Changes in oncological outcomes: comparison of the conventional and minimally invasive esophagectomy, a single institution experience

Abstract

Minimally invasive esophagectomy is becoming the routine procedure for resectable esophageal cancer. The aim of this retrospective study is to analyze the oncologic adequacy of these two procedures at our Centre. Out of 1252 registered esophageal cancer patients at our institute from 2006 to 2015, 206 patients who underwent a surgical resection with curative intent and a complete medical record were retrospectively evaluated thru hospital medical record system (HIS). Patients were allocated into the conventional open OE, and minimally invasive MIE and Hybrid esophagectomy groups. Primary outcomes are tumor recurrence and disease-free survival over a minimum follow-up of 1 year along with assessment of adequacy of pathological specimen in terms of lymph nodes harvested and clear longitudinal <1 cm and circumferential (≥1 mm) resection margins for patients with post-neo-adjuvant residual disease. Secondary endpoint is to look for trends in the adequacy of oncologic clearance in each group over the study period. Overall, there was no statistically significant difference (p > 0.05) between groups (OE vs. MIE vs. Hybrid) for median number of lymph nodes retrieved (13 vs.14 vs.15), resection margin positive disease (55.8 vs. 35.7 vs. 44 % of patients with any residual disease N = 103,50 %), or tumor recurrence (45.2 vs. 37.3 vs. 25 %). Disease-free survival over a mean follow-up of 2.3 years was higher in the conventional group (13.8 months vs. 9.7MIE and 11.8hybrid) without any statistical significance. Learning curve for MIE to achieve a comparable mean lymph nodes harvest to OE was 1 year, while pathological complete resection stayed persistently better with minimally invasive approach. Minimally invasive esophagectomy is found to be oncologically adequate and gives results matching their conventional analogue with an increasing experience.

The Role of Tumor Microenvironment in Chemoresistance: 3D Extracellular Matrices as Accomplices

“…Although promising progress has been attained in treating esophageal cancer, it responds poorly to chemotherapeutic drugs and the mortality still remains high [ 51 , 55 , 56 , 57 , 58 , 59 ]. Surgery, chemotherapy and radiotherapy are the most widely-used treatment methods but about half of advanced esophageal cancer cases result in recurrence and patients normally succumb to resistant disease [ 60 , 61 , 62 , 63 , 64 ]. There is a lack of understanding of the mechanisms driving the initiation, progression and the occurrence of refractory disease.…”

Propensity‐Matched Analysis Comparing Survival After Hybrid Thoracoscopic–Laparotomy Esophagectomy and Complete Thoracoscopic–Laparoscopic Esophagectomy

“…Over the past two decades, MIE and OE have been demonstrated to have comparable feasibility, safety, and oncologic efficacy [6][7][8][9][10][11][12], and the benefits of thoracoscopic esophagectomy have gradually been accepted with continuous improvements in relation to surgical instruments and skills required for the procedure. Palazzo et al [12] found that MIE was better in survival compared to hybrid Ivor Lewis esophagectomy or OE; however, differences between the outcomes of hTE and cTLE, the two most commonly performed MIE procedures, remain unclear.…”

“…It has been established over the past two decades that the feasibility, safety, and oncologic efficacy of MIE and OE are comparable [6][7][8][9][10][11][12]. However, possible differences in short-and long-term outcomes between hMIE and cTLE for ESCC remain unclear.…”

Eosinophilic esophagitis, Barrett’s esophagus and esophageal neoplasms in the pediatric patient: a narrative review

“…Less invasive surgical resection techniques can be considered. In a retrospective study comparing conventional open esophagectomy (OE), minimally invasive esophagectomy (MIE), and Hybrid esophagectomy, there was no significant difference between the three techniques for the outcomes of lymph nodes retrieved, resection margin-positive disease, and tumor recurrence (82).…”