, Anastomotic leaks 0 vs. 11, p = 0.041, return to theatre 1 vs. 22, p = 0.04. The 30-day, 90-day and 5-year survival was 100% vs. 99% (p = 0.391), 98.6% vs. 95.9% (p = 0.281) & 51.4% vs. 50.3% (p = 0.869), respectively. The Sweet procedure was associated with comparable oncological efficacy and survival to ILO. Furthermore, was associated with significantly shorter operative time and lower complication rates, therefore should be considered in selected cases. Having a reduced hospital stay and operative time may be more favourable in more frail patients with distal and junctional oesophageal tumours.