Can We Increase the Resection Rate by Minimally Invasive Approach? Experience from 100 Minimally Invasive Esophagectomies

Abstract

Background. Whether we can increase the resection rate of esophageal cancer by minimally invasive esophagectomy (MIE) is unknown. The aim was to report the number and results of MIE in high-risk patients considered unsuitable for open surgery and compare these results to other operated patients and to high-risk patients not undergoing surgery. Methods. At Central Finland Central Hospital, between September 2012 and July 2018, the number of operated MIEs was 100. Of these, 10 patients were prospectively considered unfit for open approach. Nineteen additional high-risk patients with operable disease were ruled out of surgery. The short- and long-term outcomes of these 3 groups were compared. Results. In patients eligible for any approach (n=90), MIE only (n=10), and no surgery (n=19), WHO performance status Grade 0 was observed in 66.7%, 20.0%, and 5.3%, respectively; stair climbing with ≥4 stairs was successfully completed in 77.8%, 50%, and 36.8%, respectively. Between any approach and MIE only groups, rate of major complications (Clavien-Dindo ≥3a) was 6.7% vs. 50.0% (p<0.001) without a difference in median hospital stay (9 vs. 10 days, p=0.542). Readmission rates were 4.4% vs. 30.0% (p=0.003). Survival rates were 100% vs. 80% (p<0.001) at 90-days, 91.5% vs. 66.7% (p=0.005) at 1-year, and 68.9% vs. 53.3% (p=0.024) at 3-years, respectively. In comparison between MIE only and no surgery groups, these survival rates from day of diagnosis were 80% vs. 100%, 68.6% vs. 67.1%, and 45.7% vs. 32.0% (p=0.290), respectively. Conclusions. By operating patients unsuitable for open approach with MIE, the resection rate increased 11.1%. These high-risk patients had, however, higher early morbidity and reduced long-term survival compared to other operated patients. Though there seems to be long-term benefit of surgery compared to nonsurgical patients, we have to be cautious when offering surgery to those considered unfit for open surgery.

Naples Prognostic Score: A Novel Prognostic Score in Predicting Cancer-Specific Survival in Patients With Resected Esophageal Squamous Cell Carcinoma

“…In the current study, McKeown or Ivor Lewis procedure with two-field lymphadenectomy was the main surgical resection for patients with ESCC (19,20). McKeown and Ivor Lewis are commonly used procedures of esophagectomy for surgeons because they can make adequate lymph nodes dissection.…”

Association of preoperative muscle-adipose index measured by computed tomography with survival in patients with esophageal squamous cell carcinoma

“…The McKeown and Ivor-Lewis procedures with two- or three-field lymph node dissection are the primary surgical options for patients [ 18 – 20 ]. Patients pathologically diagnosed with T4 tumors and/or positive lymph nodes underwent postoperative radiotherapy (RT) (45–50.4 Gy) with or without chemotherapy (cisplatin and fluoropyrimidine) within six weeks of surgery.…”

The preoperative HALP score (hemoglobin, albumin, lymphocyte and platelet) is a useful predictor in patients with resectable esophageal squamous cell carcinoma

“…To date, esophagectomy with lymphadenectomy was the main surgical technique for EC. The procedures of McKeown and Ivor Lewis were two main surgical procedures for thoracic esophagectomy [ 18 , 19 ]. The 7 th AJCC/UICC TNM staging system was performed in the current study [ 20 ].…”